CLEAR

US government report urges expanded scope of practice and telehealth

A report issued by the US Departments of Health and Human Services, Labor, and Treasury, "Reforming America's Healthcare System Through Choice and Competition," calls for easing of scope of practice laws, particularly giving examples of advanced practice registered nurses, physician assistants, pharmacists, dental therapists and hygienists, and optometrists. The report calls for changes to scope of practice laws to allow healthcare providers to practice at the top of the license and skill set. A further recommendation is elimination of collaborative practice and supervision agreement requirements. The report also suggested easing the license process for foreign-trained physicians.

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Alberta: RNs get prescribing authority

Amendments to the Registered Nurses Profession Regulation will allow RNs to prescribe common medication and order some diagnostic tests such as x-rays. RNs will need to complete additional education and have appropriate supports in the work setting before being authorized to prescribe in their clinical practice area.

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NASEMSO releases EMS scope of practice framework

The National Association of State EMS Officials has released the "Scope of Practice Model Decision-Making Framework for Emergency Medical Services." The new document is intended to provide "a standardized decision-making framework to help determine whether specific activities, interventions or roles are permitted under similar health practitioner's level of education, licensure and competence and to meet standards established by various Practice Acts and rules/regulations of each state/jurisdiction."

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AAFP State Legislative Conference reports on state bills

The American Academy of Family Physicians State Legislative Conference roundtable provided state progress reports from the chapters. Some notes:

• A Virginia bill to allow doctors of medical science programs to license advanced-study physician assistants did not advance.
• An Indiana bill will not allow chiropractors' scope of practice to include ordering and interpreting advanced diagnostic imaging on all areas of the body.
• Michigan will fund student loan repayment for family physicians practicing in underserved areas.

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AMA expands Health Workforce Mapper tool

The American Medical Association has updated and expanded their Health Workforce Mapper tool, which uses data-visualization to locate physician shortage areas. The tool provides information on an area's healthcare workforce, including specialists and subspecialists, searchable by state, county or zip code. The tool also shows healthcare facilities and information on transportation and geographic features, such as highways, mountains and waterways, that could affect access to care. The tool has been used to help inform policymakers on issues related to telemedicine and scope of practice as ways of addressing healthcare shortage areas.

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New research on nurse practitioner scope of practice

Research presented at the American Enterprise Institute focused on shortages in primary care and the effect of nurse practitioners scope of practice restrictions. The study findings, presented by Dr. Peter Buerhaus, healthcare economist and professor of nursing at Montana State University, show projected growth in the NP workforce, with primary care nurse practitioners more likely than physicians to practice in rural areas. However, the research shows that access to PCNPs is significantly less in states with laws restricting NP's scope of practice. The research also shows that "beneficiaries who received their primary care from NPs consistently received significantly higher-quality care than physicians’ patients in several respects." Regarding the claim that scope of practice restrictions are necessary to protect the public from low-quality providers, "Analysis of different classifications of state-level scope-of -practice restrictions provided no evidence that Medicare beneficiaries living in states that imposed restrictions received better-quality care."

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US: Congress considers opioid bill with expanded buprenorphine prescription authority

An opioid bill currently under consideration by both the US House and Senate would, among other measures, permanently allow nurse practitioners and physician assistants to prescribe the anti-addiction medication buprenorphine, upon undergoing extra training and receiving a special license. The bill would also allow nurse anesthetists, nurse midwives and clinical nurse specialists such prescription authority for the next five years.

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Malta considers legal profession regulation

The Attorney General in Malta is reviewing a bill to regulate the legal profession. The proposed bill defines what legal services can be offered exclusively by lawyers and what services can be offered by other professionals who are regulated by a different authority. The bill establishes regulation for law forms and the requirement that all lawyers are members of the Chamber of Advocates. The Chamber of Advocates will issue an annual practicing certificate. Continuing professional development requirements are also included in the bill. Upon review, the bill will be passed on to the Cabinet.

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Complaints and lawsuits filed against online teeth aligner companies

Several online companies have entered the teeth alignment industry by offering at-home teeth impression kits and mail-order purchase of plastic aligners. The American Association of Orthodontists has filed complaints against the companies with dental boards in 36 states, and the American Dental Association has issued a resolution urging consumers not to use such services. Those speaking out against the companies cite the potential for complications if treatment and follow-up care is not provided by an orthodontist. The Georgia Board of Dentistry recently passed a rule requiring a licensed dentist to be present when 3D dental scans are taken, effectively preventing the online companies from setting up shops in Georgia.

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Research study on scope of practice and burnout

A research study on "Burnout and Scope of Practice in New Family Physicians" concluded that family physicians who practice a broader scope of practice at the beginning of their careers may be less likely to experience burnout. The research was conducted by researchers with the American Board of Family Medicine and the University of Washington Family Medicine Residency Network. The study's ample included physicians providing outpatient continuity care. The study concluded that "family physicians who practice in more locations and performed a greater variety of procedures/clinical areas were less likely to report feeling burned out" with the strongest associations for those practicing obstetrics and inpatient medicine.

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