Physician Voices for Patient Safety
On this page:
About the bill
Impact on patients in DC
Impact of physicians in DC
What can you do?
Resources
About the bill
In November 2023, DC Health introduced B25-545, the Health Occupations
Revisions General Amendment Act of 2023. This bill was a comprehensive
rewrite of the law overseeing medical licensing and regulation in
Washington, DC. Unfortunately, the bill as written overhauled
scope of practice, place allied health professionals in oversight
positions of medical licensing, and remove the physician from the center
of the care team. After much work and a number of legislative wins, the bill passed the Council on May 7.
MSDC has long advocated that a physician is the most qualified professional at the head of a care team. Physicians have the most health education and pre-practice experience of any health professional, and thus must be involved in all but the most mundane health care decisions. Allied health professionals are a valuable part of the care team, but their medical education and experience limits their role.
The Medical Society of the District of Columbia (MSDC) is the leading voice for physicians in Washington, DC, committed to uniting physicians to advocate for physician-led health care in Washington, DC that protects patients from harm and increases access to quality care. MSDC is leading a coalition of Washington, DC specialty medical societies to advocate against the Health Occupations Revisions General Amendment Act of 2023.
Impact on DC medicine
Below is a breakdown of some of the major changes the bill contains; click on the title to expand how the bill would change that item.
Currently the Board of Medicine is composed of 10 physicians and 4 members of the public. The bill as amended would reduce the number of physicians to 9 and adds 2 physician assistants but keep
the four members of the public health.
The concern: The bill would codify that APRNs could independently diagnose, prescribe, and administer medicine.
The details: See the analysis from G2L Law Firm on the APRN provisions | See our one-pager on this issue that you can share with colleagues and the Council
The solutions: Independent Advanced Certified Nurse Practitioners should have a defined scope of practice limited to the following functions:
- Practice only in the field of certification;
- Comprehensive physical assessment of patients;
- Certify to the clerk of the court that an adult has given birth;
- Certify to the Transportation authority that an individual has special needs for certain health reasons;
- Complete date of birth and medical information on a birth certificate;
- Complete a death certificate if medical examiner does not take charge and deceased was under the care of the PN;
- Establish medical diagnosis of common short-term and chronic stable health problems;
- File a replacement death certificate;
- Issue a “do not resuscitate order” in medical emergencies;
- Order, perform, and interpret laboratory and diagnostic tests;Prescribe drugs and devices under DC controlled substance Schedules II-V with a valid DEA license, and medical marijuana under DC laws;
- Provide emergency care within the scope of their skills;
- Refer patients to appropriate licensed physicians or other health care providers;
- Certify to utility company that a client has a serious illness or the need for life-support equipment;
- Witness an advanced directive;
- Sign off on home health/care orders.
The concern: As seen below, additional allied health professions are permitted to apply anesthesia. Most concerning is the scope expansion that could permit nurse anesthetists to practice without physician collaboration.
The details: See our one-pager on this issue that you can share with colleagues and the Council
The solution: This bill asks to repeal Section 603 of DC official code ₰3-1206.03, and this action will allow nurse anesthetists to administer anesthesia without an anesthesiologist or other physician's direct collaboration. Language seeking repeal of Section 603 of DC official code ₰3-1206.03 should not be included.
This bill adds Sec. 605a, which contains language that a CRNA may plan and deliver anesthesia, pain management, and related care to patients or clients of all health complexities across the lifespan. Language adding Sec. 605a should be removed from this bill.
The expands audiologists' scope to include "cerumen management" and "interoperative neurophysiologic monitoring" and permits audiologists to screen for cognitive, depression and vision.
The bill completely rewrites the definition of the practice of "chiropractic". Chiropractors could:
- Diagnose and treat biomechanical or physiological conditions that compromise neural integrity or organ system function
- Refer patients for further medical treatment or diagnostic testing
The details: See our one-pager on this issue that you can share with colleagues and the Council
The bill would expand pharmacists' scope to include:
- Ordering labs
- Scheduling and monitoring drug therapy
- Ordering, interpreting, and performing more tests
The details: See our one-pager on this issue that you can share with colleagues and the Council
The bill would permit physical therapists to independently evaluate and treat disability, injury, or disease. PTs may also order imaging as part of their treatment plan.
The concern: The bill expands podiatrists scope of practice to allow:
- apply anesthesia as part of treatment; and
- administer vaccines and injections.
The details: See our one-pager on this issue that you can share with colleagues and the Council
Throughout the bill, restrictions on nursing scope of practice are removed or loosened throughout. Specific language outlining what and how nurses can practice is removed and replaced with more vague language giving the Mayor (read DC Health)
the ability to dictate scope. This applies to many different nursing types, like APRNs and NPs.
Articles on scope of practice
MSDC Partners with Perla to Enhance Member Access to Trusted Healthcare Advisors
Washington, D.C., August 26, 2021 – The Medical Society of the District of Columbia (MSDC) and Perla are collaborating to enhance access to trusted advisors with experience in the healthcare industry. MSDC is the largest medical organization in the District of Columbia representing metropolitan Washington physicians. MSDC’s mission is to make the District of Columbia the best place to practice medicine, which includes offering innovative, customized resources to help busy physicians.
MSDC President Dr. E.W Emanuel said, “MSDC is proud to partner with Perla, a local, physician founded, healthcare-centric B2B matching platform that allows our members to directly connect to advisors and consultants with experience, knowledge, and expertise in the healthcare industry.”
Perla is the first digital matching platform designed to directly match healthcare professionals and businesses with trusted advisors and consultants with expertise in the healthcare industry. The platform allows free access to healthcare professionals to select for the type of advisor and services they are looking for, compare advisor rates, experiences, read user reviews and contact the desired advisor.
Given the high levels of complexities in healthcare business operations, it is important for healthcare professionals and businesses to have ready access to advisors with specialized knowledge and experience in the healthcare industry. For example, with respect to physician employment agreements, the American Medical Association suggests that “[a]n experienced health care attorney in the state in which you plan to work can help you identify and resolve problematic contract provisions before they become an issue. Your state medical society may be able to provide a recommendation for a trusted attorney in your area.”
Through the Perla platform MSDC members can connect with trusted advisors in four different consulting practice areas:
(a) healthcare attorneys;
(b) banking and financing advisors;
(c) practice management consultants; and,
(d) accountants.
To ensure high levels of quality for services that are provided by Perla advisors, Perla conducts a review of all advisor’s expertise in healthcare (at least five years), credentials and references before allowing the advisor to list his/her services on the platform. Accordingly, Perla is slowly, carefully, but steadily growing its advisor network to address user consulting needs and is currently focused on growing its advisor network in the greater Washington metropolitan area.
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Media Contact:
Pia Duryea
Medical Society of the District of Columbia
duryea@msdc.org
(202) 355-9414
About the Medical Society of the District of Columbia
With over 3,000 members, the Medical Society of the District of Columbia (MSDC) is the largest medical organization representing metropolitan Washington physicians in the District of Columbia. The Medical Society, founded in 1817, is the leading voice of medicine and public health advocate on issues impacting the diverse population of our nation’s capital. MSDC is dedicated to ensuring the well-being of physicians and their patients in metropolitan Washington. For more information, visit msdc.org.
About Perla
Established in 2019 and launched in June of 2021, Perla is the first healthcare focused B2B matching platform that allows healthcare professionals and businesses to directly connect to advisors and consultants with experience, knowledge, and expertise in the healthcare industry. Perla aims to enhance access, quality, and transparency in selecting and engaging professional advisors. Currently, Perla is accessible to 6,500 physician members of local healthcare societies in the greater DC metropolitan area. To learn more, click HERE or visit Perla website at www.goperla.com.
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