By Emily Margosian, assistant editor

Health care policy is notoriously complex, and even physicians with years of experience may not be completely clear on who writes the rules. While democracy still dictates that legislators sit at the top of the regulatory hierarchy, firing off an impassioned email (or tweet) to your state senator is unlikely to inspire immediate action. Beyond Congress, a myriad of state and national boards manage key areas of practice — but which one should dermatologists contact with concerns about licensing or CME requirements? Who is responsible when the local naturopath claims dermatologic training on their website? What course of action is available when your patients are faced with onerous step-therapy requirements? Should you be sending your opinions on MOC to the president of the AAD? If you’ve asked yourself these questions, before you send that next angry tweet, consider Dermatology World’s regulatory roadmap to:

• The basics: Licensure, CME, medical scope and supervision

• Maintenance of certification

• Scope and truth-in-advertising for non-medical providers

• Payer issues 

The basics of being a physician: Who regulates?

Much like recreational marijuana and the minimum marriage age, laws dictating the practice of medicine are mostly a state-run affair. “Each state has a medical practice act, which is enacted by that state’s legislature,” explained Lisa Albany, JD, AADA director of state policy. “These statutes are really geared toward protecting the public from unprofessional conduct and incompetent acts that might occur in the practice of medicine.”

It is through these key pieces of legislation that state medical boards derive their authority — a mini-medical Constitution of sorts. “The state-created medical practice acts grant medical boards the oversight and authority to regulate physicians. The medical boards develop rules on licensure, continuing medical education, discipline, and will also handle policy or guidelines on particular issues, for example office-based surgery, or pain management,” said Albany. The boards themselves are typically comprised of a mix of members of the public and physicians from different specialties — dermatology included. “Seats are typically appointed by the governor, and we are fortunate to have dermatologists on several states’ medical boards,” said Albany.

While physicians clearly fall under the purview of state medical boards, what about the regulation of non-physician medical providers such as nurse practitioners (NPs) or physician assistants (PAs)? “The board of physicians regulates MDs, the board of nursing regulates nurses,” said Larry Green, MD, chair of the AAD State Policy Committee. “Physician assistants are often under the auspices of the board of physicians as well, as they’re considered physician extenders.” However, this can prove to be a gray area in a few states where physician assistants have established their own independent boards. “Where you generally run into issues is when physicians think that a PA board or a nursing board is trying to expand their scope into the practice of medicine — then you have to see how the legislature has defined it in the statutes,” said Albany. “Sometimes it’s just unclear, and then you may have regulations being challenged in court.”

If physicians observe scope of practice issues involving a medical provider, Albany recommends first contacting the board that directly regulates the potential offender. “If a physician believes that a nurse is doing something that falls within the practice of medicine, they could go to the medical board,” she said. “However, we would recommend that physicians contact the nursing board first, because the nurse in question is ultimately a licensee of that board. You’d do the same thing for physician assistants. If they’re being regulated by a PA board, then you’d want to go to them. If they’re being regulated by a medical board, then you can go straight to the state medical board to report.” It should be noted, said Albany, that if there’s a violation of the medical practice act, an individual could contact the medical board with concerns that an unlicensed individual is practicing medicine. Medical boards may have the authority to issue cease and desist orders and/or obtain an injunction to restrain a person from violating any provision of the state medical practice act.

If a physician feels action is needed that requires a change to state law, they can look to the AADA for assistance engaging with state legislators. “A change in scope of practice rules often involves amending the statutes, and that’s a legislative process,” explained Albany. “This is an area where we would be engaged with lobbying our state legislators to introduce a bill to remedy the issue.”

Do you have scope of practice or truth-in-advertising concerns that you would like the Academy to help address?

If so, complete the AADA’s brief form.