Report Charges Current Health Professional Regulations Have "Serious Shortcomings"; Calls For Periodic Competency Checks On All Health Professionals and Broadening Public Representation on Professional Boards

Washington, DC, October 23, 1998 -

To better protect consumers from incompetent health professionals, the Pew Health Professions Commission, led by former Senator George Mitchell, is urging Congress and states to adopt tougher standards to regulate the health care workforce.

In a report released today, the Commission warns that the current professional regulation system -- because of its conflicting policies of protecting consumers and the economic interests of health care professionals -- has "serious shortcomings." According to the report, these shortcomings have resulted in limited public accountability on the part of professional boards, support for "practice monopolies" that hinder patient access to care, and lack of national uniformity.

In releasing its report,"Strengthening Consumer Protection: Priorities for Health Care Workforce Regulation," the Commission calls for major changes in how the health professions are regulated. Specifically, the Commission recommends that all health care professionals be required to meet specific competency requirements throughout their careers, not just when they get their license to practice; that individual health professional boards increase representation of public, non-professional members to at least one-third in order to ensure that the professional board is more accountable to the public; and that states implement nationally uniform scopes of practice for all the professions.

The report notes that despite major changes in today's health care environment, most boards, such as boards of medicine, nursing and pharmacy, do not require health professionals to periodically demonstrate their competence. Legislatures have not forced regulatory boards to set standards for continuing competence, leaving that role to the private sector. The report contends that this raises major quality of care issues, and may be putting consumers at risk.

"Health care workforce regulation plays a critical role in consumer protection, yet for most of this century, our country has only enforced minimal standards for governing the health care workforce," said Mitchell. "Quite frankly, these minimal standards have served only to make certain that the most egregiously incompetent health professionals are prohibited from practicing. This is not enough. In these uncertain times for health care, we must do more to make sure that every patient receives quality care."

The report builds on a set of recommendations issued by the Commission in 1995. The Commission says that policymakers should focus on three broad areas for improving how health care professionals are regulated: health professions boards and governance structures, scopes of practice authority, and continuing competence.

Revamping professional boards within each state will be a major step, according to the report, since these are "the key to the current professional regulatory scheme." Although these boards are charged with consumer protection and are required to have open meetings, their processes are generally unknown to the public, according to the Commission. That shortcoming needs addressing, says the Commission. "In an era when information is crucial to public safety and effective markets, boards are insufficiently equipped and financed to collect, manage, and publish information that would be useful to the public," the report says.

Perhaps more importantly, a persistent lack of coordination among the individual boards or among the states has led to underuse of professionals, turf battles regarding scopes of practice, limited professional mobility, and restricted access to care for patients.

"These recommendations should not be seen by health professionals as an infringement on their prerogatives. Rather the recommendations allow health professionals to insure that all practitioners deliver care in ways that help, not harm, the public," said Ed O'Neil, executive director of the Commission. "This is the best assurance that managed care organizations are not the only voice for real quality in health care."

The report criticizes scope of practice laws, describing them as "a source of considerable tension" among health professions that leads to costly and time-consuming turf battles that clog legislatures around the country. The Commission says that more empirical evidence is needed to help legislators decide whether new or unregulated disciplines should be regulated and whether currently regulated professions should win expanded practice authority.

The Commission's future vision of health care workforce regulation encompasses a set of 10 recommendations. They will require a mix of policies demanding changes at the state, federal and private sector level. These recommendations include:

• requiring individual professional boards to be more accountable to the public by significantly increasing their public members. The Commission recommends that public members comprise at least one third of each board's membership.
• requiring states to regulate health care practitioners to demonstrate their competence in the knowledge, judgment, technical skills and interpersonal skills relevant to their jobs throughout their careers.
• having states require policy oversight and coordination of professional regulation through consumer-dominated boards or central agencies
• having Congress establish a national policy advisory body that would research, develop and publish national scopes of practice and continuing competency standards. The body would be required to develop uniform standards of practice authority, including model legislation for use by individual states.
• having states require boards to provide relevant information about healthcare practice licenses to the public in a comprehensible manner.
• having states develop alternative mechanisms for existing professions to resolve their scope of practice disputes until national models can be developed and adopted.
• having Congress enact legislation that facilitates professional mobility and practice across state boundaries.
• having states enact and implement scopes of practice that are nationally uniform for each profession and based on the standards and models developed by the national policy advisory body.
• requiring states to provide the resources necessary to adequately staff and equip all health professions boards to meet their responsibilities.

The Pew Health Professions Commission works to help policy makers and educators produce health care professionals who meet the changing needs of the American health care system. Administered by the Center for the Health Professions at the University of California, the Commission is funded by The Pew Charitable Trusts.

The Pew Charitable Trusts support non-profit activities in the areas of culture, education, the environment, health and human services, public policy and religion. Based in Philadelphia, the Trusts make strategic investments that encourage and support citizen participation in addressing critical issues and effecting social change. In 1997, with more that $4.5 billion in assets, the Trusts awarded $181 million to 320 non-profit organizations.

The Center for the Health Professions at the University of California, San Francisco is a national center committed to changing the health care workforce. The Center assists health care professionals, health professions schools, care delivery organizations, and public policy makers in responding to the challenges of educating and managing a health care workforce capable of improving the health and well-being of people and their communities.

PEW HEALTH PROFESSIONS COMMISSION

CHAIRMAN
The Honorable George J. Mitchell
Special Counsel
Verner, Liipfert, Bernhard, McPherson & Hand
University of California, San Francisco

EXECUTIVE DIRECTOR
Edward H. O'Neil, PhD
Director
Center for the Health Professions
University of California San Francisco

COMMISSIONERS
Stuart Altman, PhD
Sol C. Chaikin Professor of Nat'l Health Policy
Brandeis University
The Florence Heller Graduate School of Social Policy

Uwe E. Reinhardt, PhD
Professor
Princeton University
Woodrow Wilson School of Public and International Affairs

Ruth Ballweg, PA-C
Director
University of Washington
MEDEX Northwest Physician Assistant Program

Barbara J. Safriet, JD
Associate Dean
Yale University School of Law

Troyen A. Brennan, JD, MPH, MD
President
Brigham and Women's Physician Hospital Organization

Louis Sullivan, MD
President
Morehouse School of Medicine

Carolyne K. Davis, RN, PhD
Pew Health Professions Commission

David Swankin, JD
President
Citizen Advocacy Center

Mimi L. Fields, MD, MPH, FACPM
Health Consultant & Wellness Physician
HEAL Thyself, Inc.

Neal A. Vanselow, MD
Chancellor Emeritus
Tulane University Medical Center

Robert Graham, MD
Executive Vice President
American Academy of Family Physicians