Featured in the May/June 2014 Colorado Medicine.
John Lumir Bender, MD, FAAFP
President, Colorado Medical Society
As the 2014 Colorado Legislative session winds up, it is clear that scope battles are becoming more frequent, and harder to fight. Here are just a few of the recent discussions down at the Capitol:
Should acupuncturists give injections (they have been doing so for 15 years in Colorado without incident)?
Should the Colorado Department of Health Care Policy and Financing reduce or remove the 3,600-hour training requirement for nurse practitioner’s desiring independent prescriptive authority?
Should pharmacists be paid by insurance companies to conduct medication reconciliations (a task that even physicians are not really paid directly to do)?
What is becoming evident is that the physician perspective of serving as the consumer advocate in the name of patient safety is no longer nearly the credible argument in the Capitol that it was years ago. The legislators are focused on access, outcomes, costs and restraint of trade. This is not a phenomenon only in Colorado, but happening around the nation. Gone are the days when the Colorado Medical Society can march into the governor’s office and opine, “Practitioner X cannot perform procedure Y because of safety issue Z.” The argument is seen as turf protection, because the public only sees practitioner X doing procedure Y for less money and generally the data showing the harm is nonexistent.
What is important at this point in the discussion is not whether this development is fair, but more importantly asking how are we as physicians going to adapt? Recall that Darwin promises survival not to the smartest or the strongest, but to the most adaptable.
Physicians must start focusing more on our own restraints in the free market, and how best to overcome those, rather than spending all of our time keeping others from practicing or expanding their trade. The destiny of ancillary and complimentary service providers is to provide more and more services that look like primary care. Primary care in turn must evolve by disrupting specialty care, and specialists must focus on how to reduce or replace hospital-based services.
Anything less becomes a distraction, a further loss of credibility in the public square, and the road to extinction.
John L. Bender, MD, FAAFP