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SCOPE OF PRACTICE OF HEALTH PROFESSIONALS

Prepared byPublic Sector ConsultantsProject ManagerResearcher/WriterPeter PrattLisa KatzMichigan State Medical SocietyMichigan Osteopathic AssociationSCOPE OF PRACTICE OFHEALTH PROFESSIONALSIN THE STATE OF MICHIGANSCOPE OF PRACTICE OF HEALTH PROFESSIONALS IN THE STAT E OF MICHIGANiiTable of ContentsINTRODUCTION .. 1 THE REGULATORY SYSTEM .. 3 DEFINING HEALTH PROFESSIONS .. 5 Allopathic Medicine andOsteopathic Medicine and Surgery .. 5 Physician Assistance .. 7 Nursing .. 7 Psychology .. 9 Chiropractic .. 9 Optometry .. 10 SCOPE OF PRACTICE AND LIMITATIONS .. 13 Physicians .. 13 Physician Assistants .. 16 Nurses .. 20 Psychologists, Chiropractors, and Optometrists .. 24 DELEGATION AND SUPERVISION .. 33 Physicians .. 35 Physician Assistants .. 39 Nurses .. 39 Psychologists, Chiropractors, and Optometrists .. 42 EDUCATION, TRAINING, AND EXAMINATION .. 43 Doctor of Medicine .. 44 Doctor of Osteopathic Medicine and Surgery .. 56 Physician Assistants.

While federal programs and/or regulations can influence health professionals in their practice or employment setting (e.g., through Medicare and Medicaid funding requirements), health professional regulation is the domain of state government. Not surprisingly, this has meant that health professionals in different states are regulated differently.

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Transcription of SCOPE OF PRACTICE OF HEALTH PROFESSIONALS

1 Prepared byPublic Sector ConsultantsProject ManagerResearcher/WriterPeter PrattLisa KatzMichigan State Medical SocietyMichigan Osteopathic AssociationSCOPE OF PRACTICE OFHEALTH PROFESSIONALSIN THE STATE OF MICHIGANSCOPE OF PRACTICE OF HEALTH PROFESSIONALS IN THE STAT E OF MICHIGANiiTable of ContentsINTRODUCTION .. 1 THE REGULATORY SYSTEM .. 3 DEFINING HEALTH PROFESSIONS .. 5 Allopathic Medicine andOsteopathic Medicine and Surgery .. 5 Physician Assistance .. 7 Nursing .. 7 Psychology .. 9 Chiropractic .. 9 Optometry .. 10 SCOPE OF PRACTICE AND LIMITATIONS .. 13 Physicians .. 13 Physician Assistants .. 16 Nurses .. 20 Psychologists, Chiropractors, and Optometrists .. 24 DELEGATION AND SUPERVISION .. 33 Physicians .. 35 Physician Assistants .. 39 Nurses .. 39 Psychologists, Chiropractors, and Optometrists .. 42 EDUCATION, TRAINING, AND EXAMINATION .. 43 Doctor of Medicine .. 44 Doctor of Osteopathic Medicine and Surgery .. 56 Physician Assistants.

2 60 Nurses .. 63 Psychologists .. 68 Chiropractors .. 70 Optometrists .. 72 SCOPE OF PRACTICE OF HEALTH PROFESSIONALS IN THE STAT E OF MICHIGANiiiAPPENDICES .. 77 Appendix One: Michigan Statutory Definitionsof HEALTH Professions .. 79 Appendix Two: Comparison of Allopathic andOsteopathic Medical Specialty Certification Bodies .. 83 Appendix Three: Comparisons of HEALTH Professions .. 85 Three A: HEALTH PROFESSIONALS Scopes of PRACTICE .. 89 Three B: HEALTH PROFESSIONALS EducationTraining, and Examination .. 91 BIBLIOGRAPHY .. 93 2001 Michigan State Medical SocietySCOPE OF PRACTICE OF HEALTH PROFESSIONALS IN THE STAT E OF MICHIGANiv1 INTRODUCTIONE very day HEALTH PROFESSIONALS are entrusted with people s HEALTH careand, consequently, their lives. Society does not bequeath thisresponsibility lightly; it comes with the reasonable condition that healthcare providers, who are the subjects of this trust, abide by stringentprofessional, ethical, and legal to human HEALTH is a complex and difficult task.

3 It is no surprise,therefore, that the regulations imposed on HEALTH PROFESSIONALS also arehighly complex and difficult to understand. This document attempts toclarify the extent of and differences between those regulations as theyapply to people who work in various licensed1 HEALTH care fields in thestate of Michigan: allopathic and osteopathic medicine (particularly familymedicine, anesthesiology, ophthalmology, obstetrics-gynecology, andpsychiatry); physician assistance; nursing (comprised of licensed practical,registered, and advanced PRACTICE nurses); optometry; chiropractic; (To ensure clarity, when discussing two HEALTH professionalsfrom similar fields, , optometrists and ophthalmologists in the fieldof eye care, the paper indicates in parentheses which is the physician.)One of the primary obstacles in trying to understand the differencesbetween the described HEALTH professions is the variation in language1 Licensure is the process by which an agency of the state government grants permissionto people who meet predetermined minimal competencies ( , educational attainment,clinical training, and passing scores on examinations) to engage in the PRACTICE of theprofession and/or use particular all HEALTH PROFESSIONALS are licensed under Michigan law: Some, such as respiratorytherapists, may perform their duties without having to meet any legally specifiededucation or training requirements.

4 There is a move in Michigan to establish registrationcriteria such as those which exist for sanitarians and occupational therapists forotherwise unregulated HEALTH PROFESSIONALS . Registration is a voluntary process by whichpeople are assessed and given status on a registry attesting to their ability and currentcompetency ( , based on test scores or completion of coursework). According tocurrent Michigan law, it still is legal for certain HEALTH care PROFESSIONALS who are notregistered to PRACTICE their professions, but they must compete for jobs and salary withthose who are registered and can prove they have met certain OF PRACTICE OF HEALTH PROFESSIONALS IN THE STAT E OF MICHIGANand degree of detail used by policymakers and professional societies todefine each. To address this problem, the Defining HEALTH Professions section of this publication provides definitions based on those in thelaw, academic papers, and the texts of professional societies thattranslate complex language into language that is easy to understand.

5 Inthe section, SCOPE of PRACTICE and Limitations, which follows DefiningHealth PROFESSIONALS , the document presents a detailed discussion ofthe various HEALTH professions, explaining the different providers scopesof PRACTICE . The subsequent section, Delegation and Supervision, describes the different providers authority to delegate and supervise,and the final section, Education, Training, and Examination, discussesthe education, training, and licensure requirements for the different healthprofessionals. Practical examples presented throughout the discussionare meant to further illuminate the providers duties, responsibilities,and tasks. We hope this helps the reader to compare more easily thesimilarities and differences between HEALTH professions. In all cases, westrive to make objective document limits discussion only to HEALTH care professions licensedby the State of Michigan.

6 Information gathered for the purpose of thesecomparisons came from multiple sources, including public statute andrules; articles, journals, and other materials from professional societies andacademia; and surveys and interviews of HEALTH REGULATORY SYSTEMW hile federal programs and/or regulations can influence HEALTH professionalsin their PRACTICE or employment setting ( , through Medicare and Medicaidfunding requirements), HEALTH professional regulation is the domain of stategovernment. Not surprisingly, this has meant that HEALTH PROFESSIONALS indifferent states are regulated differently. Despite this fact, the primaryregulatory agents and mechanisms employed by states are the systems are used to regulate HEALTH PROFESSIONALS : the legal systemand the professional /voluntary system. The main agents of the legalregulatory system in Michigan are the legislative branch, which creates and amends statutes;3 the executive branch (especially the Michigan Department ofConsumer and Industry Services and its HEALTH professional boards),which promulgates rules and provides administrative and supportservices for licensing HEALTH PROFESSIONALS ( , mailing licenses andcollecting fees or investigating questionable activities); and the judicial branch, which renders opinions concerning the applicationof statutes and main agents of the professional regulatory system are professional societiessuch as the American Osteopathic Association, which help define, defend,and sometimes refine HEALTH PROFESSIONALS SCOPE and standards of PRACTICE ,including policies, procedures, and protocols to which HEALTH professionalsshould adhere.

7 These professional societies also accredit educational andtraining programs, establish guidelines for HEALTH professional education,certify people in general and specialty PRACTICE ,4 and set many quality assurancestandards, including examination of HEALTH The primary statute governing Michigan s HEALTH PROFESSIONALS is the Michigan PublicHealth Code Public Act 368 of 1978 as is the process by which a nongovernmental agency or association atteststhat an individual has met predetermined standards ( , passing a test or completion ofa course of study) specified by the certifying body. It is meant to assure the public that aperson has mastered a body of knowledge and acquired skills in a particular OF PRACTICE OF HEALTH PROFESSIONALS IN THE STAT E OF MICHIGANP rofessional societies are the origin of many major laws that govern healthprofessionals. For example, a professional society may determine thatdoctors should meet certain educational standards, nurses should workwithin a prescribed SCOPE of PRACTICE , or physician assistants shouldanswer certain questions on a licensure exam.

8 Then, a state legislaturemay adopt a law, or a regulatory board may adopt a rule that furtherrefines the professional society s recommendations or adopts themoutright, giving them the force of law. While HEALTH professional licensuregenerally is considered a legal domain, most states licensure requirementsare based on and revised according to recommendations made byprofessional societies. Such was the case when the Michigan legislature(1) passed SB 139 (Public Act 151 of 1997) to allow optometrists toprescribe anti-glaucoma drugs and (2) included language in the Board ofNursing rules (September 1998) providing for the certification of advancedpractice nurses (APNs are defined in detail later). In another example ofthis PRACTICE , the Michigan Board of Optometry required that licensurecandidates pass the examination of the National Board of Examiners inOptometry as a criterion for , professional societies make regulation recommendations thatdo not become law, but to which HEALTH PROFESSIONALS adhere example, prior to the adoption of administrative rules creatingcertification requirements for Michigan s APNs, many nurses adhered toeducation, training, and other standards established by nationalprofessional societies ( , the National Association of NurseAnesthetists), and many hospitals adopted bylaws or had formal policiesrequiring APNs to adhere to those established standards.

9 Even hospitalswithout formal standards for APNs often preferred to hire those whomet the requirements. In this way, many policies and proceduresadvocated by professional societies have become de facto, rather than dejure, HEALTH PROFESSIONSThe legal regulation of Michigan HEALTH PROFESSIONALS primarily is basedon their definition in the Michigan Public HEALTH Code. The code definesthe SCOPE of PRACTICE and sometimes oversight of each profession, listingthe tasks and responsibilities that each legally may assume. Unfortunately,the language used to define the various HEALTH professions is not uniform,making it difficult to compare one HEALTH profession to the next. Thefollowing definitions of HEALTH PROFESSIONALS based on the language inthe Public HEALTH Code were modified to improve clarity and facilitatecomparison. (See Appendix One for the original HEALTH code definitions.)Allopathic and Osteopathic Medicine and Surgery(Physicians)The PRACTICE of allopathic medicine includes the diagnosis, treatment/cure, prevention, or relieving of a human disease, ailment, defect,complaint, or other physical or mental condition.

10 Those practicingmedicine, a profession which incorporates the entire spectrum of healthcare, may accomplish the above by attending and advising patients aswell as employing medical devices, diagnostic tests, drugs or biologicals,surgical procedures, or other means. The PRACTICE of medicine entailsoffering or undertaking patient care as described above, as well as holdingoneself out as able to do so. A physician is someone who is licensed underthe state s Public HEALTH Code to PRACTICE medicine, including surgery,regardless of whether the practitioner is a generalist or PRACTICE of osteopathic medicine and surgery is a separate kind ofmedicine and surgery. It also involves the diagnosis, treatment/cure,prevention, or relieving of a human disease, ailment, defect, complaintor other physical or mental condition. To care for patients, its practitionersalso may attend and advise, as well as employ medical devices, diagnostictests, drugs or biologicals, surgical procedures, and other means.


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