Scope-of-Practice Battle Expected on Beacon Hill

As the Massachusetts Legislature wrestles with new issues of health care cost control and payment reform, an older political battle is raging over several initiatives aimed at expanding the scope of practice for non-physician health care providers.

Specifically, many health professions — including nurse practitioners, physician assistants, nurse midwives, audiologists, podiatrists, optometrists, and cosmetologists — are using health care reform as an opportunity to demand broadened roles and responsibilities.

As a strong guardian of quality patient care, the Mass. Medical Society (MMS) is opposed to many currently proposed legislative scope-of-practice initiatives. The society is concerned that, if the bills are enacted, diminished patient safety for Massachusetts residents may result.

At least nine separate bills have been filed, including one, H.B. 1520, “An Act Encouraging Nurse Practitioners’ and Physician Assistants’ Practice of Primary Care,” that proposes striking the word ’physician’ from many statutes and inserting the word ’provider.’ Such a change greatly broadens the number of heath care professionals who can perform medical services, putting at risk the protection of patients who depend on the judgment and skill of physicians.

This bill is the most worrisome, said MMS President Dr. Lynda Young. “This proposed legislation would compromise patients’ rights and undermine the quality of our health care system,” she said.

In written and oral testimony on Beacon Hill, the MMS has consistently stated that expansion of practice should be preceded by advanced training and education. Team approaches among physicians and physician extenders are essential and have a direct relationship to better outcomes and improved quality.

Moreover, the society’s view is that physician shortages should be addressed through recruitment and retention initiatives, not legislation to increase independent and expanded practice by non-physicians.

The society is firm in its support for collaboration and coordination of efforts by all health care providers as a critical factor in quality patient care. The challenge for both providers and legislators is in recognizing the unique contributions of each provider group and how best to utilize those assets in a safe, physician-led team approach to patient care.

The MMS will remain diligent in its efforts regarding scope-of-practice legislation and will continue to work with the state Legislature, patient advocates, allied health care providers, and physician specialty societies to ensure quality patient care.

Ronna Wallace writes about government affairs in Vital Signs, a publication of the Mass. Medical Society, where this article first appeared.