FROM THE PRESIDENT by LEWIS HARGETT , MD
Scope Of Practice : The Physician Must Remain the Leader in Directing Health Care
The clinical practice of medicine has changed through the years . One of my favorite television shows growing up was the Western show , Gunsmoke . A prominent character featured on the show was Doc Adams . He was the only physician in Dodge City , Kansas . There were no other physicians within many miles . He regularly traveled into the countryside to treat patients , he was the sole health care provider practicing general medicine , performing surgery , delivering babies , etc . He often served as the nurse , pharmacist and even dentist for his patients . His was the final opinion for patient treatment and he was a great doctor . Doc Adams was an invaluable asset to the community .
Fast forward to health care in today ’ s era . The U . S . has evolved into a complex system with a multifaceted team approach to patient health care . No longer are physicians solely responsible for a patient ’ s health care needs . There are now numerous stakeholders in the health care system . Currently , there has been population growth , advances in research , disease treatment , specialization of medicine and advances in technology . Also , there have been advances in medications , increased longevity of patients , payment of care by commercial and noncommercial sources , government interventions , etc . These changes have led to this increasingly complex health care system that must be navigated . However , one constant remains the same : physicians must continue to be the leaders in directing patient health care .
Physicians are facing greater challenges in overseeing the direct health care of patients . Over the years , providers who are not physicians have entered the health care system . The term “ mid-level provider ” has been used to describe non-physicians ( i . e . nurse practitioners , physician assistants and nurse anesthetists ). Initially , these non-physician providers entered the health care system to assist physicians in the management of patient health care . They achieve a level of medical education and clinical skills to administer health care for patients , as specified by their governing boards . The guidelines , rules , regulations and the laws under which they are allowed to practice medicine define their “ scope of practice .” The scope of practice has specific boundaries that the practitioner must adhere to . Practicing outside one ’ s scope of practice can increase erroneous diagnosis and treatment , increase malpractice lawsuits , cause license suspension , license revocation , other legal and ethical issues , and patient harm , including death . Adhering to the scope of practice is for the protection and safety of the practitioner as well as the patient .
Initially , the non-physician providers were required to work under the guidance of a physician and to assist physicians with patient health care . As a member of physician-led teams , these providers have contributed to the care of patients over the years . They practice alongside physicians at every level of medical care to include hospitals , clinics , physician offices , operating rooms , etc . Their numbers continue to increase , and they have become an integral part of the health care team . However , there is a major concern regarding non-physician providers ’ ongoing advocacy for greater independence without physician guidance . Non-physicians continue to seek “ scope of practice expansion .” This push for greater autonomy without physician guidance should be alarming to the medical profession .
On their website , the American Medical Association defines scope of practice as “ those activities that a person licensed to practice as a health professional is permitted to perform , which is increasingly determined by statutes enacted by state legislatures and by rules adopted by the appropriate licensing entity .” Scope of practice can vary from state to state depending on their laws , rules and guidelines . The governing bodies of these mid-level health care providers lobby state legislatures and their regulatory bodies to pass laws and encourage expansion of their scope of practice . In fact , some states now allow non-physician providers to practice medicine without the guidance of a physician . This has led to non-physician providers establishing their own medical practices . These non-physician providers do not have the extensive medical education , knowledge and training to meet a patient ’ s health care needs . Also , instead of assisting physicians , these providers now compete with physicians
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