Calif. docs fighting legislative battles on scope of practice

As healthcare reform expands coverage, nonphysician providers are seeking to expand their portfolio of licensed services and are facing intense opposition from doctors to their efforts.

In California, three bills before the Legislature propose to expand the scope of practice for nurse practitioners, optometrists and pharmacists, with two bills advancing and one bill being stalled.

A bill expanding pharmacists' scope of practice (PDF) has passed the Senate and is now before the Health Committee of the Assembly.

The California Medical Association has taken a neutral position on the bill after amendments were added calling for additional pharmacist training and limiting what treatments pharmacists can prescribe for such things as smoking cessation.

A bill expanding optometrists' scope of practice (PDF) has stalled, though the CMA said it expects it to be “resurrected” in the next legislative session.

A bill expanding nurse practitioners' scope of practice (PDF) passed the Senate and was defeated in an Assembly committee by a 6-3 vote, but then was granted reconsideration for another vote and was approved by the committee today.

The AARP, a former supporter of the nurse practitioner bill, has withdrawn its support for the bill, stating that recent amendments “undermine the intent” of the measure.

Despite the loss of the AARP’s support, the Assembly’s Business, Professions and Consumer Protection Committee voted a second time on the bill Aug. 13, and this time approved it by an 8-to-2 vote.

The advocacy group, Californians for Patient Care applauded the vote and said the legislation was necessary to deal with both a physician shortage and the influx of new patients to the health system after they gain coverage through the Patient Protection and Affordable Care Act.

“Under the ACA, about 4.7 million more Californians will be eligible for health insurance starting in 2014, and about 1.4 million will be newly eligible for Medi-Cal,” the group’s president Carmella Gutierrez, said in a news release. “However, there are not enough trained medical professionals to appropriately care for these new patients, particularly those who need access to primary care health professionals.”

The bill is expected be heard before the Assembly Appropriations Committee next week.

The state's lawmakers are facing pressure from both sides, but provider shortages in rural and urban communities are forcing some to take votes they're not entirely comfortable with. "If we don't pass this, I feel we'd be supporting the status quo, and we are not in a status quo situation right now,” Assembly member Kevin Mullin, a Democrat from the San Mateo area, told California Healthline.

Despite some compromise on the pharmacist bill, the CMA is maintaining a hard line.

“CMA strongly believes that simply expanding the scope of practice of allied health practitioners to give them independent and/or expanded practice will do nothing to improve access to care or quality of care in our state,” a CMA news release said. “Allowing practitioners to perform procedures they simply aren't trained to do can only lead to unpredictable outcomes, higher costs and greater fragmentation of care.

Follow Andis Robeznieks on Twitter: @MHARobeznieks