An independent task force contends that the regulation of physicians, nurses and other health professionals is out of sync with the rapidly evolving healthcare industry and needs an overhaul.
The report by the Pew Health Professions Commission suggests that regulatory authorities in the states re-examine their standards and methods with an eye toward making them more uniform, open and consumer-oriented. The commission was created by the Pew Charitable Trust, a Philadelphia-based philanthropy.
Among its recommendations:
Agree on a common vocabulary for regulation to avoid confusion among states and professions.
Make licensing standards consistent across state lines so that professionals may easily move around.
Base entry-to-practice rules on standard competency examinations. Require practitioners to demonstrate competence over time to maintain their professional standing.
Where professionals demonstrate skill in a certain area, lower the boundaries to practice of that skill. Allow their scope of practice to expand.
Put more members of the public on state professional boards. Restructure boards so they reflect a continuum of care instead of one professional domain.
The American Medical Association called the report "naive" but said some of the recommendations are valuable. The American Nurses Association supported the call for uniform language and greater public access to information but said some of the recommendations "would lead not to a more effective regulatory system but rather to a dramatically weakened one."
M. Roy Schwarz, AMA group vice president for professional standards, said: "We first learned about it after it was finished. Therein lies one of our concerns. It might have helped if they had gotten input from groups such as ours, who have been working on this for some time." The recent Pew Commission report that recommended closing 20% of medical and nursing schools (Nov. 20, 1995, p. 4) suffered for the same reason, he said.
"Secondly, their recommendations are bold, they have far-reaching implications, but in may ways they are naive," Schwarz said. "It almost seems like people who have not been involved extensively in caring for patients wrote some of these recommendations."
In fact, no nurses or physicians served on the Pew Commission task force that wrote the report. By design, most of the members were regulators and consumer advocates.
The AMA supports continuing competency tests, as does the ANA, but wonders how competency should be defined and proven. Both groups take issue with the call to widen the scope of competency. Schwarz said Pew "blurs the lines between the professions" and ignores the differences in training.
Virginia Trotter Betts, ANA president, said: "Unnecessary restrictions on scope of practice should be eliminated" without dropping important distinctions between healthcare professions.
Paul B. Hofmann, a member of the Pew Commission, said it was natural to expect professional organizations to defend their autonomy "any time the conventional status quo is challenged." But he welcomed strong reactions as an opportunity to invite "genuine analysis and productive output by those organizations."