The California state Senate is reviewing three bills that have been introduced to lessen the effects of a predicted upcoming physician shortage. Under the proposed laws, nurse practitioners, optometrists and pharmacists would assume some of the responsibilities currently handled only by doctors.
President Obama’s Patient Protection and Affordable Care Act is providing more care to more people. As a result, the ability of California physicians to meet growing patient demand may be stretched thin.
Organizations of nurse practitioners, optometrists and pharmacists seem to favor the new proposals. Physician groups do not. The latter caution that allowing these professionals to assume some doctors’ roles could hurt patients by allowing other health care providers topractice medicine beyond their abilities and training.
All three bills were introduced by state Senator Edward Hernandez (Democrat, West Covina). All of the bills were questioned in one way or another by the president of the California Medical Society Paul R. Phinney.
SB 491, Expanding the Role of Nurse Practitioners
“The bill would require that, on and after July 1, 2016, an applicant for initial qualification or certification as a nurse practitioner holds a national certification as a nurse practitioner from a national certifying body recognized by the board [Board of Registered Nursing.]”
This senate bill would allow nurse practitioners to increase many of their duties, which previously were permitted only under a doctor’s supervision. SB491 would allow nurse practitioners to diagnose, treat and prescribe drugs and devices. They also would be allowed to refer patients to other health care practitioners, be allowed to delegate duties to a medical assistant, be required to complete a course in pharmacology, and be required to register with the Drug Enforcement Administration if they prescribe controlled substances.
Medical society president Phinney questioned “the breadth” of a nurse practitioner’s ability to diagnose and thus treat patients.
Beth Haney, president of the California Association of Nurse Practitioners, addressed Phinney’s questions. She said that 18 states and the District of Columbia have approved independent practice bills. Giving nurse practitioners more independence would also let them practice in underserved regions such as inner cities or rural areas.
SB492, Adding to Optometrists’ Duties
Currently an optometrist’s duties include but are not limited to:
- Doing eye examinations
- Treating eye infections
- Prescribing prescription lenses
- Diagnosing and treating some other eye diseases if they are state certified
One part of the bill, Section 3041, is repealed and replaced by a new series of optometrists’ duties and responsibilities. The bill also gives such wide-ranging and vague responsibilities to optometrists, that they would be taking over some of the jobs that only physicians should be allowed to handle, the Union Tribune quotes Phinney as implying. Giving optometrists these options is “dangerous and reckless,” Phinney says.
The author of the bill, Hernandez, who is a licensed optometrist, replies that the new law is not meant to infringe on a doctor’s right to treat any disease. The bill, he said, is only meant to expand the duties of the optometrist to diagnose illnesses such as diabetes, which often are first noticed by an optometrist while he or she is doing a regular eye examination.
SB493, Broadening the Pharmacist’s Job
The third of the three bills proposes that pharmacists be allowed to:
- Administer drugs that have been ordered by a prescriber
- Furnish self-administered hormonal contraceptives, prescription stop-smoking drugs and prescription medicines that do not require a diagnosis and are recommended for international travelers, as specified
- Order and interpret tests to monitor and manage the efficacy and toxicity of drug therapies, as specified
- Independently initiate and administer routine vaccinations, as specified
The bill also would establish a board of recognition for an advanced practice pharmacist. Phinney again expressed concern about broadening the responsibilities of pharmacistswithout applying physician oversight.
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