What’s the news: The AMA and 80 leading physician organization are sounding the alarm about a bill gaining traction in Congress that would let pharmacists evaluate, diagnose and treat patients in cases that now require physician oversight. The bill’s passage would result in more misdiagnoses, as well as siloed, delayed and incomplete care, leading in turn to worse patient outcomes and higher health care costs.
H.R. 3164, the Ensuring Community Access to Pharmacist Services Act, has been sponsored by Rep. Adrian Smith (R-Neb.). The bill would amend the Social Security Act to allow Medicare payment for pharmacists to evaluate, diagnose and treat patients for a range of illnesses including COVID-19, respiratory syncytial virus (RSV) and streptococcal pharyngitis. The measure also would let pharmacists test and treat patients in response to an unspecified “public health need” related to a public health emergency.
A companion bill, S. 2426, has been introduced by Senate Majority Leader John Thune (R-S.D.) and Elizabeth Warren (D-Mass.). The AMA opposes the Senate bill for the same reasons it does the House bill, as both inappropriately allow pharmacists to diagnose and treat patients without having received the necessary education or training to do so.
The House bill adds that the services must be provided under a collaborative practice agreement, but meaningful collaboration would be difficult to establish in community pharmacy settings. Typically, such agreements are established in situations in which a pharmacist is part of a health system or working in a physician’s office, letting the pharmacist manage drug therapy based on a physician-created protocol. Moreover, the proposed legislation also allows some circumstances in which the collaborative practice agreements could be created between a pharmacist and a nonphysician.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
Why it’s important: Pharmacists are experts in medication and are an important part of the physician-led health care team, but they have limited training in diagnosis and management. The doctor of pharmacy curriculum does not include practice experience with diagnosis, physical examination, triaging severity or prescribing medication.
Pharmacists are well-trained in dispensing medications, advising patients on their use and understanding drug-to-drug interactions, but their training does not compare with that of physicians. Pharmacists are required to go through four years of post-graduate education, no residency and 1,740 hours of clinical training, while physicians undergo four years of medical school, three to seven years of residency training and 12,000–16,000 hours of clinical training.
Indeed, an AMA survey of U.S. voters has found that 95% of respondents (PDF) said it is important to them for a physician to be involved in diagnosis and treatment decisions.
In a letter to Smith (PDF) and co-sponsor Rep. Brad Schneider (D-Ill.), 80 physician organizations including the AMA detailed the many safety issues of allowing pharmacists to practice medicine.
“The results of a test alone are not enough to make a conclusive diagnosis or to rule out other complications. For example, physicians are trained in residency to identify a serious illness, such as a respiratory disease, and to perform differential diagnoses; pharmacists simply are not,” says the joint letter. “Without a comprehensive physical exam by a trained professional done in the full context of the patient’s health, the severity of an illness is easily under-appreciated, and the underlying causes of symptoms may be overlooked.”
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See how the AMA defends against scope of practice expansions that threaten patient safety.
And pharmacists, particularly those in community settings, are already overwhelmed and overworked, with 71% of pharmacists in a pharmacy chain and 91% of pharmacists in community pharmacies rating their workload as high or excessively high.
The letter points out that pharmacists said their “three most common ‘highly stressful’ job aspects were ‘having so much work to do that everything cannot be done well’ (43% reporting ‘highly stressful’), ‘working at current staffing levels’ (37% reporting ‘highly stressful’) and ‘fearing that a patient will be harmed by a medication error’ (35% reporting ‘highly stressful’).”
Additionally, the allowance in the bill that authorizes Medicare payment to pharmacists for “testing and treatment services that address a public health need” represents “an alarming and largely undefined expansion of clinical authority to a nonphysician provider,” the joint letter says.
Learn more: Further explore with the AMA what sets apart pharmacists and physicians and read this AMA Leadership Viewpoints column that details why expanding test-to-treat policies is a harmful prescription.
Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
And discover great resources from the AMA that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.
