Nonphysicians bypass legislatures, use own boards to expand scope

Legislatures are still the main avenue for change, but at least nine states have seen groups try to alter practice rules through regulatory boards.

By Myrle Croasdale, AMNews staff. Feb. 12, 2007.

A growing number of allied health professions seeking scope-of-practice expansion are going through their regulatory boards instead of state legislatures, physician leaders say.

Executives at national groups such as the American Optometric Assn., state groups such as the Texas Podiatric Medical Assn. and other organizations say their boards are amending regulations within their authority and that their professions are not putting patients at risk. But physicians view the actions as illegal and a threat to patient safety.

"To get a state board to issue an advisory opinion is a quick way to get [scope changes], and the only way to challenge it is in court, which is expensive," said John B. Neeld Jr., MD, past president of the American Society of Anesthesiologists. "If they get a friendly state board, they're home free. It's a big train that's left the station, and it's gathering momentum."

Oklahoma gained national attention in 2004 when the Oklahoma Board of Examiners in Optometry adopted rules permitting optometrists to perform surgery with a scalpel, a move the state legislature backed with legislation later that year.

The Texas Medical Assn. is in legal battles with the state's chiropractors and podiatrists, whose boards have made regulatory changes the TMA considers scope expansions. At least seven other state medical associations are seeing allied health professions pursue scope changes through their boards. Podiatrists, optometrists and certified registered nurse anesthetists are among the most active groups, the medical society leaders said.