Feb. 24, 2023: State Advocacy Update

The Georgia Composite Medical Board recently revised a question on its medical licensing application to remove stigmatizing language that has been a barrier to physicians seeking care for mental health and wellness.

The question previously asked whether, “During the last 7 years, have you suffered from any physical, psychiatric, or substance use disorder that could impair or require limitations on your functioning as a professional or has resulted in the inability to practice medicine for more than 30 days, or required court-ordered treatment or hospitalization?” More than 40% of physicians say that these types of questions lead them to not seek care for burnout or depression. The previous question further required applicants who answered “yes,” to “provide treatment history documentation to include diagnosis, treatment regimen, hospitalization, and ongoing treatment/ medication to the Board.” 

The Medical Association of Georgia, AMA and Dr. Lorna Breen Heroes’ Foundation were among the organizations who worked with the GCMB to update the question, which occurred at a Feb. 2, 2023 board meeting. The question now reads: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner? NOTE: If you are currently enrolled in Georgia PHP, you may answer NO.” 

“The Board believes this is a step in right direction to address clinician burnout and encourage mental health care while still protecting patients from impaired professionals,” said GCMB Chair Matthew Norman, MD. “Applicants should not fear loss of a license or denial of a licensure application for seeking mental health services.” 

If your state is interested in reviewing and revising medical licensing questions, please contact AMA Advocacy Resource Center attorneys [email protected] and [email protected]. 

In a major victory for Mississippi patients, the Mississippi State Medical Association has defeated all eleven of the scope of practice bills introduced in the state legislature so far during this legislative session. 

• HB 727, HB 796 and SB 2796 would have granted independent practice to advanced practice registered nurses.  
• HB 9 and HB 1317 would have expanded the scope of practice for pharmacists. 
• HB 275, HB 420 and HB 421 would have removed the physician referral requirement for physical therapists. 
• HB 1011, SB 2060 and SB 2363 would have granted scope of practice expansions to podiatrists. 

HB 1317 was the only bill to advance out of committee and it was ultimately defeated on the floor of the House. The AMA sent a letter (PDF) opposing the bill, which would grant pharmacists the authority to independently diagnose and prescribe medications for a wide range of potentially serious health conditions.  

Last week, through the advocacy efforts of the South Dakota State Medical Association (SDSMA) which were supported by the AMA, SB 175, a bill that would authorize physician assistants full practice authority without physician supervision, was defeated on the Senate floor. The AMA sent a letter (PDF) to the South Dakota Senate in strong opposition to the bill, which would allow physician assistants to practice medicine, including diagnosing and treating patients, ordering and performing x-rays and other diagnostic testing, and prescribing controlled substances without any physician involvement. While the AMA greatly respects the contributions that physician assistants make to the health care team, the AMA was deeply concerned about the increase in health care costs and threat to patient safety if physicians were to be eliminated from the health care team. Physicians complete more than 10,000 hours of clinical education and training during their four years of medical school and three-to-seven years of residency training. By sharp contrast, the current physician assistant education model is two years in length with 2,000 hours of clinical care—and it includes no residency requirement.

It is worth noting that this is the third year in a row this type of bill had been introduced, and this year marks the greatest margin by which it has been defeated. The AMA is proud to work alongside SDSMA in their continuous work to ensure the highest quality care for their patients. 

Last week, the AMA sent a letter (PDF) to the chairs of the Idaho House and Senate Health and Welfare Committees in strong opposition to Idaho Senate Bill 1052, which would expand optometrist scope of practice by allowing optometrists to perform surgical procedures on the eye. Specifically, the AMA outlined the following concerns:  

• Eye surgery is invasive and complicated and must be taken seriously. 
• Ophthalmologists (physicians) and optometrists (non-physicians) are not interchangeable.  

The AMA sent another letter (PDF) to the chair of the Missouri House of Representatives Healthcare Reform Committee opposing House Bill 271 and House Bill 329. These bills would allow advanced practice registered nurses (APRNs) the authority to provide medical care, including prescribing medications, without any physician involvement and allow certified registered nurse anesthetists to provide anesthesia care without any physician involvement. The AMA provided substantial comments on the following reasons for their opposition: 

• Patients want physicians involved in their diagnosis and treatment decisions. 
• APRNs’ skillsets are not interchangeable with that of fully trained physicians as is evident based on the vast difference in the education and training between the two distinct professions.  
• Increasing scope of practice of APRNs can lead to increased health care costs and lower quality of care. 
• Scope expansions have not been proven to increase access to care in rural areas.  
• Preserving safe anesthesia care makes sense.   

Finally, the AMA sent several letters to the chairs of the House Business and Labor Committee of the Montana House of Representatives opposing scope of practice bills in Montana. In particular, the AMA opposes: 

• House Bill 313 (PDF), which would allow physician assistants to practice medicine without any physician involvement. 
• Senate Bill 100 (PDF), which would expand naturopaths’ prescriptive authority. 
• Senate Bill 112 (PDF), which would grant pharmacists the authority to diagnose, prescribe for and treat a broad range of potentially serious health conditions. 

While the AMA recognizes the crucial role of all health care professionals in the health care system, patients want and expect physicians, the most educated and highly trained health care professionals, to be involved in their care. The passage of these bills would put patient safety at risk in Idaho, Missouri and Montana. 

Mississippi psychiatrist Katherine Pannel, DO, is urging state lawmakers to decriminalize fentanyl test strips as an important harm reduction step to save lives. House Bill 722 would provide an exemption under “Paraphernalia” to state that the term “does not include any materials used or intended for use in testing for the presence of fentanyl or a fentanyl analog in a substance.” The AMA and the Mississippi State Medical Association support the bill and have used recent social media posts to urge the Mississippi legislature to vote “Yes” on this evidence-based harm reduction initiative.  

Read a recent op-ed by Dr. Pannel.

The Federation of State Medical Boards (FSMB) is requesting comments on its draft policy, Strategies for Prescribing Opioids for the Management of Pain. The FSMB established a new Workgroup on Opioid and Addiction Treatment in May 2022 to undertake a comprehensive review of existing FSMB recommendations related to opioids and update them as appropriate. In completing its work, the FSMB reported that the workgroup conducted a thorough review and analysis of FSMB’s existing opioid-related policies, related state and federal guidelines and policies, guidance documents from selected medical specialty organizations, and a targeted literature review. The workgroup also received input from a diverse group of medical and health policy stakeholders that included experts in pain medicine and addiction treatment, government officials, and patients living with pain. 

View the FSMB draft (PDF).  

Comments are due March 21, 2023, and must be submitted online. 

A final draft will be considered by the FSMB House of Delegates at its Annual Business Meeting on May 6, 2023. 

• Feb. 24, 2023: Advocacy Update spotlight on prior authorization in Medicare Advantage
• Feb. 24, 2023: National Advocacy Update