COLLABORATE UNIFY HEAL
( continued from page 11)
physical therapy prescription filled out by the physical therapist in order for the physical therapist’ s care to be legally authorized and therefore reimbursable. I realize that there is fraud in our imperfect world and so my authorizing signature is a legal necessity. But the notion that I would question a physical therapist’ s independent judgment and skill is laughable.
I love that pharmacists can give vaccinations under their own authority. The staff in my office have too much to do already, and stocking vaccines is a logistical and financial challenge. When one of my patients needs an HPV vaccination series, I don’ t even need to fool with a prescription. I just tell the patient to walk into their most convenient drugstore chain the next time they need something, and while they’ re there tell the pharmacist that Dr. Goldberg said they need their HPV vaccination series. And get your flu shot( and anything else you’ re due for) while you’ re at it. It’ s better to get it taken care of while you’ re doing some shopping anyway, rather than waiting around a doctor’ s office until someone’ s available to give you a shot.
So why should we as a profession care so much about legislation that expands authority for allied health providers to order tests or perform procedures while working independently? The answer is because there’ s a huge difference between working at the top of your professional license as part of a team, versus caring for patients solo while performing without a net. As a subspecialty trained physician, I theoretically have a set of skills that should allow me to do many things independently, and yet I have never worked outside a setting where I had a broadly supportive team. I’ ve mixed chemotherapy, but I have never practiced in a facility that did not have oncology-specialized pharmacists. Early in my career, many gynecologic oncology patients went to the ICU post-op. We managed ventilators, floated PA catheters and did our own critical care. But I also know that my patients do better when managed( or at least co-managed) with a full-time intensivist. Just because I can do something doesn’ t mean that’ s what’ s best for my patient.
For some of the allied health professional societies, broadening legal authority to perform certain medical functions is seen as a matter of professional prestige, but it’ s being dressed up to look like it’ s good for patients. It is neither of these things. It is ironic that as physicians, we have the broadest legal authority, and yet we are the least likely to exercise that independence. After all, as a board-certified OB-GYN with a Kentucky medical license, I’ m legally permitted to open an outpatient clinic to treat skin diseases or even offer office-based cosmetic procedures. With the shortage of dermatologists( and every other specialty), I’ m sure I could develop a very lucrative business. However, my fund of knowledge in dermatology is not anything close to what I wish it were, and I would never even remotely consider such an idea. I care too much about making sure patients really get good care.
I don’ t watch a lot of medical dramas, but the few I’ ve seen don’ t seem to do a good job of portraying the importance of a team-based approach in the delivery of high-quality care. They may present a team of physician trainees with an emphasis on academic hierarchy, but what seems to be missing is the contributions that dieticians, pharmacists, physical and occupational therapists, audiologists, speech therapists, nurse practitioners, physician assistants and many others make in the provision of optimal care for our patients, when those contributions are made as part of a team. None of us can be optimally effective when we work in a siloed environment, no matter how highly trained we are, and that is especially true if one’ s training has less depth and breadth. Unfortunately, this concept may not be appreciated by those whose view of medicine is shaped by what they know from watching television.
When legislators have in the past been convinced to broaden legal authority for non-physicians to work independently, performing tasks that normally fell to physicians, it usually involved recollections of Kentucky’ s Frontier Nursing Service going out to the underserved areas of rural Kentucky nearly a hundred years ago and making a real impact on public health. Unfortunately, that does not appear to be what has happened with recent broadening of independent practice authority for nurse practitioners. Although good data is unavailable from the Kentucky Board of Nursing, anecdotally there appears to be a significant number of licensees who have opened cash-only practices which provide cosmetic procedures or various“ alternative” health clinics that may or may not provide care within evidence-based guidelines. At the last Physicians’ Day at the Capitol, one of our state senators who in the past has been in favor of expanding independent practice authority for allied health professionals asked me to find out how many nurse practitioners are practicing independently in underserved areas versus affluent cities. That data is unfortunately proving difficult to collect.
GLMS and KMA will continue to make legislators aware of the importance of delivering healthcare within a team-based framework, and the undesirability of siloed“ independent” practice for any healthcare professional, even physicians. However, this must be a group effort. Over one fifth of our legislators reside in the Louisville metropolitan area, and most likely receive their medical care from a GLMS physician, as do their constituents. They listen to you, and they trust you. Help them understand that our concerns about scope of practice legislation center around patient safety, quality of care and avoidance of wasteful spending. Physicians are certainly not in economic competition with the allied health providers we rely on every day. We need to stop allowing the medical profession to be portrayed as protecting economic turf, when all we are really trying to do is ensure that our patients receive high-quality care. In the modern era of healthcare delivery, high-quality care requires promoting a team-based approach, rather than encouraging more healthcare providers to work in an independent, siloed environment.
Dr. Goldberg is a gynecologic oncologist and President-Elect of the Greater Louisville Medical Society.
12 LOUISVILLE MEDICINE