The Obamacare train is clearly in motion, and it has had quite a bit of trouble leaving the station. It’s important that we not let the technical issues with the rollout distract from the far worse consequences of the law that loom on the horizon, including a movement to re-define what constitutes a “doctor.” This change could harm patients and taxpayers.
Instead of at the national level, many healthcare fights will play out in state legislatures across the country. One of these battles is where the scope of procedures medical practitioners can perform are determined. Over the past year, legislation that would allow healthcare practitioners that are not medical doctors to perform increasingly complex procedures has been proposed in both red and blue states – Tennessee, Louisiana and California in particular. In each of these states, Democrat legislators have tried to give what are often termed “allied health professionals” – like optometrists, pharmacists, and nurse practitioners – the ability to perform procedures reserved for highly trained medical doctors.
The quest by non-M.D. health professionals to expand their scope – and with it, their paychecks – is not a new development by any means. Optometrist and nurse practitioner lobbies have been working to push the issue for years, culminating in a victory for optometrists in Kentucky in 2011, achieved largely through backroom legislative dealing.
The passage and implementation of the Affordable Care Act, with its anticipated spike in demand for healthcare services, has merely provided a fresh hook for these professional lobbies to frame their push for more power in the context of “patient access.”
But access to what, exactly? In Tennessee, Kentucky, and California, optometrists, who are not medical doctors, fought for the ability to provide “primary care” and even perform surgeries on the eye. At present, most of these complex procedures are reserved for ophthalmologists, medical doctors who attended medical school and completed a residency and medical internship – more than 17,000 hours in training in total, compared with less than 3,000 hours for optometrists.
Simultaneous with these legislative battles, allied health professionals are waging a public relations campaign aimed at glossing over the vast differences between them and medical doctors. For example, Tennessee optometrists changed their association’s name from the Tennessee Optometric Association to the Tennessee Association of Optometric Physicians.