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Fighting the Good Fight Against Scope Expansion
Posted on: 6/1/2013
Eldon A. Trame, MD
ISMS President
Eldon A. Trame, MD  

Every year ISMS battles a variety of expansion bills introduced by allied health professionals, and sometimes groups without any health care training, seeking to increase their "scope of practice." This often means they want authority to perform services that require medical training – without actually completing a full medical course of study.

Our legislative advocacy team does a superior job of identifying unreasonable scope expansions and working either to stop those bills early in the legislative committee or amend proposals so that changes to the law aren’t harmful to patients.

Every once in a while circumstances allow an ill-conceived scope bill to advance in the process farther than it should. This happened in the recently adjourned spring 2013 legislative session with S.B. 2187, a plan to give psychologists full prescribing rights. If you aren’t familiar with S.B. 2187, a quick read of our coalition position paper will fill you in on just how harmful it would be to patients. We consider psychologists an important member of the health care team, but allowing them to prescribe powerful psychotropic medications is not safe care.

From early on ISMS aggressively worked with the Illinois Psychiatric Society and like-minded groups to lobby against S.B. 2187. We were joined by patient advocates, health systems and even a concerned group of psychologists who were against giving their own profession prescribing rights.

Despite this strong coordinated opposition, the psychologists had several factors working in their favor.The bill’s sponsor holds a leadership position in the Illinois Senate, which allows him to exert influence over other lawmakers to support his priority bills. He actively worked S.B. 2187 and convinced several lawmakers who had previously expressed opposition to change their minds. Another drawback is the large number of new senators "learning" about scope and health care bills for the first time. All these factors came together to push S.B. 2187 through the Illinois Senate.

ISMS knew S.B. 2187's fate rested in the Illinois House and redoubled our efforts to educate lawmakers. We also received added support from the Scope of Practice Partnership (SOPP), an American Medical Association-led coalition of state societies and national specialties, many of which regularly contend with scope issues. Once contacted, the AMA SOPP acted quickly to authorize resources for legislative advocacy use on this issue.

Ultimately, the psychologist prescribing proposal stalled because the necessary votes just weren't there due to our staunch unity. In the waning days of the Illinois House session, S.B. 2187 was transformed to a "shell bill," meaning it stays alive for potential other, future legislative purposes. Stopping this prescribing initiative was important for Illinoisans, but our success reaches beyond our borders and beyond the myriad of narrow specialty interests.

National organizations pay close attention to scope expansions as they migrate from one border to the next. Illinois would have been the first "big state" to authorize psychologists prescribing, emboldening national psychologists’ interests to press for authority elsewhere. Further, other non-physician health professions use scope successes to advance their own cause. Today it was psychiatrists on the frontline, but I guarantee you that tomorrow it will be anesthesiologists, pediatricians, ophthalmologists, OB/GYNs, internists, or fill in the blank with your specialty, if unsafe scope expansions are allowed to advance unchallenged.

Scope battles aren't simply narrow turf fights that separate physicians by specialty, geography or anything else. ISMS' efforts are a fundamental protection of what defines medical care and the best interests of our patients. Future scope challenges remain, but for now I extend my heartfelt thanks to the Illinois stakeholders, and our national partners, who joined us in this effort to stop this latest scope expansion proposal.



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