State Medical Society Just Says No: To Podiatrists, Midwives and Optometrists

The Massachusetts Medical Society was busy today trying to block a slew of health bills that would give certain providers, ranging from naturopaths to nurse midwives and physician assistants, greater authority and scope in their practices. (And thereby, theoretically, diminish the power of physicians).

The Society’s opposition to the nine bills before the Joint Committee on Public Health, “is based on its belief that, should these bills be enacted, diminished patient safety for Massachusetts residents could result,” the organization said in a press release. Here are a few of the legislative proposals they oppose, in their own words:

– House 2367 – An Act to Create a Board of Registration in Naturopathy – Saying that naturopathy is “a hodge-podge of nutritional advice, home remedies, and discredited treatments,” the MMS opposes a bill that would make naturopathic doctors licensed health care providers in the Commonwealth.

–House 1476 and Senate 1145 – Acts Relative to the Registration of Podiatrists – These are identical bills that would extend the scope of practice of podiatry beyond the diagnosis and treatment of the foot to include the ankle and the leg below the knee. The MMS said “this is an unfortunate example of non-physicians seeking to practice medicine without having to undergo the educational and training requirements demanded of all medical doctors or orthopedic surgeons.

–House 2348, House 2357, and House 3163, Acts relative to optometric patient care – These bills would expand the practice of optometrists by allowing them to prescribe oral therapeutic medications. MMS opposes these bills because there is sufficient access to ophthalmologists to treat any eye disease and that optometrists are seeking to expand their business at the expense of their patients.
“Doctors of optometry are not medical doctors” the MMS said, and “optometry is a different profession from the treatment of disease.”

–House 2369 – An Act Relative to Enhancing the Practice of Nurse Midwives – The Medical Society opposes this bill because it repeals the existing legal structure for nurse midwifery as practiced in Massachusetts for decades and “severs the connection between nurse midwives and obstetrician gynecologists and eliminates a requirement to work with a hospital-based team.” The Society said it believes that the existing statutory requirements contribute to our good outcomes, convey a public protection benefit and have no negative impacts whatsoever on patient choice to work with nurse midwives. “If the decision were to be made for the best interest of children,” the Society concluded in its testimony, “the decision would be clearly not to support legislation designed to eliminate or minimize physician participation in obstetrics.”

–House 1520, An Act Encouraging Nurse Practitioners and Physician Assistants of Primary Care and House 1477, An Act to Streamline Health Care Services by Allowing Nurse Practitioners to Verify Medical Papers and Records – The bills seek to eliminate the word “physician” from current state statutes and instead use the term “provider,” raising the issue of the statutory role of physicians in patient care. While it would eliminate the word ‘physician’ from statutes, the bill offers a nebulous definition of primary care provider to the public health laws of the Commonwealth. The bills also strike out the current law requiring that the name of a supervising physician be listed on prescriptions of physician assistants…”

Are there any nurse midwives, podiatrists or physician assistants out there who care to respond? Please…

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  • Abe

    We see a tremendous amount of referrals in our podiatric practice from PCPs and Orthopedic Surgeons. Why?

    Podiatrists are often leaned on by orthopedic surgeons (with longer residencies) because podiatrists specialize in the health of the foot and ankle and develop deep clinical experiences over the their careers.

    The story is that no matter your accreditation, when you have reached the limits of your ability to treat your patient, knowing when to refer them to a more qualified professional for a particular case is a sign of true professionalism.

    Podiatrists are not “paraprofessional” they are often the last line of treatment when MD’s run out of ideas.

  • Greatneckfootdoc

    My Name is Dr. Alec Hochstein, I am a Podiatrist, in NewYork and I have read your posts with the utmost interest. It is always disappointing when politics gets in the way of patient care and in this case access. This thread is not one that will solve the issues at hand but hopefully we can educate a few small minded individuals.

    I do not want to get into a debate over who knows more or who is better qualified to treat what condition. I am quite comfortable in my area of expertise, which encompasses specialties in multiple systems. I do not care what letters you have after your name, I only care about how you approach a patient, and their conditions, whether it be cardiac, renal, vascular, podiatric, infectious, this is what matters. I have been fortunate to practice in multiple large hospital facilities and level one trauma centers and to be perfectly honest, I have never felt discriminated against for my degree which by the way is D.P.M. Doctor of Podiatric Medicine, I am a board certified foot surgeon, and have saved hundreds of limbs and lives, and not one of those people or their families care where I went to school, I am the expert, end of story, thats what they want to know.

    For my young students, now is a time to be learning and growing, do not start your career believing in a statement that just has no foundation in medicine, you will lose what is so great about practicing medicine the interaction that you have with your peers, the ability to consult and learn from one another and bring that to your practice and your patients. No one can do it alone, we are a team, and you can never win without all the players.

    Mark congratulations on your accomplishments I wish you good health, and a prosperous career, but you have much to learn, it is apparent from your post that you simply haven’t a clue, which is why it carries no weight, I would love the opportunity educate you. I can only assume you have had some poor influences that have unfortunately put you at a disadvantage.

    I write this post for no other reason than to help Mark and James, I personally could care less about political agendas that are ultimately about money….I welcome you to reach out to me, I am easy to find let google be your guide :-) or follow me on Twitter @iPodiatrist.

    And by the way it is highly offensive to call Nurses, Optometrists, Dentists or Podiatrists, Para-professionals, we are Professionals, and highly skilled ones at that.

  • Wound specialist/CO.

    As a highly trained wound specialist with over 15 years in practice, I will say that it’s unfortunate for everyone involved ( but especially the pt.), that certain groups are being excluded ( referring to this article ). I am usually called in to treat wounds when they are life and/ or limb threatening. I utilize a team approach that includes key players of diabetic specialists, vascular & plastic surgeons and podiatrists. It is with this team and the PCP/myself that we get things turned around…never an easy task despite the knowledge base of the “Dream Team”.

    Unfortunate that everyone has such a closed mind they are unable to embrace medical careers other than that of “MD” ( and definitely not a poke at the doc, but rather at those who create some of these ridiculous laws/bills ). Podiatrists are not recognized nearly enough despite the huge knowledge base some have……maybe one day we all will receive the recognition deserved??!!

  • Kitty

    I have a primary care physician who I respect and trust and see regularly. That said, I also have a chiropractor who periodically re-aligns my back. The reason for that – when I first had back problems, there was nothing my primary could do for me. I really needed an adjustment and the chiropractor was the correct practitioner to help me with that. Similarly, my husband and I are trying to conceive. We see both a reproductive endocrinologist as well as an acupuncturist and supplement both courses of treatment with meditation and yoga.
    I think that if doctors allow para-professionals to supplement their practice, rather than a threat to their patient base, then both types of practitioners can help the patient get healthy. Remember – your patients are not stupid and they have a right to direct the course of their own care and treatment.

  • Thomas

    Personally, I’m sick of “medical professionals” using the Fear Factor to proclaim their almighty Godhood. They make it sound like they are infallible an have never “ordered the wrong tests” or “misdiagnosed” anyone.

    what they are afraid of is competition. Their views are ego and money driven.

  • Mark

    As a fourth year medical student about to begin a seven year residency, I can say without compunction that the education of doctors far exceeds that of the various paraprofessionals. There is no doubt that increasing the power of such providers to act and prescribe independently of actual physicians in our medical system will decrease the quality of care. Ordering the wrong tests, or a few unnecessary tests, or missing a diagnosis can be of major detriment to a patient.

    • James

      As a fellow medical student, I can safely say that you know next to nothing about the structure of the healthcare system or the realities of outpatient care in this country (sadly, medical schools still woefully undertrain future physicians with regard to health policy and healthcare administration; in addition, there is exactly one 4 week outpatient rotation required at most medical schools in order to graduate, giving students precious little exposure).

      I think this is a contentious and complicated debate, and the snippet above hardly gives us enough information to have an educated discourse about it. I don’t necessarily disagree with your conclusion, though I think it’s far more complicated that the simple statement that “increasing the power of such providers… will decrease the quality of care.”

      That said, please do not assert yourself as a “fourth year medical student about to begin a seven year residency” as if that gives you some credibility to speak on the issue. As a fourth year medical student, you know a lot of anatomy and physiology, a little bit of medicine, and virtually nothing about training of “paraprofessionals”, health policy, healthcare administration, outpatient medicine, insurance, licensure, or the multitude of other areas into which this debate extends.

    • George

      I am a Podiatrist as well with surgical privileges in 4 hospitals (including residency surgical training and Board Certification). I have over 30 years of experience dealing with foot conditions of all types. There is no better teacher than experience. If you think you will always make the right diagnosis in your life, you have much to learn, regardless of what initials are after your name. Learn humility first and that no one person has a monopoly on knowledge. Good luck with your Residency and learn to work with others.

      George