The costs of college and graduate education have soared out of control. I’m a strong advocate for giving people less expensive ways to learn what they need to know in order to work. Overly broad professional licensure requirements can contribute to unnecessarily high education costs and generally to higher costs for consumers.
We only let certain people hold themselves out as doctors, lawyers, electricians, plumbers hearing instrument specialists, etc. There are over 40 distinct fields protected by boards of registration established by state law.
Rules like this are absolutely necessary to protect the public, but they also become weapons in the hands of professional associations seeking to protect commercial turf for their members — always, of course, in the name of protecting the public. The legislature considers dozens of bills in every session to expand or contract the various practice areas defined by law.
I tend to want to let people work and feel that the public is usually well served by having more competition among professionals. There are two particular bills pending now which matter to constituents of mine. In both instances, my first reaction — contrary to my general bias — was to favor turf protection because they involve scary procedures — the administration of anesthesia and the use of dry needles for muscular therapy.
In both cases, after strong presentations by the excluded professionals, I’ve come to lean the way I usually lean — in favor of permitting the expanded practice.
Senate 1079 would expand the scope of what Certified Registered Nurse Anesthetists CRNA’s can do. (It also gives mores authority to nurse practitioners but I have always been comfortable with that.)
CRNA’s are highly trained professionals with several years of specialized post-graduate education and supervised clinical experience. The available evidence suggests that CRNA’s have enough education to safely administer anesthesia and we should let them do that. The Institute of Medicine of the National Academies so concluded in 2011, stating in their report on the Future of Nursing:
No studies suggest that APRNs are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs. In fact, evidence shows that nurses provide quality care to patients, including preventing medication errors, reducing or eliminating infections, and easing the transition patients make from hospital to home.
Empirical research and on-the-ground experience demonstrate that APRNs provide safe and effective care within the scope of their training,
certification, and licensure. Moreover, effective and beneficial collaboration among health care providers can, and typically does, occur even without mandatory physician supervision of APRNs.
CRNA’s who are my constituents perceive the issue as one of streamlining bureaucracy — they don’t like chasing down physicians to get perfunctory approval to do things that they are well trained to do. They respect physicians and know that they don’t have the broad medical educations that physician anesthesiologists have and want to be able to consult them as needed. Anesthiologists have chosen to oppose expansion of care, and assert the necessity of their direct supervision, but effectively acknowledge the lack of reliable evidence showing the superiority of a care model in which they have legal control over practice.
Bottom line: I’m strongly leaning to supporting Senate 1079 if it comes before me for a vote. I believe that allowing CRNA’s to practice at the highest level they are trained for will help control both health care costs and higher education costs.
On a separate topic in the same category, I am leaning towards opposing legislation which would define the scope of acupuncture licensing so as to prohibit the use of dry needling techniques by trained physical therapists. Section 7 of Senate 1107 would add the following statement to the definition of acupuncture:
The use of needles on trigger points, motor points, Ashi points, and/or for intramuscular needling for the treatment of myofascial pain will be considered the practice of acupuncture.
My first supportive reaction to this limitation was based on representations by acupuncturists that physical therapists would start dry needling patients “after a weekend course.” That sounded unsafe to me. More recently, I met with a PT who explained the education that he had been through — a six year combined batchelor’s and doctoral program. After some additional investigation, I do believe that PT’s have adequate training to know how to safely use of needles in therapy.
The practice of acupuncture, by legal definition, is based on “Traditional Oriental Medical Theories”. Acupuncturists use needles to manage a broad range of conditions according to their training. Physical therapists, by contrast, base their practice on western scientific theories. They are not holding themselves out as knowledgeable in alternative medicine. If, based on their adequate Western training, they believe that the use dry needles for specific muscular conditions could be helpful to their patients, they should be able to administer dry needle treatment. They appear to be no more likely to endanger their patients than acupuncturists are. So, I’m back to my basic orientation on this issue as well.
Although important to my constituents, neither of these bills is immediately before me. I’m just articulating my leanings in response to the concerns raised by constituents. I’ll keep listening on both issues and would welcome discussion in this forum.