Exam room disclosure: Nonphysicians must be clearly ID’d, states say

In Utah, a billboard advertisement showed a nurse practitioner dressed in a white coat with a stethoscope. The caption read, “I make house calls,” and the woman had the abbreviation “Dr.” before her name.

In Mississippi, some physicians wanting to ensure appropriate follow-up care for discharged hospital patients have struggled to find those patients’ primary care physicians. The people who patients said were their doctors were not listed in the state’s physician directory because they were midlevel health professionals, not physicians.

Such examples demonstrate how patients can be confused about the credentials of health care professionals, say supporters of the American Medical Association’s Truth in Advertising campaign. Since the campaign launched three years ago, 25 states have introduced legislation aimed at curtailing such confusion. Laws have been enacted in 12 of those states.

“Patients deserve transparency in health care,” said AMA Board of Trustees Chair Steven J. Stack, MD. “To provide the clarity necessary for patients to make informed decisions about their health care, the AMA supports Truth in Advertising legislation to help patients understand the level of education and training of the health care professionals providing their care.”

But opponents say such legislation is unnecessary, duplicates existing safeguards that inform and protect patients, and results in vague provisions that could be used politically to restrict some health professionals.

“It is important for patients to understand the licensure, credentials, training and qualifications of the professionals who are treating them. However, this information already is being shared in health care facilities across the country through verbal introductions and conversations with patients, posting of credentials and name badges,” said Janet Deppe, spokeswoman for the Coalition for Patients’ Rights, an alliance of 35 organizations representing nonphysician health professionals. “Imposing duplicative requirements on the industry could increase the cost of care and distract from the primary mission of providing quality care to patients.”

The American Academy of Physician Assistants has not taken a position on the Truth in Advertising campaign, but most states already have laws requiring PAs to represent themselves accurately to patients, said AAPA President James Delaney, a certified physician assistant.

“We certainly believe that patients deserve access to accurate information, including the identity and qualifications of their health care providers, and we are pleased that patients are increasingly familiar with the role of PAs,” he said.

Ninety-two percent of U.S. adults believe that only licensed medical doctors or doctors of osteopathic medicine should be able to use the title “physician,” according to a 2012 AMA survey of 801 adults nationwide. Eighty-seven percent of respondents said they would support state legislation to require all health care advertising materials to clearly state a professional’s level of education, skills and training.

AMA model legislation recommends requiring health professionals to identify their license type in ads, wear a clearly visible photo identification badge when seeing patients and post their license type in their offices.

States have differing requirements

The provisions adopted vary among the dozen states that have enacted related laws.

Louisiana is one of the latest states to approve legislation in 2012 aimed at ensuring patient care disclosure. The Louisiana State Medical Society pursued the measure after a physician complained that he was seeing midlevel health professionals advertising themselves as “Dr.” without clarifying what kind of doctor they were, said Greg Waddell, vice president of legal affairs for the medical society.

Under the law, health professionals who identify themselves as “Dr.” to patients either verbally or in writing must state their credentials.

“The title of doctor — for good or for bad — in the medical setting carries such a strong connotation of a physician, and the patient is easily confused,” Waddell said. “We found in some instances some nonphysicians who use the title actually have PhDs in nonmedical fields.”

The Mississippi State Medical Assn. worked two years to get its Truth in Advertising legislation approved. The bill was signed into law April 18. It requires health professionals to post their credentials in their office and physicians to post their credentials in the office of any midlevel health professional with whom they have a collaborative agreement, said Blake Bell, counsel and government liaison for the Mississippi medical association.

About two dozen organizations joined together to pursue the measure, which became law April 18.

“We were going to be upfront about what we were trying to get done and why we were trying to get it done,” said Mississippi State Medical Assn. President and CEO Claude Brunson, MD. “If you are educated and you worked hard to get that education, why not be proud and show that off to patients?”

Health profession licensing boards are working to adopt related rules and regulations, Bell said.

Removing ambiguity

Utah worked on its Truth in Advertising legislation for about a year before the measure was approved in 2011, said Utah Medical Assn. CEO Michelle McOmber.

The law requires anyone advertising health care services who is not an MD or a DO to list his or her licensure type in the ad. Acronyms are not allowed, McOmber said. The law is meant to avoid situations that were contributing to patient confusion, such as certified nurse anesthetists introducing themselves as the patient’s anesthesiologist, or owners of pain clinics advertising themselves as “Dr.” without clarifying they are chiropractors, she said.

“We just wanted transparency among health care providers,” she said.

Pennsylvania was among the first states to adopt legislation in 2010. The law requires that health care professionals in the state wear photo ID badges clearly stating their credentials in large, bold letters. The law is working its way through the regulatory process with the Pennsylvania Dept. of Health.

Rules may not be finalized until 2013, said Marilyn Heine, MD, president of the Pennsylvania Medical Society and a hematologist-oncologist and emergency physician in southeast Pennsylvania.

The law affects everyone except for independent practitioners and is an important first step, she said.

“The intent of the legislation is transparency,” Dr. Heine said. “It’s really important that patients understand who is providing their care. It may be their choice to see someone with a different level of education and training, but that needs to be their choice.”