Empowered by insurers and states, nonphysicians push practice limits

Organized medicine educates legislators about the patient safety issues in scope-of-practice debates.

By Myrle Croasdale, AMNews staff. Feb. 9, 2004.

Growing pressure from allied health professionals and alternative medicine practitioners to expand their scopes of practice has inspired a new level of activism within the medical profession.

As 2004 unfolds, a raft of proposed laws seeking to expand or create new scopes of practice are hitting physicians. The new laws come essentially from two groups -- the allied health professions or nonphysicians such as optometrists, psychologists, and those working in the field of complementary and alternative medicine, such as naturopaths.

The Federation of State Medical Boards' special panel on scope of practice and a working group formed under the auspices of the AMA are in the midst of creating resources for state medical groups and legislators that will address patient safety and other issues that routinely arise with each piece of scope-of-practice legislation.

Non-MD, non-DO practitioners, who have argued successfully that expanding their scope expands access to care, are emboldened by past victories. These include a congressional mandate that chiropractors become part of the Veterans Health Administration, prescribing rights for psychologists in New Mexico and independent status for certified registered nurse anesthetists in 12 states.

The road to change in CRNA status in those states was paved by a federal rule letting states opt out of Medicare requirements.

And alternative medicine practitioners have been energized by consumer demand. Studies show that an estimated 43% of Americans have used some form of complementary or alternative medicine and spend up to $40 billion on it a year.