Healthcare is a team sport. Every player has the important role of providing access and managing costs. When it comes to safety, leadership of the healthcare team must remain with those with the highest level of education and training. Physician supervision is key to protecting North Carolina patients. For this reason, the Coalition opposes SB 695/HB 807.
As crossover approaches at the North Carolina General Assembly it is possible that SB 118/HB 913 – Naturopathic Doctors Licensing Act may be debated. This legislation proposes to create a third classification of physician in North Carolina.
Current law permits the licensure of Medical Doctors (MD) and Doctors of Osteopathy (DO) – both regulated by the North Carolina Medical Board. SB 118/HB 913 propose to license Naturopathic Doctors (ND) under their own licensing board.
Only 18 states currently license naturopaths, none of which are in the Southeast.
Allowing practitioners without medical training to refer to themselves as doctors is confusing to the public and poses a risk to safety. Use of the initials ND is especially confusing when compared to MD (medical doctor) and NP (nurse practitioner) titles.
SB 118/HB 913 would allow naturopaths to order tests and manage chronic disease as a primary care provider. The bills allow naturopaths to treat infants and children, diagnosis and treat mental health conditions, even diagnosis and treat cancer.
If naturopathic treatment is endorsed by the legislature as adequate treatment of life-threatening and chronic disease, patients are put in harms way. Ineffective naturopathic treatment could delay much needed medical services, leading to complications and even death.
Finally, in states where naturopaths have been licensed, there appears to be an immediate and constant push for expanded scopes of practice to include the ability to prescribe controlled substances. The American Association of Naturopathic Physicians notes on its website, “… seven more states are pursuing scope modernization, particularly expanded prescribing authority” this year alone.
For these reasons the Coalition opposes SB 118 and HB 913.
North Carolina’s OB/Gyn doctors and Certified Nurse Midwives work side-by-side as partners to ensure that their patients – women and soon-to-be-born children – get the best and safest care possible. Cooperation and high standards of care are only enhanced by flexible, but necessary, physician supervision of nurse midwives. Physician OB/Gyns complete twice as many years of education and over ten times as many clinical training hours as nurse midwives.
Nurse midwives are an essential part of a team approach to ensuring the safety of thousands of mothers and children in our state. As with any team, leadership by those with the most experience and education is necessary.
Every mother and child deserves the best and safest care. Lowering standards of care – reducing safety – to increase access to care is a false choice that no woman or family should face. That’s why NCCPP opposes reducing safety standards such as eliminating the requirement that nurse midwives work supervised by a physician.
Passage of SB 695 or HB 807 would allow lesser qualified providers to direct the care of patients with the highest risk. It could also leave those providers unprepared to handle complications that arise in even the healthiest patients. Passage of this legislation will give women and their families a false sense of security that midwives can do everything necessary to keep mothers and their newborns as safe as possible.
Every pregnant woman and every newborn in our state deserves the best and safest care – because problems during labor and delivery can come at any moment, without warning, for even the healthiest women. Eliminating physician supervision of nurse midwives is simply not worth the risk.
Did you know that physician supervision provides greater flexibility to the way nurses practice in our state?
North Carolina law is unique from many other states in that it is accommodating to both nurses and physicians – resulting in better patient care. While other states limit nurses to the skills acquired during 1-2 years of training, North Carolina law allows nurses to expand their expertise well beyond their formal education. This broadening of their responsibilities is achieved by working side by side with a supervising physician.
Physician supervision allows nurses to achieve additional on the job training from someone with over a decade of medical education, thereby practicing well beyond what was learned in nursing school.
In fact, advanced practice nurses in North Carolina can perform any medical act approved by a supervising physician.
Supervision allows nurses to practice to the fullest extent possible, while
maintaining the safety net of physician expertise vital to patient safety.
As the needs of our state change, physician supervision allows nurses to maximize their skills and practice without the limitations of their training. Otherwise, nurses simply do not have the training necessary to safely and independently practice medicine.
Senate Bill 695 proposes to allow nurses to independently provide neonatal care, mental health services and any other medical care across the life span of a patient – despite very limited training.
Two years of education prepares nurses to follow pre-approved protocols, but it does not prepare them to independently diagnose and treat complex disease.
Nurses play a vital role in the patient care team, but
two years of training is no substitute for the expertise of a physician.
For these reasons the Coalition supports physician supervision of nurses and opposes SB 695.
Doctors can train for as long as 15 years before they are allowed to treat patients without supervision – because extra years of training can mean the difference between life and death. A nurse’s’ training is considerably shorter – which makes their supervision by a physician critical to patient safety.
For this reason the Coalition supports continued physician supervision of nurses and opposes SB 695.
Medical school is a rigorous, full-time, four-year program consisting of classroom work as well as thousands of hours of clinical training. After graduation, MDs enter into a residency program that ranges from 3-7 years of additional training. In some instances, fellowship training may also follow, adding 1-2 more years to the process.
Physicians train for at least a decade – some for much longer – before
they are permitted to practice without supervision.
The years required to become a physician are essential, ensuring that physicians of all specialties – from primary care to neurosurgery – obtain the knowledge and skills necessary to safely practice.
Nurses obtain their certifications in a variety of ways. However, no matter their training pathway, nurses do not undergo the level of training necessary to independently diagnose and treat complex medical conditions.
Even advanced practice nurses may only complete an additional
2 years of education and training after college.
The extra years of training that physicians receive can mean the difference between life and death. For this reason the Coalition supports continued physician supervision of nurses and opposes SB 695.
The North Carolina Board of Electrolysis Examiners have filed proposed rules to take effect on August 1, 2015. Among other regulations, these proposed rules would make changes to the requirements for physician supervision of electrolysis providers.
PUBLIC HEARING: Sunday, April 26, 2015, 9:30 a.m.-1:30 p.m.
Trinity Oaks, 728 Klumac Road, Salisbury, NC 28144
The North Carolina Board of Electrolysis Examiners will accept public comment regarding proposed rules changes found here. The rule change proposes to clarify provisions regarding applications for licensure, school and instructor certifications, fee increases, continuing education, and agreements with Supervisory Physicians.
New language would specify that agreements with supervising physicians include an acknowledgement that current guidance from the North Carolina Medical Board with respect to laser hair removal and laser surgery by non-physicians will be observed and monitored. The new rules would also require attestation that the supervising physician will be readily available and able to respond quickly to patient emergencies and questions by those performing electrolysis procedures under the physician’s supervision.
Comments can be directed to:
Susan Magas, 2 Centerview Drive, Suite 60, Greensboro, NC 27407, phone (336) 856-1010, or firstname.lastname@example.org.
Comment period ends: June 1, 2015
Legislation has been filed in the NC Senate that puts patients at great risk. Senate Bill 240proposes to eliminate the requirement of physician supervision of nurse anesthetists (CRNAs). North Carolina law has always required physician supervision of nurse anesthetists providing anesthesia medical care. Unfortunately, this important patient safety standard is under attack.
Physician supervision is, and should remain, the law.
The North Carolina Medical Board has always required physicians to supervise nurse anesthetists providing anesthesia services – this helps ensure the safety of services provided. Physician anesthesiologists complete almost double the education and more than ten times the clinical training of nurse anesthetists.
In 1998 and again in 2005, the N.C. Attorney General concluded that North Carolina law requires “the anesthesia care of a patient [must] be under the supervision of a physician.”
In 2005 the N.C. Court of Appeals rejected a lawsuit by nurse anesthetists by finding that “physician supervision of nurse anesthetists providing anesthesia care . . . is a fundamental patient safety standard required by North Carolina law.”
The requirement of physician supervision is supported by multiple academic studies suggesting that physician involvement in anesthesia care improves patient outcomes. Additionally, every hospital in the state requires the supervision of nurses providing anesthesia services.
North Carolina law has always required physician supervision of nurse anesthetists. It should remain that way. We value the important contributions of CRNAs, but a physician-led care team provides the most effective — and safest — care for patients.
* Training Chart Courtesy of ASA “When Seconds Count”
Patient education is key when it comes to understanding the roles of various healthcare providers as well as the risks posed by medical treatment not overseen by a physician. A 2015 AARP Magazine Infographic provides patients with the fundamentals of physician office roles, calling attention to the dramatic differences in training between physicians and nurse practitioners.
The graphic reads, “The physicians are still the ones in charge — and those with the most training, as indicated by the length of their white coats, the longest of any health care professionals. MDs have 3 to 7 years of training after med school.”
View the graphic on the AARP website here.
What is Scope of Practice?
Professional scope of practice refers to a set of parameters placed into state law to define what acts a licensed healthcare provider may, or in some cases, may not perform.
As a result, the law does not limit what medical acts a physician may perform. The North Carolina Medical Board provides oversight to physician practice, ensuring the public is protected from any potentially harmful behavior.
Non-physician health care providers have a legislated scope of practice that places limitations on their practice. This may appear in one of many ways.
- As a definition in statute. For example 90-143 defines Chiropractic as “the science of adjusting the cause of disease by realigning the spine, releasing pressure on nerves radiating from the spine to all parts of the body, and allowing the nerves to carry their full quota of health current (nerve energy) from the brain to all parts of the body.” As a result activities outside of this defined scope are prohibited without legislative authority.
- As a specified list of permitted activities. For example 90-722 lists 5 categories of practice that a polysomnographic technologist may engage in. This list if further broken down into a very specified list of tests that may be performed by these practitioners.
- In the form of physician supervision. Physician assistants and advanced practice nurses are not limited by a definition of practice or list of tasks. However, each must practice with a supervising physician’s approval.
How is Scope of Practice Determined?
In North Carolina the legislature specifies the scope of practice of various healthcare providers within Chapter 90 of the General Statutes. These decisions are often based on the level of training of the healthcare provider, balanced with the potential for harm to patients.
Can a Licensing Board Make Changes to Scope of Practice?
Not in North Carolina. Statute often allows licensing boards to write rules to clarify acceptable practice guidelines. For example, the Medical Board and Board of Nursing have rules in place to determine what information must be included in a supervisory agreement between the two providers. However, a licensing board cannot allow its licensees to practice outside of the legislated scope of practice or eliminate the requirement for physician supervision.
Why Do Providers Need a Scope of Practice?
It is important that these permissions, and in some instances limitations, are specified within state law in order to protect patients from harm. Just as state law describes who can operate motor vehicles, it is also tasked with determining who is qualified to provide medical care.
Almost every year the NC General Assembly is faced with proposed legislation to license naturopaths to practice medicine in North Carolina. This session is no exception with Senator Stan Bingham filing SB 118 – Naturopathic Licensing Act, last week.
During past debates illegally practicing naturopaths have offered their services as a form of “primary care” – a thought that is troubling to our members. Many patients fail to ask questions regarding the qualifications of their health care provider. If naturopaths are able to use the title of doctor or physician when practicing this could further confuse the public, presenting the false perception of medical training.
Additionally, licensure of naturopaths as physicians is troubling because:
- ineffective naturopathic treatments may delay necessary or needed medical services and put patients at risk
- the lack of ethical standard for naturopaths could lead to patient exploitation through sales directly to patients of “naturopathic remedies”
- this bill places no limitations on naturopaths when it comes to providing mental health care, treating children, or even diagnosing cancer.
For these reasons the Coalition opposes SB 118 as introduced.