California's Dangerous Healthcare Experiment

California is embarking on a dangerous path that will endanger patients and actually reduce access to quality care under the guise of increasing access.

The California State Senate recently passed three pieces of legislation -- Senate Bills 491, 492 and 493 -- that would allow nurse practitioners, pharmacists and optometrists to expand the scope of care they offer. Some of the provisions in these bills would essentially substitute these allied health professionals for medical doctors.

The catch is that these medical practioners are not medical doctors and have significantly less training than M.D.s. They are trained in their specialty, but they did not attend medical school, did not complete a residency, did not complete a specialized internship, and have significantly fewer hours of training.

Take optometrists -- health care practitioners, O.D.s, who often perform vision tests and fit eyeglasses -- and compare them with their M.D. counterparts, ophthalmologists. Ophthalmologists undergo nearly seven times as much clinical experience as optometrists (17,000 hours vs. about 2,500), equipping them to diagnose and treat a broader range of diseases and to do surgery on eyes -- one of the human body's most sensitive organs.

A similar clinical experience gap exists for nurse practitioners compared to their internal medicine or family practice counterparts. Pharmacists' clinical experience actually treating patients is currently non-existent.

Physicians and non-physicians all provide necessary services. The problem? Some California lawmakers want to treat non-M.D. health care practitioners as though they had the same level of training as medical doctors and are thereby qualified to perform the same scope of procedures.

The result is that two tiers of health care will emerge -- one consisting of wealthy Americans who can pay to be treated by well-trained medical doctors and another of those less financially well off who will be treated by providers with less training.

If these bills become law, it won't be a surprise when we see which Californians (the poor and working class) get stuck with lower-quality care.

In fact, some Californians have already gotten a preview of this two-tiered system. Not the working class, but our state's veterans. In 2009, nearly a third of Veterans with glaucoma -- 110 of 381 patients - who were treated by optometrists alone at a Northern California VA facility suffered substantial vision loss that could have been prevented. The optometrists were "practicing beyond their scope, in violation of VA policy," according to a VA probe of the incident.

These Veterans deserved better, as do all Californians regardless of economic status.

Another major risk presented by the legislation is that while the Medical Board of California will oversee M.D.s, nurse practitioners, pharmacists and optometrists performing the tasks of a medical doctor will be self-regulated by their own Boards under separate qualifications and rules. There is no possible justification for anything other than a single system in which the same rigorous qualifications apply to everyone who is authorized by the state to diagnose and treat serious medical conditions.

Proponents of the three scope of practice bills argue that the scope expansion for which they are advocating only applies to minor procedures and common illnesses, pointing to diabetes as an example. However, diabetes is the seventh leading cause of death in the U.S., according to the National Institutes of Health. It is the leading cause of kidney failure, non-traumatic lower-limb amputations, and new cases of blindness among adults, as well as a major cause of heart disease and stroke. Labeling such a disease as "minor" disregards its impact on people's lives.

With vital medical care on the line, is it really too much for the state have a standard where patients can feel confident that when they are facing serious medical conditions they will be able to be cared for by a medical doctor who has been properly trained?

The fact is California is looking for an easy solution to a very challenging problem. As H.L. Mencken once said, "[T]here is always a well-known solution to every human problem -- neat, plausible, and wrong."