Lawmaker wants to expand roles of medical professionals

March 13, 2013

By Michael J. Mishak, LA Times

SACRAMENTO -- Citing a doctor shortage in California, a state lawmaker wants to expand the roles of nurse practitioners, pharmacists and optometrists to help treat what is expected to be a crush of newly insured Californians seeking care next year under the federal healthcare law.
At a news conference at a community clinic here, state Sen. Ed Hernandez (D-West Covina) announced plans Wednesday to introduce a series of bills that would redefine professional boundaries for certain mid-level health workers, allowing them to provide more services than currently allowed under state law.
"The system we have now is overburdened," he said. "We have to make sure that if we're going to mandate every person in this country to buy health insurance ... that that care is available for them."
Although the details have yet to be finalized, nurse practitioners want the ability to set up independent practices. Pharmacists and optometrists want to be designated primary care providers so they can diagnose and manage some chronic illnesses, such as diabetes and high-blood pressure.
"I'm not saying we need to replace physicians," said Hernandez, who is also an optometrist. "But we have to realize that there are health professionals that are educated, provide care and provide it safely and can fill that provider gap."
The proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.
Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety.
The California Medical Assn. says healthcare professionals should not exceed their training. The group argues that nurse practitioners and other mid-level professionals are best deployed in doctor-led teams. They can perform routine exams and prescribe medications in consultation with physicians on the premises or by teleconference.
Such "scope-of-practice" fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures.
Since Jan. 1, more than 140 additional proposals have been launched in 33 states.