Fighting for truth in advertising in Indiana

By Victoria Houghton, Managing Editor, August 1, 2022

DermWorld spoke to Carrie Davis, MD, FAAD, former chair of the Government Affairs and Advocacy Committee at the Indiana Academy of Dermatology, about efforts with the American Academy of Dermatology Association (AADA) to advocate for truth in advertising legislation.

DermWorld: In a win for Indiana patients and dermatologists, the state legislature enacted legislation prohibiting the use of the term “dermatologist” (and other “ologists”) by non-physicians. Tell us about the bill and why the Indiana Academy of Dermatology (IAD) supported it?

The IAD was heavily involved in advocating for this bill as there have been several recent incidences of non-physicians advertising themselves as “dermatologists” or other specialists and individuals whose advertisements or websites fail to include their professional title. People in our state deserve to understand who they are seeing for their health care.

DermWorld: Tell us about your advocacy efforts — what did they entail?

Dr. Davis: In the fall of 2018, I wrote a resolution for the annual convention of the Indiana State Medical Association (ISMA) that gave a directive to the ISMA to bring specialties together to work on truth in advertising model legislation and then find a legislator to author the bill. We needed to be on the same page with all medical specialties to be able to successfully pass legislation on the topic. My resolution passed, and for several years we successfully opposed attempts by advanced practice registered nurses to obtain independent practice. In 2019, an independent practice bill almost passed the Indiana legislature but ultimately died. This was a wake-up call for Indiana physicians to be more proactive on this issue.

So, we set up a meeting with many specialty groups to talk about truth in advertising: What we want and what we can agree on. Ultimately, we decided we wanted to see license type in advertisements (in layman’s terms). We wanted badge laws, and we wanted to own “ologist” terms so only physicians could call themselves “dermatologists,” “cardiologists,” “pediatricians,” etc.

Although we drafted and filed a bill in late 2019, the bill did not get a hearing in 2020 or 2021 because of COVID and the state was focused on the pandemic and other emergency issues. The delay worked to our advantage, because the ISMA received an AMA Scope of Practice Partnership Grant, which allowed us to form a coalition of physicians: the Indiana Physician Coalition (IPC). The IAD was also awarded advocacy grants from the AADA.

We worked on grassroots efforts in late 2021 and asked physicians in Indiana to reach out to their legislators, establish relationships, and discuss scope and truth in advertising (TIA) issues. Physicians told their legislators that we had a bill coming to improve transparency in health care. Somehow, a new state senator got wind of the house bill and wanted to author the same bill in the Senate. He approached the ISMA and asked if he could author the bill in the Senate. Ultimately, it was this Senate bill that was carried through to the end and passed into law.

The ISMA and IAD lobbyists worked hand in hand to talk to committee members of the senate and house health committees months before the legislative session began. We urged physicians to do the same with their legislators well ahead of the session too. The ISMA held a physician advocacy day in February 2022 where a group of physicians went to the statehouse and had meetings with various members of the health committees and the Governor to discuss health care issues including our transparency in health care advertising bill. I attended this and spoke to Gov. Holcomb and his staff directly.

DermWorld: What were some of the key talking points you utilized when educating lawmakers about the importance of truth in advertising?

Dr. Davis: A study conducted in Indiana in 2020 revealed that one in four Hoosiers are not confident that the provider they saw in the past few years was a physician or non-physician practitioner. I have been in practice for over 13 years, and I have seen so many patients who thought the primary care or specialist provider they saw before me was a physician when, in fact, they were not. There have been instances of non-physicians in Indiana who have obtained their doctorate of nursing practice who refer to themselves as “doctor” or even “medical doctor” in the clinical setting and in their advertisements with no clarity of their license type as a nurse practitioner.

The AMA also revealed in a recent survey that 55% of patients believe it is difficult to identify who is a licensed medical doctor and who is not from their advertising or other marketing materials. Many patients are reluctant to ask their health care professional about their training and certification. Using terms for providers in advertisements based on license type such as physician, physician assistant, nurse practitioner, psychologist, and podiatrist — rather than only educational certificates or degrees or an alphabet soup of acronyms — is the best way for patients to understand the difference between these types of providers and make a truly informed choice about their options for health care. Patients deserve this transparency. Now in Indiana with passage of SEA 239, they have it.

DermWorld: Tell us about the role collaboration played in your successful advocacy efforts.

Dr. Davis: I am so proud of the collaboration and multi-specialty approach we had in Indiana to accomplish this goal. It most certainly took a village to get this done. As noted above, it took several years for us to successfully push for truth in advertising laws in Indiana. I firmly believe in organized medicine and the need for physicians to work together toward a common goal instead of splintering apart. The dermatologists in this state, the IAD, and the AADA worked closely together to talk to legislators, send emails, write letters, and co-write testimony that I was able to give in both the senate and house health committees. The staff from the AADA provided me with advice and answers to questions along the way and I am grateful for them. The AMA provided the ISMA the Scope of Practice Partnership Grant and certainly helped both the AADA and ISMA with issues and questions that came up as the bill made its way through the legislature. The Indiana Physician Coalition is the ultimate example of collaboration among physicians. This group was formed specifically to be a unified voice to the public and legislators about the importance of the physician-led team and transparency in health care advertising. I do not think we would have been successful without this collaborative approach.

DermWorld: Based on your experiences this year advocating with your state legislature, how valuable is grassroots advocacy?

Dr. Davis: I cannot stress enough the importance of grassroots advocacy. I think some people underestimate the impact an individual can make by responding to call-to-action emails, calling their legislators, or meeting with them in person. I met with my state representative almost a year before this bill passed and she was very receptive — a strong supporter and eventually a co-author of this bill. The communication another dermatologist in our state had with his state senator resulted in that senator authoring the companion bill in the Senate, which was ultimately the one that passed! And that all happened because a dermatologist communicated with his state senator!

In the final weeks of the legislative session, a member of the House Public Health Committee had reservations about passing the bill. A dermatologist in her district set up a phone call to discuss her questions and relay the importance of the bill with her. This was crucial in getting the bill through the House Public Health Committee and to the full House for passage.

Numerous times throughout the session, the ISMA via the IPC, as well as the AADA, sent out grassroot alerts to physicians throughout the state and had hundreds of physicians contacting their legislators and asking for their support. Legislators want to know what their constituents think. We are the experts in medicine and, for us specifically, dermatology. If we are not leading the narrative, I promise you someone less qualified is. We must remain engaged and have our voices heard to protect our patients, our specialty, and the future of medicine.

DermWorld: Truth in advertising battles with 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 fighting for truth in advertising legislation?

Dr. Davis: There is no need to reinvent the wheel. There are several states in the country now with good truth in advertising laws that can be replicated. Pursue legislation if your state has none. Pursue legislation to improve your law if there are components that are missing or can be better.

My advice to other AAD members pursuing or thinking about pursuing TIA legislation is to learn from those of us who have done it. We have lots of information and experience to share. Also, be prepared for non-physicians to oppose this legislation and be ready to counter their arguments. You may think “how can anyone ethically oppose health care licensure transparency”? But they will. Also, be prepared to make compromises. No state has a perfect law in my opinion. Even in Indiana, we were unable to get the badging piece passed with the rest of the bill, but Indiana is now the first state where only physicians can call themselves dermatologists. In the end, Indiana is now leaps and bounds ahead of where we were in protecting Hoosiers and providing them with the information and clarity they need to make an informed choice when seeking out and receiving health care. I am so honored to have been involved in getting this law passed in Indiana. I am grateful to everyone who helped and participated in getting this accomplished. I am proud of what we have done. I am willing, able, and excited to help anyone do the same in their state and welcome anyone to reach out to me for questions, help, or advice: carriedavismd@gmail.com.

Carrie Davis, MD, FAAD, is former chair of the Government Affairs and Advocacy Committee at the Indiana Academy of Dermatology (IAD), past president and current Board member of the IAD, chair of the AADA Congressional Policy Committee, and at-large member of the Commission on Legislation for the Indiana State Medical Association.

Additional DermWorld Resources