AMA wants doctor oversight for diagnostic tests

Las Vegas -- Diagnosing disease and interpreting tests is the practice of medicine, and physicians should be supervising any work in that area, says a new AMA policy.

Delegates to the Association's Interim Meeting in November said laboratory workers -- including PhD scientists -- are getting more involved in new lab technologies that require specialized training and education. But delegates said such training does not include the ability to make a diagnostic interpretation for patients.

Specialty societies representing nonphysician lab personnel and PhD scientists want to expand their scope of work to independent practice in clinical settings, delegates said.

Physicians at the meeting said interpreting lab results to make a medical diagnosis is a skill honed by clinical judgment and experience obtained during medical education, training and practice. They said patients are best protected when doctors assess clinical and laboratory data to make a diagnosis.

"We need to protect our patients by preserving the practice of medicine," said alternate delegate Candace Keller, MD, an anesthesiologist in Florida.

Delegates sought to build upon existing AMA policy that supports clearer definitions of scope of practice of physician extenders to include appropriate physician supervision to ensure quality care.

The new policy states that a PhD clinical lab scientist or other nonphysician lab personnel should work under supervision of a physician to perform tests that will be the basis of a diagnostic interpretation for a patient. It also says the Medicare physician fee schedule should pay only authorized persons for the diagnostic interpretation and should not provide payments directly to nonphysician lab personnel working under a physician's supervision.

Physicians also called on the Association to pursue legislative, regulatory and legal actions to counter expansions of the scope of work of PhD clinical lab scientists and other nonphysician workers into medical practice without meeting state licensure requirements.

"Our concern was to make sure those scientists are doing what they are trained to do and not doing the diagnostic interpretation, because that interpretation falls into the practice of medicine," said AMA Trustee J. James Rohack, MD, a cardiologist in Texas.

Building stronger boards

Delegates also discussed a resolution calling for state medical boards to have full authority to regulate the practice of medicine by practitioners who are not regulated by nursing or other boards, a concept some called a "super board" on the state level. The resolution said organized medicine needed a unified response to counter the inability or unwillingness of state boards and the Federation of State Medical Boards to stop the unlicensed practice of medicine.

Delegate Jane Fitch, MD, an anesthesiologist in Oklahoma, said the heart of the proposal is patient protection. Several delegates said medical boards don't want super boards that would regulate all practitioners because it would stretch board resources too thin.

AMA leaders said there was confusion about the resolution, that the intent was not to create a super board or have state medical boards regulate all health professions. But they said it is critical for boards to define and defend the practice of medicine to ensure that patients get high quality care.

Delegates referred the matter to the AMA Board of Trustees for decision.

Dr. Rohack said AMA staff would give the board additional information on the issue and the board likely would make a decision early next year.

"The reasons physicians are so concerned about the scope issue is patient safety," Dr. Rohack said. "People who are not adequately trained can create harm to patients."