The Journal of the Arkansas Medical Society Med Journal March 2019 Final 2

WHAT HAVE WE DONE FOR YOU LATELY? Session Going Hot and Heavy DAVID WROTEN EXECUTIVE VICE PRESIDENT W e are now in the trenches of the legis- lative session. By the time you receive this issue of The Journal, the General Assembly will have begun the process of holding hearings on scope of practice bills. Today, January 28, is the final day to file legislation that increases the scope of practice for health care providers. Once filed, there is a two-week waiting period before hearings begin. Before today is over, we expect several scope of practice bills to be filed. Here is what we know, as well as what we expect. Optometry – As part of a national effort, op- tometrists have filed legislation to allow them to do surgery. Three states allow them to perform surgical procedures on and in the eye and surrounding tis- sue. Three other states allow them to do surgery on the eyelid. AMS has already been working with the state and national ophthalmology organizations to educate legislators on the dangers of this legislation, and the public is joining the fight. A poll of Arkansas voters shows overwhelming opposition, with 85% saying Arkansas should reject this legislation. Advance Practice Nurses – We expect sev- eral bills to be filed before the day is over that would expand the scope of APRNs. Among those bills will be attempts to allow prescribing for Schedule II drugs, repeal of the collaborative practice agree- ment requirement, mandated equal reimbursement as physicians, and mandated recognition as primary care providers for programs like Medicaid and the patient-centered medical home. Nurse practitioners are good at what they do and have an important role in patient care, but the interests of patients are best served when nurse practitioners work as part of a health care team. Arguments that they are as well trained as primary care physicians simply do not hold up to scrutiny. Fast-track, and internet-based APRN programs are no replacement for four years of medical school and three years of patient-centered, clinical residency programs. Certified Registered Nurse Anesthetists – CRNAs are advanced practice nurses with additional training in anesthesia care. Their practice act allows them to administer anesthesia “under the supervi- sion of a physician.” That usually means an anes- thesiologist. However, in many places – like rural Arkansas and even ambulatory surgery centers, where anesthesiologists are unavailable – the su- pervising physician is usually the operating surgeon. CRNAs say that removing the supervision require- ment will increase access. The reality is that they are already practicing anywhere they wish. The supervi- sion requirement, particularly in the case of it being the surgeon, acts as a safety valve with the surgeon assuming his or her rightful place as the head of the surgical team. There is no evidence that removing the requirement will increase access. Pharmacists – The pharmacy profession is changing rapidly, with multiple organizations play- ing a role in legislative issues. You have organiza- tions representing chain pharmacies, others repre- senting community pharmacies, and then others, like the Arkansas Pharmacists Association, repre- senting them all. This session, we anticipate deal- ing with efforts to expand pharmacists’ ability to give immunizations, dispense oral contraceptives, and dispense anti-smoking drugs – all under a general, statewide protocol. Back for the third ses- sion will be legislation to allow substitution of in- terchangeable biosimilars. I have to say that unlike the other health care provider groups, pharmacists actually try to work with us, often resulting in legis- lation that benefits both professions. The biosimilar substitution bill is a joint effort of AMS and APA, but it is too early to determine whether we will reach agreements on the other issues. So, those are the scope of practice bills we know are going to be introduced before the day is over (1/28/19). There may very well be others. One thing is certain: your involvement and attention to these issues is crucial. Don’t be lulled into think- ing that just because we believe it’s bad medicine, that legislators will believe that as well. If they do not hear from their physicians back home on these issues, they could easily assume you are ok with, for example, optometrists performing surgery. 196 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY David Wroten Executive Vice President Penny Henderson Executive Assistant Journal Advertising Nicole Richards Managing Editor Jeremy Henderson Art Director EDITORIAL BOARD Appathurai Balamurugan, MD, DrPH, MPH Family Medicine/Public Health Tim Paden, MD Family Medicine Sandra Johnson, MD Dermatology Issam Makhoul, MD Oncology Naveen Patil, MD, MHSA, MA, FIDSA Internal Medicine/Infectious Disease Benjamin Tharian, MD, MRCP, FACP, FRACP Gastroenterologist/Hepatologist Robert Zimmerman, MD Urology Tobias Vancil, MD Internal Medicine Darrell Over, MD Family Medicine EDITOR EMERITUS Alfred Kahn Jr., MD (1916-2013) ARKANSAS MEDICAL SOCIETY 2018-2019 OFFICERS Lee Archer, MD, Little Rock President Amy Cahill, MD, Pine Bluff Immediate Past President Dennis Yelvington, MD, Stuttgart President Elect Chad Rodgers, MD, Little Rock Vice President George Conner, MD, Forrest City Secretary Bradley Bibb, MD, Jonesboro Treasurer Danny Wilkerson, MD, Little Rock Chairman of the Board of Trustees VOLUME 115

The Journal of the Arkansas Medical Society Med Journal March 2019 Final 2 | Page 4