Doctors block bids to expand nurse, dentist roles

Nurses, dentists and psychologists asked the Illinois legislature this spring for more authority to make medical decisions with demand expected to surge under the federal health care law, but each time lawmakers sided with doctors and turned them down.

It was a resounding victory in Springfield for the Illinois State Medical Society, which has represented doctors in a long-standing turf battle over how to address a growing shortage of medical services in rural and low-income urban neighborhoods across the state.

Nurses and other medical providers argued they could help ease the burden if given more control, but in lobbying hard to defeat or gut those proposals the doctor’s group argued they lacked proper qualifications.

“From the position of safety, we want to make sure no one is practicing beyond their abilities,” said Dr. Eldon Trame, president of the society, which represents more than 11,000 doctors in the state.

Hundreds of thousands of Illinois residents will be newly eligible for health insurance next year under President Barack Obama’s health care law — and they will be looking for primary care providers.

Existing doctor shortages are expected to worsen. In one-fifth of Illinois counties, there already are widespread shortages of primary care doctors. Another 200 pockets of Illinois also have shortages, both in urban and rural areas. It would take nearly 1,000 new primary care doctors, according to government estimates, to bring all those areas of Illinois up to a healthy supply.

Some experts say nurses with advanced degrees could help fill the gap if legal barriers were removed. The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, has urged the removal of state and federal obstacles preventing nurse practitioners from providing primary care.

But in the session that ended Friday, doctors won major changes in the bills they opposed, deleting or adding language to make the measures more acceptable. Other bills were referred to committees and never called for a vote in the full House or Senate because of the medical society’s lobbying, and the doctors group took credit on its website.

Advanced practice nurses wanted the right to practice independently, without a written agreement with a doctor, but met opposition from the medical society.

Sue Clark, a lobbyist for two Illinois nurses’ organizations, said lawmakers were at first willing to sign on as co-sponsors to the bill. As she lobbied for the measure, Clark said, many lawmakers, who had said they would co-sponsor, later told her they were no longer able to help. “I’d say, `What happened?’ and they’d tell me, `The medical society came in and asked me not to sign.”’

That forced a compromise, Clark said. A negotiated bill passed the legislature that will make it easier for nurses to set up written agreements with physicians, for example, allowing a nurse to set up an agreement with a doctor anywhere in Illinois. But the nurses weren’t able to eliminate the written agreement entirely.

The doctors’ safety argument confuses Clark. There’s no danger, she said, in letting highly trained nurses work without a doctor’s supervision. Sixteen states already have eliminated the requirement for a written collaborative agreement without any increase in malpractice rates. Nurses know when to refer the sickest patients to doctors, and many studies have shown no difference in outcomes between nurse practitioners’ care and doctors’ care, she said.

Dentists also lost out in the turf war. The Illinois State Medical Society worked successfully to remove language from a bill that would have allowed trained dentists to give flu shots and other immunizations.

“They were very adamant in their opposition,” said Dave Marsh, director of government relations for the Illinois State Dental Society.

The dental society plans to bring the issue to lawmakers again but focus narrowly on flu shots. The group will argue dentists should be prepared to respond to a future flu pandemic. They’ll make the case that the Affordable Care Act will increase the number of patients eligible for free flu shots and increase the need for professionals who can give them, Marsh said.

The medical society argued that dentists don’t have enough training to safely vaccinate patients with chronic illnesses or allergies or to spot adverse interactions with other medications. Marsh countered that the bill would have required adequate training and that dentists are experienced at giving injections safely.

“In a physician’s office, the physician doesn’t give the vaccination. It’s the nurse (who gives the shot), or they send you to the pharmacist,” Marsh said. He called on the medical society to “forget your petty territorial issues and look at the big picture.”

The doctors group also worked against bills that would have set up state licensing requirements for direct-entry midwives, colon hydrotherapists and naturopaths.

The Illinois State Medical Society supports a team approach with doctors and nurses working together to address the primary care shortage, which “is very urgent,” said Dr. Eldon Trame, the group’s president.

Trame said he expects nurses and others who want to expand their role in the practice of medicine will use the Affordable Care Act and the deepening primary care shortage to bolster their case with lawmakers in 2014 and beyond.