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Nonsurgeons encroach into your territory
New Mexico law allows optometrists to do surgery
Ambulatory surgery providers have often raised concerned about nonsurgeons venturing into surgical territory. Now one state has sanctioned the practice.
A new law in New Mexico allows optometrists to provide services generally performed by surgeons, even though they have not undergone the appropriate surgical education and clinical training, according to the American College of Surgeons. The law permits optometrists to use scalpels to remove simple lesions of the eyelid or on the skin surrounding the eye and to perform anterior punctures, the college says. College officials had urged the governor to veto the bill and pointed out that a simple lesion could, in fact, be a precancerous growth, a sebaceous cell carcinoma, or lymphoma.
The law justifies the action with the following language: The training and skills of dentists have expanded and evolved. In 2001, Chapter 576 expanded and amended the scope of the practice of dentistry to include the entire oral and maxillofacial area as it related to restoring or maintaining dental health. This amendment would continue the scope's modernization by allowing any procedure within that area to be performed by a dentist with the requisite skills and training. The bill provides protection to the public by authorizing the department to approve the requisite skills and training of the particular dentist and by limiting the procedures to those which have been granted through hospital procedures.
For their part, leaders in the outpatient surgery field say this example only is the latest of the effort of nonsurgeons to get state legislative approval to perform surgery.
"Nonsurgeons are looking for weekend certification to do surgery," says Scot Bradley Glasberg, MD, a cosmetic and reconstructive plastic surgeon in New York City and chair of government affairs for the American Society of Plastic Surgeons. "Clearly, [they] can't learn how to do these surgeries over just a weekend."
Dentists are one of the most frequent examples, as they seek to expand their scope of practice to perform surgery on the head and neck, as well as other areas, Glasberg says. Some dentists are even performing blepharoplasty (eyelid surgery). New York legislators have a bill (A07044) before them now that allows dentists to perform surgical procedures on the eyes, face, forehead, and other areas of the head and neck, he says. "Clearly that's outside the scope of their training and education."
Some states are taking the opposite approach, however. Florida passed a Truth in Medical Education (TIME) law that went into effect in 2006 that requires physicians and nonphysicians to disclose in their ads the type of license they have, Glasberg reports. "Individuals may cloud that in their advertising and marketing," he says.
Also, the American Medical Association (AMA) House of Delegates passed Resolution 902 in 2006 that said the AMA's policy is that state medical boards have full authority to regulate the practice of medicine for all people within a state, regardless of what board of nursing, midlevel practitioners, or other groups says. The resolution said the AMA will campaign to identify and elect/appoint physicians to state medical boards who support this view. The AMA also said it will work with state medical boards to assist law enforcement authorities in prosecuting unlicensed medical practice by limited or midlevel practitioners.
So what should ambulatory surgery providers do? Educate, Glasberg advises.
"I think it's an issue of educating the public and legislators about the differences between physicians and nonphysicians in terms of their ability to perform surgery," Glasberg says. "It comes down to appropriate education and training."
Highlight the training of your surgeons, including board certification, he advises. Glasberg says only about a quarter of his patients ask about his training, but that figure is up from about 10% of patients 10 years ago, he says. "I emphasize to [all] patients that they should be asking those questions," he says.