California wants to dumb down medical care with EVERYONE playing an MD

[Socrates25]

http://www.latimes.com/health/la-me-doctors-20130210,0,1509396.story


This goes above and beyond the usual "NPs and PAs should do primary care" stuff. This legislation opens the floodgates to EVERYONE -- NPs, PAs, pharmacists, psychologists, optometrists, chiropractors, naturopaths and everybody else who thinks they can play doctor.

Note how the guy supporting the bill is an optometrist who thinks he can diagnose/manage diabetes. Take a look at this gem:

Hernandez, who said he would introduce his legislation and hold a hearing on the issue next month, said his own experience as an optometrist shows the need to empower more practitioners. He said he often sees Medicaid patients who come to his La Puente practice because they have failed their vision test at the DMV. Many complain of constant thirst and frequent urination.

"I know it's diabetes," he said. But he is not allowed to diagnose or treat it and must refer those patients elsewhere. Many of them may face a months-long wait to see a doctor.

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[Pleepl3us]

I would usually think stories like this are laughable but knowing how messed up California is politically I thinking frightening is a better term to use.

 

[Wavy Doctor]

Interesting..

so as an IMG I might have a shot at working in Cali in say 5 years time?

 

[Dharma]

is there any collective voice representing physicians when it comes to issues like these? nurses form like voltron (and although i disagree with some of their agendas) they seem to be getting what they want because of it. what about the docs (the real ones, not the noctors i mean)? no banding of any sort? no AMA stepping up to get $hit done on the political front to prevent crap like this from happening? please fill me in on the "why not" because i'm obviously a bit ignorant of the reasons.

 

[88845]

This is a sickening push by California legislators and the mid-level professional societies, but the overarching failure I see is the cap on residency slots placed by Congress in 1997. There are many bright and able international medical graduates willing to do primary care in Health Professional Shortage Areas (HPSAs) even keeping in mind the lower relative pay. Make more primary care residency spots!

 

[septoplasty]

Interesting..

so as an IMG I might have a shot at working in Cali in say 5 years time?

Probably not since the PA's will say you're incompetent. Even if you've graduated top of your class from Oxford. Ah the irony.

 

[deleted87716]

is there any collective voice representing physicians when it comes to issues like these?

It's a state issue. The AMA works mostly at the federal level, although they sometimes assist with state issues through the state medical societies.

http://www.cmanet.org

 

[Dharma]

It's a state issue. The AMA works mostly at the federal level, although they sometimes assist with state issues through the state medical societies.

http://www.cmanet.org

What kind of representation to physicians have at the state level?

 

[deleted87716]

What kind of representation to physicians have at the state level?

See the link...? ---> http://www.cmanet.org

That's the CA chapter of the AMA.

State specialty societies (e.g., the CAFP for family physicians) also lobby at the state level.

 

[Dharma]

See the link...? ---> http://www.cmanet.org

That's the CA chapter of the AMA.

State specialty societies (e.g., the CAFP for family physicians) also lobby at the state level.

my bad. i looked real quick at your reply in the middle of a genetics study session marathon. thx blue!

 

[Jessipeds]

Agree with you, they need more spots....although there are always tons of FP programs that do not fill.....

 

[Jessipeds]

We need stronger lobbying....we gotta stick together as physicians and not let these people take away what we have worked so hard for, and for so many years

Not to mention the harm coming to patients from seeing these unqualified people

 

[deleted87716]

We need stronger lobbying.

Have you contributed to AMPAC or any specialty PAC?

http://www.ampaconline.org

http://www.aafp.org/online/en/home/policy/fammedpac.html

If not, don't say "we."

 

[VA Hopeful Dr]

Agree with you, they need more spots....although there are always tons of FP programs that do not fill.....

Even if every program filled, it wouldn't be enough. The predicted shortage is staggering (something like 20,000+). In addition, there are an awful lot of family doctors in their late 50s/early 60s who are going to start thinking long and hard about retiring pretty soon - especially with all the new regulations coming down.

 

[SpecterGT260]

that is actually kind of terrifying... how does an optometrist expect to be able to manage diabetes? These things are issues of now knowing what you don't know. I am well aware of many (maybe even most) of the complications and treatments and protocols for diabetes and would still not be comfortable managing a diabetic on my own.

 

[facetguy]

that is actually kind of terrifying... how does an optometrist expect to be able to manage diabetes? These things are issues of now knowing what you don't know. I am well aware of many (maybe even most) of the complications and treatments and protocols for diabetes and would still not be comfortable managing a diabetic on my own.

He'll keep an eye on it, of course.

 

[SpecterGT260]

He'll keep an eye on it, of course.

If that doesn't work would you like a crack at it?









Sent from my DROID RAZR using SDN Mobile

 

[jkhamlin]

is there any collective voice representing physicians when it comes to issues like these? nurses form like voltron (and although i disagree with some of their agendas) they seem to be getting what they want because of it. what about the docs (the real ones, not the noctors i mean)? no banding of any sort? no AMA stepping up to get $hit done on the political front to prevent crap like this from happening? please fill me in on the "why not" because i'm obviously a bit ignorant of the reasons.

LOL! You have some classic lines there about physician pretenders!

My state (OK) is one of only two to license optometrists to do surgery. The ODs think because they took a single, month long course alongside ophthalmologists, that this qualifies them to do surgery. And ***** politicians agreed. What's worse, the ***** politicians were mealy mouthed about it; I know you're surprised. The governor at the time, Brad Henry, actually stated that adding surgery to their scope of practice isn't increasing or changing their scope of practice! We have come to the point in this country where politicians will lie that blatantly to us.

 

[jkhamlin]

Have you contributed to AMPAC or any specialty PAC?

http://www.ampaconline.org

http://www.aafp.org/online/en/home/policy/fammedpac.html

If not, don't say "we."

One of the reasons physicians don't contribute to, or work with organizations like those is that those organizations spend too much time tearing down physicians and medicine by supporting things like Obamacare. Very few physicians actually support the AMA, of which AMPAC is part. The nursing associations, and other physician pretender associations, however, are quite heavily supported by nursing because all they do is look out for the interests of nurses.

 

[deleted87716]

Anyone who avoids supporting their professional organization over a single issue is cutting off their nose to spite their face. Grow up, folks. Compromise is the way of the world.

If you're not at the table, you're on the menu.

 

[Silent Cool]

LOL! You have some classic lines there about physician pretenders!

My state (OK) is one of only two to license optometrists to do surgery. The ODs think because they took a single, month long course alongside ophthalmologists, that this qualifies them to do surgery. And ***** politicians agreed. What's worse, the ***** politicians were mealy mouthed about it; I know you're surprised. The governor at the time, Brad Henry, actually stated that adding surgery to their scope of practice isn't increasing or changing their scope of practice! We have come to the point in this country where politicians will lie that blatantly to us.

jk,

I saw that over on the ophtho thread. Do you think that this will open the floodgates for optometrists to do scalpel surgery in CA?

 

[SpecterGT260]

jk,

I saw that over on the ophtho thread. Do you think that this will open the floodgates for optometrists to do scalpel surgery in CA?

 

[jkhamlin]

Anyone who avoids supporting their professional organization over a single issue is cutting off their nose to spite their face. Grow up, folks. Compromise is the way of the world.

If you're not at the table, you're on the menu.

Single issue? Grow up?

Ummm... This is NOT a single issue, and it's the vast, vast, vast majority of physicians that you're saying "grow up, folks" to. Maybe you need to take a long, hard look in the mirror.

 

[jkhamlin]

jk,

I saw that over on the ophtho thread. Do you think that this will open the floodgates for optometrists to do scalpel surgery in CA?

That will be their next big push, no doubt. But first, they have to get enough ignorant legislators in a majority of states to buy into their nonsense.

 

[deleted87716]

This is NOT a single issue.

You'll have to be more specific, then.

 

[CAPharmacist97]

you know what they say..once california goes, also goes the rest of the nation

 

[rabsa]

My neighbors and I have plenty of guns. Studies, promulgated by us and published in our own journals, show we can protect our locale just as well as the police--albeit for six months only, and only for relatively minor crimes, like string spraying someone's driveway. We have plenty of experience on the front lines of the community. Oh, and people like us better: we dish out their parking tickets with a smile and a high five.

So, why shouldn't we be able to form our own independent neighborhood patrol (NP) service? We don't need to be regulated by the police, since obviously we have a different, um---je ne sais quois---and we can set up our own credentialing and certification services. Unlike the months of police academy, we can also train new NPs overnight; just fund our guns and ammunition. There is a shortage of policemen in our area, so this would naturally solve all our crime issues while simultaneously lowering costs and the like.

We will be sure to wear proper police uniforms and appropriate regalia, so the public won’t be able to perceive any difference in the quality of law enforcement. We also should be rightfully paid the same as conventional policemen, since beginning in 2015, our overnight training course will be extended to two nights, culminating in the Deputy Chief degree. NPs are the future of law enforcement. If things get out of hand, we’ll call up the national guard.

 

[SpecterGT260]

you know what they say..once california goes, also goes the rest of the nation

I believe only Californians say this. And then proposition 8 happens.

 

[dynx]

Anyone who avoids supporting their professional organization over a single issue is cutting off their nose to spite their face. Grow up, folks. Compromise is the way of the world.

If you're not at the table, you're on the menu.

Bah, my professional organization is my subspecialty representation. Not the AMA.
And before you give me the if we don't stand together BS....the problem here is the FP folks basically gave a middle finger to specialties in regards to Obama care in order to get more pay for "primary care providers". Did Obama forget to mention that "primary care providers" aren't going to just be family practice MDs, but are actually going to be NPs and PAs as well? Whoops! If we give every NP and PA 10% more and the salary of primary care MDs drops 20% oh well, on average the new primary care providers are technically getting more, exactly what Obama advertised. So forgive me if I retreat behind the lines and choose to band together with other surgeons to protect our turf for as long as we can since the idiot lobby of the P=MD crowd has allready proven themselves to be too stupid to be a usefull ally. Barring a mutually beneficial alliance the FP folks far better to use in this situation as cannon fodder. Clearly logic, reasoning and carefull interpretation of legislation aren't enough to get them on the right side of an issue, not when thier big-whigs can get a photo op with the president! No sir, only a prison style @ss assault is going to make them see the light so let happen. We dont need to support them, we tried that and failed, but the pain will bring them around to our side.
They made thier bed.

 

[Magus]

In response to the OP, this federal bill was just introduced in Congress and is supported by the AMA and American Psychiatrists Association (APA). It is called the Truth in Healthcare Marketing Act of 2013:

http://www.medscape.com/viewarticle/803077?nlid=30823_1049&src=wnl_edit_dail

If you don't have a Medscape account, see below:

https://bucshon.house.gov/press-rel...tt-introduce-“truth-healthcare-marketing-act”

Any thoughts? Hope this passes so we can finally draw a line in the fight to stop the misleading of the public (upholding the public trust is a duty of every physician according to the Hippocratic Oath) by the mid-level advocacy organizations.

In my humble opinion as a medical student, the only professionals who should be legally allowed to call themselves Doctors in patients' eyes and in the clinical setting (hospital/clinic) should have successfully completed either an MD or DO program (+ residency in most cases).

Please support this bill if you agree, doctors' lobbying groups respond to your support!!

 

[ajh1983]

In response to the OP, this federal bill was just introduced in Congress and is supported by the AMA and American Psychiatrists Association (APA). It is called the Truth in Healthcare Marketing Act of 2013:

http://www.medscape.com/viewarticle/803077?nlid=30823_1049&src=wnl_edit_dail

If you don't have a Medscape account, see below:

https://bucshon.house.gov/press-rel...tt-introduce-“truth-healthcare-marketing-act”

Any thoughts? Hope this passes so we can finally draw a line in the fight to stop the misleading of the public (upholding the public trust is a duty of every physician according to the Hippocratic Oath) by the mid-level advocacy organizations.

In my humble opinion as a medical student, the only professionals who should be legally allowed to call themselves Doctors in patients' eyes and in the clinical setting (hospital/clinic) should have successfully completed either an MD or DO program (+ residency in most cases).

Please support this bill if you agree, doctors' lobbying groups respond to your support!!

I'm thrilled to see this bill. Physicians need to be re-christened nowadays. Way to many lookalikes.

 

[jkhamlin]

You'll have to be more specific, then.

Are you purposely being obtuse?

 

[SpecterGT260]

Anyone who avoids supporting their professional organization over a single issue is cutting off their nose to spite their face. Grow up, folks. Compromise is the way of the world.

If you're not at the table, you're on the menu.

Single issue? Grow up?

Ummm... This is NOT a single issue, and it's the vast, vast, vast majority of physicians that you're saying "grow up, folks" to. Maybe you need to take a long, hard look in the mirror.

Single issue? Multiple issue? How about a single sense of of issues in general? This "be specific" thing seems like a nonsense "cite your sources" counter in an inconsequential opinion based argument.

Here is why I throw the AMA letters that I get straight into the trash:

I have seen no compelling evidence to suggest "support" and "results" are going to be positively correlated. Is that single or an aggregate of multiple issues? I honestly don't give half a dry white dog turd..... It is what it is. If "growing up" means blindly paying into a group lest I risk being dubbed "immature" by some nameless faceless nobody on the other end of the internet, well.... we may be using different definitions of the word

 

[deleted87716]

Even though this is getting a bit tangential to the OP:

Why the AMA is in decline, and should doctors care?
http://www.kevinmd.com/blog/2011/06/ama-decline-doctors-care.html

 

[Robin des Bois]

jk,

I saw that over on the ophtho thread. Do you think that this will open the floodgates for optometrists to do scalpel surgery in CA?

Why doesn't optometry simply get intergrated into medicine?

 

[SpecterGT260]

There are a number of mid-level practices which exist largely because physicians don't want to do that sort of work for various reasons. The day to day of an optometrist is not at all like an ophthalmologist.

 

[Robin des Bois]

There are a number of mid-level practices which exist largely because physicians don't want to do that sort of work for various reasons. The day to day of an optometrist is not at all like an ophthalmologist.

But it would still be better than having optometrists act like physicians. Having mid-levels act like physicians is dangerous for the patients, because they lack the training of physicians.

 

[SpecterGT260]

But it would still be better than having optometrists act like physicians. Having mid-levels act like physicians is dangerous for the patients, because they lack the training of physicians.

You will have to explain to me how you thought I was suggesting mid levels should act as physicians.

 

[Robin des Bois]

You will have to explain to me how you thought I was suggesting mid levels should act as physicians.

It ain't you who are suggesting it. I'm describing what they are pushing the politicians to grant them. If it continues like this, we will have people without the adequante training practicing medicine.

 

[SpecterGT260]

The scope of practice of some of these spin-off type professions is the issue, not their existence in general. Physicians are not likely to want to check and set lenses or deal with ingrown toenails (that's 2 professions there... btw). This is why simply absorbing those other jobs is not really a valid plan. At the level of training of a physician, there are better things I could be doing with my time.

 

[Digsbe]

As a pharmacy student this is how I view the issue.

I think pharmacists are competent enough to manage diseases and practice under a CPA with physicians. Pharmacists have been doing it for years in government health systems like the VA and IHS. It appears that the limiting factor behind this becoming widespread is Medicare billing and reimbursement which may change in time. The physician should always be the one doing the initial evaluation and diagnosis, but after a diagnosis I think it's appropriate for a pharmacist to manage therapies in which they have competency. I think pharmacists holding the Pharm.D. are qualified to do so for most common chronic diseases like diabetes, asthma, hypertension and the like. Residencies exist to provide specialized training for other disease states. I would not call this type of care "dumbed" down.

I do not think pharmacists should ever be the ones providing office procedures, surgeries, diagnosing, or taking on patients from physicians whom they do not have agreements with. They are doctors of pharmacy trained and specialized in clinical applications of pharmaceutical agents and their diseases. We are not trained to do surgeries or perform procedures outside of giving a physical, injections, and other basic things. Proper diagnosis should be made by the physician and they should be able to review what the pharmacist does similar to how an NP or PA operates.

I can't speak about an O.D.'s training nor do I know the laws concerning CPAs that they can hold with physicians.

As far as independent practice goes... NPs and PAs should not be allowed to practice independently. Pharmacists are licensed to practice pharmacy independently and Optometrists are licensed to practice optometry independently, but an expanded scope of practice should be under the guidelines of a CPA in accordance with what the individual is trained to do.

I may go to medical school after pharmacy school, oncology and internal med strongly interest me. If I want to diagnose or practice medicine independently I should go to med school.

 

[SpecterGT260]

I think pharmacists holding the Pharm.D. are qualified to do so for most common chronic diseases like diabetes, asthma, hypertension and the like. .

How would you assess the progression of these illnesses?

 

[zenman]

As a pharmacy student this is how I view the issue.

As far as independent practice goes... NPs and PAs should not be allowed to practice independently. Pharmacists are licensed to practice pharmacy independently and Optometrists are licensed to practice optometry independently, but an expanded scope of practice should be under the guidelines of a CPA in accordance with what the individual is trained to do.

I may go to medical school after pharmacy school, oncology and internal med strongly interest me. If I want to diagnose or practice medicine independently I should go to med school.

You should be allowed to practice independently but NPs and PAs shouldn't? Look pharm student whipper snapper, NP's have been practicing independently for years, 20 plus in my adopted state of NM. And every time I order a polypharm consult quit telling patients to ask me about such and such as I'm already up on it.