FSMB to form guidelines on integrative care

Other policy recommendations approved by the Federation of State Medical Boards address Internet prescribing and disciplining doctors for disruptive behavior.

By Jay Greene, AMNews staff. May 1, 2000.

Dallas -- A proposal to regulate nonphysicians -- midlevel practitioners such as acupuncturists, chiropractors, physician assistants and optometrists -- failed at the annual meeting of the Federation of State Medical Boards.

But the FSMB instructed its Special Committee on Questionable and Deceptive Health Care Practices to develop guidelines to help state boards deal with issues involving appropriate practice of medicine in integrated practices. The guidelines also will outline physician responsibilities when co-managing patients with licensed alternative health care providers.

In a resolution proposed by the Mississippi State Board of Medical Licensure, the FSMB was asked to "seriously consider the limits of paraprofessionals' practice of medicine and try to arrive at some standards to be promulgated and distributed" to state boards and nonphysician groups.

Although the plan failed, FSMB agreed to inform boards on changing scopes of practice of midlevel practitioners and licensed nonphysicians.

"Regulation of nonphysicians is inconsistent with our mission and falls outside the scope of the federation," said William Fleming, MD, FSMB's past president. Dr. Fleming said the FSMB's role is to protect the public from poorly performing physicians, not midlevel practitioners. Medical associations are better suited to develop model scopes of practice for nonphysicians than regulatory bodies, the FSMB said.

"The [FSMB] recognizes scope-of-practice issues are of significant concern to medical boards in defining the practice of medicine in an environment of expanding scopes of practice for midlevel practitioners," according to an FSMB board report.

Nationwide, dozens of states have approved or are considering approving bills to grant additional prescriptive rights or expanded scopes of practice to advanced practice nurses and other nonphysicians. The FSMB agreed to monitor acupuncturists, chiropractors, lay midwives, nurse anesthetists, nurse midwives, nurse practitioners, pharmacists, physician assistants, podiatrists, psychologists and optometrists.

The Advocacy Resource Center of the American Medical Association also maintains a database on changing scopes of practice of nonphysicians and provides assistance to medical groups fighting expansions or negotiating changes.

In other action, the FSMB:

• Approved policies to encourage state boards to provide profiles on licensed physicians to the public. Profiles on physicians should include demographic information, medical education, licensure status, criminal convictions, medical malpractice and disciplinary actions.
• Recommended changes in professional conduct and ethics regulations. Some recommendations include disciplining doctors for disruptive behavior, citing doctors for unprofessional conduct if they improperly prescribe through the Internet and developing guidelines on the ethics of selling goods from physician offices.

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