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’s 2021 Annual Report Showcases DC Physician Achievements
As 2021 comes to a close, the members of the Medical Society of the District of Columbia should be proud of what together they have achieved on behalf of patients and the profession in the District. As professionals dedicated to the practice of medicine in the second year of a grueling pandemic, MSDC’s physician leadership and members demonstrated strong resolve and made great strides on core priorities including physician wellbeing, patient and physician advocacy, and physician membership and impact. Below is a video snapshot and overview of the past year.
See the 2021 ANNUAL REPORT
2021 HIGHLIGHTS
MSDC prioritized physician wellbeing with comprehensive wellness resources, information, and necessary and safe social connection
MSDC is dedicated to providing resources and support for individual physicians in their struggle against burnout, especially during the prolonged pandemic. MSDC launched a Healthy Physician app to put help at physician’s fingertips. The app, available in Google Play and App stores, is filled with wellness tips, inspirational notifications, access to wellness professionals, relevant events, peer messaging options, and a listing of resources. MSDC provided uplifting “dose of wellness” cards to deliver emotional inspiration. MSDC continues to raise awareness on the causes and negative impact of physician burnout and assist struggling physicians.
Understanding the unprecedented burden and isolation that physicians have endured, MSDC hosted safe online and in-person events to restore wellbeing. MSDC celebrated healthcare heroes with an online awards ceremony in the spring and offered wellbeing webinars during the year. After healthcare professionals had ample access to the vaccines, MSDC selectively added safe in-person events including a summer rooftop social, outdoor healthy hour, and a hybrid in-person online annual meeting in the fall.
MSDC leveraged new advocacy tools and physician leadership to yield major advocacy wins and lay the groundwork for success in 2022
The Medical Society provided a multi-pronged approach to advocacy with its highly engaged and inclusive physician-led advocacy, innovative self-driven advocacy curriculum, online forums with DC Councilmembers, and multitude of opportunities to testify at DC Council hearings. This broad blend of opportunities yielded major advocacy wins for the DC physician community on women’s health, tobacco product cessation, and temporary licensure, to name a few. It also laid the foundation for further success in 2022 on interstate licensure reciprocity, physician reimbursement, health equity, and other physician advocacy priorities. (Read more about 2021 physician agenda wins)
Physicians continued to lead the way in educating the public about the evolving COVID-19 pandemic and variants and the science of COVID-19 vaccines. There are countless examples all of which demonstrate physicians’ superior public health credentials and extensive training. MSDC is pleased to share the DC and national physicians who contributed to its vaccine literacy series: Dr. Hana Akselrod of The GW Medical Faculty Associates, AMA liaison to the CDC’s Advisory Committee on Immunization Practices Dr. Sandra Fryhofer, and Dr. Melissa Clarke.
MSDC’s physician member community grew in size, diversity, and impact despite unprecedented challenges
MSDC’s membership --now nearly 3,200 members--continues to grow in recognition that, truly, physicians are stronger together. Recognizing the importance of diversity in medicine, MSDC reported on the impact of unconscious bias in medicine. The physician leadership, especially MSDC’s Board of Directors, has grown more diverse and representative of the DC physician population.
The membership has seen significant activity in its sections dedicated to early career physicians, women physicians and private practice physicians. MSDC launched a Private Practice Physicians Section to address the challenges of private practice physicians and leverage the support of MSDC’s growing membership. The rebranded Early Career Physicians Section, led by medical student, resident, and early career physician leaders, convened a delegation to advocate at the AMA Special Meeting in November and offered programs to support professional development and personal wellbeing. The Women in Medicine Section continued to provide women with leadership opportunities, online community, and programs to support the needs of women in medicine. Look for a continuation of programs and resources in all of these sections throughout 2022.
MSDC looks forward to 2022
In reviewing the year that has passed, MSDC President Dr. Nevin shares this final thought, “As we enter 2022 with many unanswered questions and uncertainty, one thing you can depend on (as you have since 1817) is MSDC working every day for physicians, medical students, healthcare professionals and the residents of the District.”
Do not hesitate to contact MSDC (at 202-466-1800 or hay@msdc.org) with your concerns and priorities. There are many opportunities to get involved and supported through MSDC’s communities and programs. The leadership and staff look forward to connecting with you in-person and online in the new year.
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