Many of our colleagues don’t follow or are unaware of the dozens of scope of practice battles that are all too common between certain specialties and other health professions. (And sometimes people with no health care training whatsoever want to practice medicine, too!) Even if you don’t have a vested interest in these scope disputes, you should still be concerned.

Individually, some of these fights may be perceived as turf battles, but in reality they are attempts to water down the practice of medicine. We’ve earned the right to call ourselves doctors.  Anyone who wants to provide medical care should also earn that right through the classroom and not seek it through the statehouse.

Don’t get me wrong, I appreciate the work and commitment of allied health professionals.  They are an important part of the team and they should be allowed to fully function to the level that is supported through their training and education. Too often though, non-physician clinicians seek to practice beyond their training.  For internal medicine - my specialty - I think it makes sense to establish a medical home for patients with the physician leading a team of allied health professionals, each doing what they do best.

Each year, state lawmakers hear from a number of professions pressing for scope expansions, and they hear from us on why these expansions aren’t good for patient care. After a few years of the same debate, lawmakers usually seek compromise, thinking if they get both sides to agree it will be the end of the issue. However, compromise often isn’t the end of the story.

Here’s a good case in point. In 2007, optometrists wanted to remove a prohibition of oral medications from their practice act. Lawmakers worked out a compromise to allow prescribing rights for some oral medications, which remains the current Illinois standard for optometrists. 

Here we are in 2011 and guess what Illinois optometrists are seeking again? Full prescriptive authority! Optometrists are backing House Bill 1494, which would allow them to prescribe virtually any drug or substance for treatment of the eye, with only a few restrictions. This is typical for most scope battles.  Middle ground agreements are often short lived and considered another step up the ladder for their ultimate goal of practice independence.

Here’s a sampling of some of the other bills we are currently defending against in Springfield (I’ll bet these look familiar):

• Under HB 3133 certain advanced practice nurses (APNs) would be able to request the ability to practice and prescribe without a collaborative agreement. If they don’t get that right, there is another bill that would allow full prescriptive authority for nurses (HB 2978 and SB 2255).
• Even though the Illinois House already defeated licensure for direct-entry midwives once already this year, they aren’t giving up.  HB 2940 would allow the least trained individuals to independently practice and provide one of the most critical services to women. The certification program on which they are relying for licensure only requires “active participation” in 20 births and attending another 20 births as the primary midwife. In contrast, all physicians learn how to deliver babies and participate in some births in medical school, but only those of us who receive significant additional obstetrical training in residency go on to offer regular birthing services to patients.
• Nurses aren’t the only group seeking prescriptive authority. “Pharmacist clinicians” want prescribing rights under HB 2028.
• Naturopaths aren’t even licensed in Illinois, yet they want the ability to present themselves to the public as medical doctors. If enacted, HB 3350 would give them that right.

More examples are in the works and even more are expected to emerge as the legislative season progresses. My message to you is we must remain vigilant. The groups seeking these scope expansions will keep coming back. ISMS is committed to defending our profession.  I ask for your commitment, too.

Visit ISMS’ Legislative Action Hub to follow hot legislative issues that affect your patients and profession, including scope of practice and more.

Contact: Steven M. Malkin, MD, 800-782-4767 or by e-mail.