State Government Affairs Update

Latest advocacy endeavors look to rein in inappropriate scope of practice initiatives

AOA continues to fight unnecessary expansion efforts by non-physician clinicians.


Inappropriate scope of practice expansions by non-physician providers can threaten the health and safety of patients. The AOA, in support of its belief in physician-led teams, continues to fight unnecessary scope-of-practice expansion efforts by non-physician clinicians that might interfere with a physician’s ability to provide the best care possible for patients.

Physicians are the only health care providers who complete comprehensive medical education, training and examination requirements. The physician-led team-based model of care ensures that providers with complete medical training are appropriately involved with care.

With a looming physician shortage projected of between 40,800 and 104,900 physicians by 2030, according to a 2017 report by the Association of American Medical Colleges, some states are looking to non-physician clinicians to fill the gaps.

Recent state legislative efforts include inappropriate scope of practice expansion attempts by established categories of non-physician clinicians, as well as authorization of the practice of medicine by newly created provider types such as assistant/associate physicians (APs) and Doctors of Medical Science (DMS).

“All patients, regardless of income or location, deserve access to fully trained and licensed physicians,” says Raine Richards, JD, director of public policy at the AOA. “Allowing providers who complete less education, training and testing than physicians to practice medicine is not a solution to the physician shortage.”

The AOA encourages states to explore other avenues to attract and maintain an adequate supply of physicians for residents, including:

  • loan forgiveness,
  • tax credits tied to providing care in underserved areas,
  • establishing appropriate payment for services delivered via telemedicine, and
  • increased funding for primary care residency programs.

The Bureau of State Government Affairs plans to introduce two policies at the 2018 House of Delegates taking place July 16-22 in Chicago which would support uniform licensure pathways for all health care providers based upon scope of practice and oppose the creation of special licensure pathways for physicians who are not enrolled in an accredited residency program or haven’t completed at least one year of postgraduate medical education.

Here’s a breakdown of the latest victories and issues facing DOs:

AP/graduate registered physician (GRP) bills in 2018

State Issue
New Hampshire House Bill 1506 would allow APs to obtain full physician licensure after five years of practice and passage of an (as yet undeveloped) exam, without completing a residency program or passing steps/levels of COMLEX/USMLE. The AOA opposed the bill with support from the American College of Osteopathic Family Physicians (ACOF) and the American College of Osteopathic Internists (ACOI).
Hawaii HB 1813 would license APs and allow them to provide primary care in medically underserved communities under limited supervision by a fully licensed physician. The AOA opposed the bill with support from ACOFP, ACOI and the Hawaii Association of Osteopathic Physicians & Surgeons.
Mississippi HB 1107 would have created GRP medical licensure. Medical school graduates who did not match into a residency program would be allowed to provide direct patient care under limited supervision of a fully licensed physician. The bill died in committee.

Bills to license naturopaths are expected in 18 states in 2018-2019. The AOA opposed the following scope of practice expansion attempts this year:

State Issue
Maryland HB 497 would allow athletic trainers to evaluate and treat illnesses, in addition to injuries.
Maryland HB 863 would allow nurse anesthetists to independently order and interpret tests and radiographic imaging studies, order medications and provide preoperative care.
Indiana HB 1384 would allow chiropractors to diagnose physical injuries, conditions and disorders, conduct invasive diagnostic tests, order and interpret diagnostic imaging on all parts of the body and treat infectious diseases and endocrine disorders. The bill was amended after the AOA and Indiana Osteopathic Association commented in opposition.
Hawaii HB 1949 / Senate Bill 2299 would allow naturopaths to prescribe testosterone.

Doctor of Medical Science Degree (DMS)
The Doctor of Medical Science degree is currently being offered for PAs who have completed a master’s degree. Programs proclaim to provide candidates with one to two years of additional training to prepare them for advanced clinical and scholarly roles to bridge the gap between PA and physician training. Lincoln Memorial University-DeBusk College of Osteopathic Medicine in Tennessee was the first school to offer the degree, which is not accredited by the AOA. Its first class will graduate this year. Lynchburg College in Virginia enrolled its first class this past fall. Currently, there are no state licenses available for DMS degree holders. The AOA and the Tennessee Osteopathic Medical Association recently commented in opposition to HB 1926/SB 2122. The AOA will continue to monitor similar bills in Washington and Virginia for opportunities to comment.

The AOA has commented in favor of the following payment/physician workforce issues this year:

State Issue
Alabama SB 210 would provide scholarships for medical students in exchange for a commitment to practice family medicine in a rural area of the state after residency.
Oregon HB 4107 would ensure appropriate payment for an evaluation code that results in osteopathic manipulative treatment, even if the evaluation code is billed on the same day the procedure is performed.

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