Scope of Practice

PHYSICIAN VOICES FOR PATIENT
SAFETY

 

In November 2023, DC Health introduced B25-545, the Health Occupations Revisions General Amendment Act of 2023. This bill is a comprehensive rewrite of the law overseeing medical licensing and regulation in Washington, DC.

Unfortunately, the bill as written would overhaul scope of practice, place allied health professionals in oversight positions of medical licensing, and remove the physician from the center of the care team.

MSDC has long advocated that a physician is the most qualified professional at the head of a care team. Physicians have the most health education and pre-practice experience of any health professional, and thus must be involved in all but the most mundane health care decisions. Allied health professionals are a valuable part of the care team, but their medical education and experience limits their role.

The Medical Society of the District of Columbia (MSDC) is the leading voice for physicians in Washington, DC, committed to uniting physicians to advocate for physician-led health care in Washington, DC that protects patients from harm and increases access to quality care. MSDC is leading a coalition of Washington, DC specialty medical societies to advocate against the Health Occupations Revisions General Amendment Act of 2023.

Certain professional decisions critical to high quality patient care should always be the ultimate responsibility of the physician practicing in a health plan...

MSDC Policy Manual, 285.008 Physician Decision-Making

Below is a breakdown of some of the major changes the bill would introduce, click on the title to expand how the bill would change that item.

 

Board of Medicine

Currently the Board of Medicine is composed of 10 physicians and 4 members of the public. The bill would reduce the number of physicians to 6 and adds 2 physician assistants, 1 chiropractor, 1 podiatrist, and an acupuncturist.

Advanced Practice Registered Nurses

The bill would codify that APRNs could independently diagnose, prescribe, and administer medicine.

Anesthesiologists and applying anesthesia

The concern: As seen below, additional allied health professions are permitted to apply anesthesia. Most concerning is the scope expansion that could permit nurse anesthetists to practice without physician collaboration.

The solution: This bill asks to repeal Section 603 of DC official code ₰3-1206.03, and this action will allow nurse anesthetists to administer anesthesia without an anesthesiologist or other physician's direct collaboration. DCSA does not want to repeal Section 603 of DC official code ₰3-1206.03.

This bill adds Sec. 605a, which contains language that a CRNA may plan and deliver anesthesia, pain management, and related care to patients or clients of all health
complexities across the lifespan. DCSA wants to remove Sec. 605a from this bill.

Athletic Trainers
The bill repeals law that requires limiting athletic trainers to only providing first aid, opening the door to athletic trainers potentially practicing some form of medicine.
Audiologists

The expands audiologists' scope to include "cerumen management" and "interoperative neurophysiologic monitoring" and permits audiologists to screen for cognitive, depression and vision.

Chiropractors

The bill completely rewrites the definition of the practice of "chiropractic". Chiropractors could:

  • Diagnose and treat biomechanical or physiological conditions that compromise neural integrity or organ system function
  • Refer patients for further medical treatment or diagnostic testing
  • Use x-rays and diagnostic imaging to diagnose skeletal disorders
Clinical lab technicians

The bill would not longer have physicians overseeing their work but instead a clinical laboratory director

Optometrists

The bill would completely blur the line between optometrists and ophthalmologists by:

  • Permitting prescribing antibiotics, antihistamines, non-steroidal anti-inflammatories, glaucoma medicine, and analgesics included in Schedules III through V controlled substances as well as Schedule II controlled.
  • Allow them to diagnose, treat, and manage open-angle glaucoma
  • Apply for a DEA license
Pharmacists

The bill would expand pharmacists' scope to include:

  • Ordering labs
  • Scheduling and monitoring drug therapy
  • Ordering, interpreting, and performing more tests
Physical Therapists

The bill would permit physical therapists to independently evaluate and treat disability, injury, or disease. PTs may also order imaging as part of their treatment plan.

Podiatrists

The concern: The bill drastically expands podiatrists scope of practice to allow:

  • diagnosis, treatment, and care of all structures and tissues around the foot and ankle;
  • care for all tissue below the knee;
  • care for soft tissue in the wrist and hand area;
  • apply anesthesia as part of treatment; and
  • administer vaccines and injections.

The solution: This bill amends Paragraph (14) of D.C. Official Code § 3-1201.02(14) to define "Practice of podiatry” to include the administration of local anesthesia, monitored anesthesia care, and conscious sedation. Other scope of practice expansions for podiatry include care of human hand and wrist, and administration of injections, vaccinations, and immunizations. Podiatrists should not be administering monitored anesthesia care. Podiatrists do not have the qualifications and training to manage a patient's airway so this language should be stricken.

Nursing

Throughout the bill, restrictions on nursing scope of practice are removed or loosened throughout. Specific language outlining what and how nurses can practice is removed and replaced with more vague language giving the Mayor (read DC Health) the ability to dictate scope. This applies to many different nursing types, like APRNs and NPs.

What can you do?

  1. Sign our physician letter opposing the scope of practice changes in the bill.
  2. Share this information with your specialty society and have them contact Robert Hay with questions or concerns.
  3. Reach out to Councilmembers and tell them why you object to this bill.

 

Articles on scope of practice

 

Big Picture Thinkers Needed for New Public Health Task Force

Oct 11, 2023, 08:47 AM by MSDC staff
The newest MSDC task force will look ahead to help MSDC prepare now for future challenges.

Do you spend your spare minutes concerned about the next set of public health issues? Do you worry DC will not be ready for the next pandemic, epidemic, or ignored health crisis? Do you want to speak with key health leaders and help craft a plan to prepare DC medicine for what's coming next? MSDC has a new opportunity for you.

At its September meeting, the MSDC Board of Directors created a new Public Health Task Force. Over the next nine months, this group will think through and share the major public health issues that will shape society in the coming years.

We are seeking a few physician volunteers who can dedicate about 2-3 hours a month on this important effort. More information is below.

What is the PHTF?
The Public Health Task Force (PHTF) was created by the MSDC Board of Directors to look into the future and identify healthcare trends and issues that the Society can begin to address now. Its work includes:

  • Interviewing key DC health policy leaders and health influentials.
  • Overseeing any public health grants or projects MSDC receives in 2023-2024.
  • Analyzing and recommending action based on what it hears in interactions with officials.

What is the time commitment?
The task force will meet no more than once a month, if that, and its work will conclude by June 2024. The first meeting would be in November or December 2023. Task Force members may also participate in interviews and conversations with stakeholders if their schedule permits. Meetings will be done via Microsoft Teams. Projects and tasks will be monitored using project management software like Asana.

Who is on the task force?
The task force will be composed of 7-10 MSDC voting members, with an emphasis on those in primary care, as well as a representative from the District government and non-MSDC member policy experts. MSDC Treasurer Dr. Tu is the Chair.

How do I learn more or agree to join the task force?
Email Robert Hay at hay@msdc.org. We are aiming to have this task force operational by the MSDC annual meeting on October 27.



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