Ophthalmology academy president: Scope-of-practice crisis threatens quality, and Okla. is on the front line

Regarding "Oklahoma optometrists get OK for scalpel use" (Briefs, Dec 6.):

Recently, optometrists in Oklahoma succeeded in broadening their scope of practice to encompass more than 100 surgical procedures, including those requiring the use of scalpels. This was accomplished through legislation passed by the state Legislature, with no conditions for special training or education. In response, organized ophthalmology and medicine in Oklahoma, and nationally, have launched a campaign to challenge this threat to our patients and to eventually repeal this dangerous law.

While this particular battle is between ophthalmology and optometry, the scope-of-practice crisis looms for all of medicine. Psychologists, nurse anesthetists, midwives and nurse practitioners, among others, are all attempting to expand the services they may provide and charge for, not through education and training but through the enactment of state legislation and administrative regulations. This is well understood by the AMA and other national and state medical societies, who have come together to support our effort in Oklahoma.

Paradoxically, while medical and osteopathic physicians are being increasingly required to meet higher standards of care, legislative and regulatory bodies are simultaneously lowering the quality of patient care by expanding the scope of nonmedical practitioners, with little attention to the requirement of additional education and training. They are effectively dismantling our time-tested accreditation, licensing, certifying and credentialing processes by piecemeal awarding of clinical privileges to nonphysician practitioners.

Oklahoma is now the front line, but in 2005, legislatures across the country will consider a multitude of bills that expand allied health scope of practice. The issue has already moved beyond Oklahoma through a Dept. of Veterans Affairs directive that authorizes Oklahoma-licensed optometrists to perform laser surgery in VA facilities throughout the United States. The medical profession must join together to prepare for and aggressively meet this threat to quality patient care. It will require a campaign to educate the medical community, to educate citizens about the risks associated with lowered health care standards, and to bring pressure to bear on political leaders and elected officials to stop the practice of "dumbing" down the standard of health care. Our patients deserve, and should demand, no less.

Allan D. Jensen, MD, president, American Academy of Ophthalmology

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/12/20/edlt1220.htm.