Credential disclosure sought by bill

In 25 years of practice as a family physician, Ray Stowers, DO, has encountered numerous patients who received treatment from someone they mistook as a physician.

He has seen clinics advertise themselves as family practice centers when there is no family physician associated with the business. And he's heard of nonphysicians using a "Dr." prefix to make patients believe they are a medical doctor.

Dr. Stowers and others nationwide are seeking to clarify such misrepresentation and minimize patient confusion about who is providing medical care.

Two congressmen introduced a measure on Jan. 26 that would require people providing medical care to be honest about their training and qualifications.

The Healthcare Truth and Transparency Act has the backing of several physician organizations, including the American Medical Association, the American Osteopathic Assn. and the American Society of Anesthesiologists. Several states have taken similar action to rein in patient confusion and prevent fraud, and more are considering such legislation.

"There is a lot of research that there is a great deal of confusion about this," said Dr. Stowers, a member of the AOA's board of trustees. "In the time of a team approach to health care, it is important that [patients] know who they are dealing with."

This is the second consecutive year the federal bill has been sponsored by Reps. John Sullivan (R, Okla.) and David Scott (D, Ga.). The measure would require anyone advertising health care services to state in the advertisement the license that authorizes them to provide those services.

The proposal would make it unlawful for anyone to provide deceptive or misleading information that causes patients to believe they have training or qualifications that they do not. The Federal Trade Commission would enforce the law.

"Patients deserve clear and accurate information to make informed decisions about who they choose to provide their care," said AMA Board of Trustees Member Rebecca J. Patchin, MD.

The AMA has drafted even more stringent model legislation to require practitioners to identify their license type in ads, wear a visible photo ID badge when seeing patients and post their type of license in their offices.

Patients have a right to know whether the person treating them has gone through the rigors of medical education and training, Scott said.

"You have people who are out there who are scam artists," he said.

Confusion among patients

An AMA survey released Jan. 26 found that 44% of 850 adults queried nationwide think it's difficult to identify who is a medical doctor in health care ads. Eighty-three percent prefer a physician to be in charge of their care, and 87% support federal legislation requiring health professionals to be clear about their credentials.

"Although 90% of those surveyed said that a medical doctor's additional years of education and training are vital to optimal patient care, the survey found much confusion about the qualifications of health care professionals," Dr. Patchin said.

Even in the hospital environment, patients can be perplexed by the variety of professionals coming to their bedside throughout the day, including physicians, nurses and others. It's difficult for patients to keep track of who is who and what their qualifications are, said Mark A. Warner, MD, president of the American Society of Anesthesiologists.

"As the number and types of providers expand, it becomes ever more difficult for providers, patients and their families to understand who they are dealing with," he said. "We just want to make sure that patients and families understand who they interact with in these environments."

Arizona, California, Illinois and Pennsylvania have passed laws calling for transparency among health professionals.

The California and Arizona laws require advertisements for medical services to include a health professional's title and license type.

Pennsylvania and Illinois mandate that health professionals wear clearly visible name badges stating their credentials.

Physician organizations in other states, including Colorado, plan to introduce similar legislation this year.

In California, it took two years of meeting with professional organizations to address concerns before the legislation was passed in 2010, said Ross Warren, chief consultant for state Assemblywoman Mary Hayashi. She sought the legislation in part because the state was seeing a large number of medical spas offering medical treatments without physician oversight.

"More and more we're seeing things that are within the practice of medicine being performed by uncredentialed people," Warren said.

Impact of health reform

The Healthcare Truth and Transparency Act is needed now more than ever as the nation moves forward with the health system reform law, Dr. Stowers said.

An estimated 32 million additional Americans will gain coverage under the law.

The more patients who need care, the greater the opportunity for confusion, especially among those new to the health care system, he said.

"Health care reform is bringing on a tremendous urgency here," said Dr. Stowers, vice president and dean for the Lincoln Memorial University-DeBusk College of Osteopathic Medicine in Harrogate, Tenn.

The American Nurses Assn. was among the groups that opposed the proposal, which died in committee last year.

In a 2010 statement, the association cited concerns that the bill would limit nurses' scope of practice and said it represented an "unprecedented and unnecessary imposition of federal trade law on health care practice."

The ANA declined to comment for this article.

Sullivan said his legislation would not limit any health professional's approved scope of practice. "We just want people to do what they were trained to do," he said.