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AAO: Keep safety standards high in scope-of-practice expansions
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The American Academy of Ophthalmology agrees with a joint federal report’s recommendations on scope of practice, the organization announced in a press release.
The report, issued by the U.S. Department of Health and Human Services, the U.S. Department of the Treasury and the U.S. Department of Labor, made several recommendations regarding cost savings and delivery of care.
It discusses scope-of-practice restrictions and recommends laws and regulations that allow for expanded scope of practice in order to allow competition and greater access to care but warns against expanding if health and safety concerns exist.
The AAO said it agrees with the recommendation, stating that scope-of-practice regulations “protect patients from harm during surgery by ensuring that only those with the necessary medical education and clinical training are authorized to perform surgical eye procedures.”
“Too often there is a rush to extend surgical privileges to those who lack the years of medical education and clinical training necessary for understanding and safely performing critical procedures,” AAO President Keith D. Carter, MD, PhD, said in the release. “It is critical, certainly in eye care, that should our states opt to expand scope of practice, that they eschew any dangerous softening of surgical standards and heed the recommendations in this report by preserving regulations that protect patients seeing surgery and complex medical care of eye disease.”
Perspective
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Elizabeth Yeu, MD
In a recent joint report published by the three cabinet secretaries of the U.S. Departments of Health and Human Services, Treasury and Labor, various patient safety guidelines were addressed. More specifically, recommendations were made for health care delivery to be placed under greater control at the state level. Where scope of practice is concerned, the expansion of scope is not recommended if “legitimate concerns” exist. This report is being fully supported by the American Academy of Ophthalmology.
I am not sure how much this recommendation will redirect or affect scope of practice issues, legislatively or clinically, compared with what is happening today. No one would argue that clinicians should be able to practice at the top of their license. Appropriate education must underlie all of this, but how much education is necessary to justify competence with expansion of a clinician’s scope? This needs to be better defined or standardized, and maybe this joint report can serve as a platform as to what needs to happen moving forward. How much surgical training should be required to perform a skill set? How much extra training should be required of an oculoplastic surgeon to expand their scope to perform full face lifts? Medicolegally, scope has even been questioned with cataract surgeons who perform a pars plana anterior vitrectomy.
Lastly, and more controversially, is the encroachment of medical and surgical scope of professional eye care by ODs. Certainly, the expansion of scope of practice should clearly be withheld or prohibited if patient care would be compromised. In a similar vein, not expanding the scope of practice to include other clinicians in professional eye care will also have a detrimental effect on patient care and access to care. I do not know if leaving this responsibility up to individual states will be enough to best define the rules of engagement and who the players will be. Some overarching guidelines must serve as the foundation. While I do not claim to know how this structure should look, I strongly suspect this will require some nationwide and federal input for it to actually work.
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