Raising the Physician Voice on Scope of Practice Issues

Many medical journals have been covering the dramatic shift in physician employment. Earlier this month, the Physicians Advocacy Institute and Avalere released a study reporting that nearly?four of five?physicians (77.6%) are now employees of hospitals or health systems and other corporate entities. Washington State Medical Association (WSMA) membership data reflects that, as well, with 74% of our membership now employed by a hospital, health system, or other corporate entity.

The shift away from private, independent practice has been dramatic since the passage of the #Affordable Care Act when many hospitals, with the support of state policymakers who favored an integrated approach to health care, merged with local medical groups to become health care systems. In recent years, insurance companies and private equity have followed suit. It is rare today to find a physician practice that is owned and operated by physicians.

?With this development, it’s all the more critical to ensure good patient care in Washington is being driven by physicians. Paramount to the mission of the WSMA—to provide strong physician leadership and advocacy to shape the future of medicine and advance quality care for all Washingtonians—is that in whatever setting physicians practice, the independent medical judgment of the physician is respected and that the patient-physician relationship is protected.

?The clinical voice must not only be protected at the bedside, it also must be included at the table where decisions that impact patient care and community health are being made. WSMA’s role is to organize and raise that voice in all the places where it matters. Take our organized testimony before the Department of Health on the issue of the scope of practice of naturopaths as just one example.

?On Wednesday, April 24, Washington State Department of Health held a public hearing on Senate Bill 5411?that would make several updates to the naturopathic practice act including:

• Expanding prescriptive authority to include controlled substances schedules II-V. This change would include opioids.
• Allowing a naturopath to sign and attest to any certification cards, forms, or required documents that a physician can sign.
• Changing the definition of “minor office procedure” to include primary care services and treatment of minor injuries.

During this hearing, the physician voice was heard loud and clear. An impressive number of physicians and a physician assistant testified at the hearing including:

• Katina Rue, DO
• John Bramhall, MD, PhD
• Matthew Hollon, MD, MPH
• Kim Morrissette, DO
• Katrina Bassett, MD
• Jeffrey Frankel, MD
• Scott Hippe, MD
• Justin Stamschror, MD
• Timothy Clement, MD
• Thomas Madejski, MD
• Vasisht Srinvasan, MD
• Kevin Hodges, MD
• Navid Malakouti, MD
• Chris Chambers, MD
• Jeffrey McLaren, MD
• Sung-Won Kim, MD
• Paul Surrette, PA-C

We are so impressed and so grateful for these folks presenting such a powerful and unified front. This is just one example of WSMA living out our motto: physician driven, patient focused. In addition, the American Medical Association , Washington State Hospital Association , and numerous physician specialty organizations joined the WSMA in voicing concerns about the proposal.

?By the end of the hearing, Department of Health staff said a preliminary recommendation on the proposal will be issued in late May or early June. At that time, concerned parties will have another opportunity to share written comments. If you have questions about how to participate in this sunrise review, email WSMA Associate Policy Director Billie Dickinson.

?Additionally, WSMA’s president, Nari Heshmati, MD, and I will present on Washington state’s experience with scope of practice to a national audience at the AMA’s Scope of Practice Summit. We look forward to sharing our work with some 200 physician leaders and staff from state medical associations and national specialty societies when they gather to discuss such legislation being introduced across our nation.

?As always, the WSMA evaluates scope of practice proposals on an individual basis, partnering on those that safely promote access to care and opposing others that put patients at risk by inappropriately expanding the scope of nonphysicians who lack the appropriate clinical education and training. Your clinical expertise and frontline knowledge about patient care and safety are critical to these discussions. Let us know your thoughts and concerns on this topic.