Ask the expert: Battling scope expansions in Louisiana
Ask the Expert
By Victoria Houghton, Managing Editor, October 1, 2021
DermWorld spoke to Erik Soine, MD, FAAD, immediate past president of the Louisiana Dermatological Society, about its efforts with the American Academy of Dermatology Association (AADA) to advocate against state scope of practice expansions.
DermWorld: In a win for Louisiana dermatologists, the Louisiana State Legislature recently rejected a bill that would expand non-physician scope of practice. Tell us about the bill and why the Louisiana Dermatological Society opposed it.
Dr. Soine: For our state, this is an ongoing battle. NPs and PAs have been seeking full independent practice for the last several years. Traditionally, these bills have been struck down quickly in committee, but this was the first year that one of the bills, the nurse practitioner bill, made it past committee by one vote and then ended up on the floor of the House. It passed overwhelmingly in the House which was shocking to our state society. It was really a battle in the Senate to get it defeated.
While we are thankful and grateful for nurse practitioners and the value they bring to the team of the house of medicine, our society doesn’t feel that independent practice is safe for patients without adequate physician oversight. You cannot take the physician out of the team.
Ask the AADA expert
Read more from AADA staff about what dermatology can expect in the future with scope legislation.
DermWorld: The Louisiana Dermatological Society received an AADA State Advocacy Grant. Tell us about that grant and how you used the grant funds for your advocacy efforts.
Dr. Soine: We received an AADA state advocacy grant originally to introduce a medical spa bill which would make physician oversight more important for cosmetic procedures. We did introduce that bill through a local senator in 2019, but he pulled the bill at the last second so that effort was defeated. We were planning to reintroduce it, but our efforts refocused toward the nurse practitioners and the PAs with independent practice. We used the advocacy grant funds to retain a lobbyist, Stephen Wright with Seersucker Strategies, who has been immensely helpful moving our state society forward in terms of management services and lobbying these efforts.
DermWorld: Tell us about the role collaboration and grassroots advocacy played in your advocacy efforts.
Dr. Soine: Over the last several years, we have engaged the Louisiana State Medical Society and strengthened our partnership with them. In terms of advocacy, most of the issues that come up align with both of our advocacy agendas. Having dermatologists seated at the table with the Louisiana State Medical Society benefits them and us. We tried to piggyback our lobbying efforts with their lobbying efforts.
In terms of grassroots advocacy, “call to action” emails to all our members were helpful. We identified key senators and representatives and key dermatologists in their constituencies to contact their local representatives on a personal level. In addition to mass emails, we really made a concerted effort to get in touch with each individual senator to express our concerns and advocate for our specialty and our patients. It’s surprising how many physicians actually know their legislators and how much influence we have just by calling them. They’re approachable and want to hear from us.
Scope of practice
Learn more about the Academy’s advocacy efforts against scope of practice rules that threaten patient care and safety.
DermWorld: Based on your experiences this year advocating with your state legislature, how valuable is grassroots advocacy? Why should the rank-and-file dermatologist get involved?
Dr. Soine: When I was talking to my own state senator, they said they wished to hear from us more often. If they have unbiased opinions coming from their constituents, especially people that they know and trust, that carries a lot of weight in their minds. That’s what they were elected to do, and they want to hear what their constituents want. If you just leave it to the society or association to advocate for you, it gets mixed in the lobbyists’ pitches. The squeaky wheel gets the grease.
DermWorld: Tell us about how you went about educating lawmakers about the dangers of NP independent practice?
Dr. Soine: A lot of this advocacy effort really was an educational campaign with our senators and representatives. One of the biggest issues that we came to realize is how little our legislators knew of the education that physicians, dermatologists, and nurse practitioners receive. These local legislators don’t do what we do — they don’t understand the education and certification requirements that are needed to keep patients safe and how extensive physician training is compared to extenders. Also, we had to tell them that NPs and PAs don’t suddenly move to rural areas when they gain independent practice. It seems in theory like it would work and improve access to care, but practically I don’t think there’s ever been any evidence that independent practice leads to expanded access or better care. There are other ways that we can increase access to care, such as teledermatology, and we don’t have to sacrifice quality care to get there.
I will add that some of these lawmakers came to us frustrated. They would ask us, “If you don’t want NPs to have independent practice, what are you going to do about this to improve access to care?” Most of the senators and representatives who were pushing this bill were rural, and they’re just listening to their constituents complaining about access to care. The one thing we need to take away as dermatologists is that there is a problem there, and we have to come up with creative and innovative ways to increase access to care and be a part of the solution.
Advocacy priorities
Read more about the AADA’s advocacy priorities.
DermWorld: Scope of practice expansions for non-physician providers is a reoccurring theme in state legislation throughout the country. What advice do you have for other states and Academy members who are also up against these dangerous bills that threaten patient care and safety?
Dr. Soine: It takes a concerted organized effort. Being proactive on these bills is paramount to defeating them. You have to get involved in those legislative sessions and know which bills are coming up, because had we not been there with representation at the state capital, they may have slipped this through without us even knowing. Stay organized as a state society and be active in the advocacy game. I’m fairly confident that this issue will come up every year. We must continue to advocate for our patients’ safety.
Additional DermWorld Resources
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