Changes in Medical Licensing
By Jerry Kopel
Dec. 5, 2009
Doctor Dave is bored. After spending three
decades as a specialist in internal medicine, he retired. Now he wants
to again practice after three years of golf and travel. The Dept. of
Regulatory Agencies recognize the value of a reinvigorated Dave as part
of the medical practice of Colorado.
DORA's recent Sunset recommendations for medical practice totaled 27
statutory revisions and two administrative changes. The total of
revisions offered will allow an open-ended ability for legislators with
social priorities to seek new regulations not part of the DORA package.
Such as? The reduction in the ability to obtain abortions in Colorado.
DORA suggestions include possible ways to provide citizens with low or
no incomes with additional medical care. Presently retired physicians
away from the practice more than two years face barriers in returning
because of lack of knowledge about new medical alternatives.
The law provides that the doctors must demonstrate continued competency.
That may include a period of supervised practice. DORA wants a new
special license to facilitate the doctor's transition back into practice
and by statute avoid it being listed as a disciplinary license, where it
is presently improperly placed.
If the doctor deals only with patients who cannot pay, 25 other states
offer pro bono or volunteer licenses. Those states include Arizona,
Kansas, Nevada, Oklahoma and Wyoming.
To qualify for an Arizona pro bono license, the doctor "may not have had
the license revoked or suspended, may not be the subject of an
unresolved complaint, and must meet all the qualifications required for
full license at no fee or salary, or through charitable organization at
no cost to the patients or the families." In Arizona, the pro bono
license fee is waived.
Colorado dentists and nursing boards presently allow a retired-volunteer
status license if the service to patients is free. The license is at a
DORA's thinking is "providing physicians who are no longer charging fees
for medical services with the opportunity to secure a pro bono license
would increase access to health care service for the indigent and
underserved population across Colorado."
COPIC, the company that provides liability coverage to many physicians
in Colorado, could waive premiums for liability insurance for those
retired physicians providing service at no cost. These doctors are
restricted from performing invasive surgery, and the number of hours
allowed to work is limited. And the doctors are subject to the same
oversight as fully licensed physicians. (DORA does not believe liability
insurance should be waived.)
The same approach would be useful for physician assistants who have
retired and now are willing to work at no cost to the patient.
Another approach suggested: Allow physicians to supervise up to three
physician assistants, instead of just two. That adds addition medical
service. Physician assistants do not have their own practice. They
practice only under the personal and direct responsibility and
supervision of a licensed physician, including the authority to
DORA points out a state commission has suggested "exploring ways to
minimize barriers for mid-level providers, especially in the rural areas
where there is a shortage of physicians." Over the past five fiscal
years, a smaller proportion of complaints were filed against physician
assistants than complaints against doctors.
Half of the states allow supervision of three or more assistants for
physicians. Five states have no restrictions on numbers and Connecticut
allows six assistants.
Malpractice insurance. The minimum level for professional liability
insurance, states DORA should be increased to $1 million per incident
and $3 million annual aggregate per year. This would double the present
minimum which was adopted by statute 22 years ago. Colorado minimum for
liability insurance, states DORA, "are woefully inadequate" based on
statistic levels of payments presently ordered. COPIC claims a vast
majority of doctors already carry the proposed minimums.
In the past 32 years, claims DORA, medical costs have increased 113
percent and liability insurance coverage has increased 52 percent.
Many of the same DORA researchers came to similar conclusions in a
Sunset review of the Colorado statute regulating podiatrists. A
podiatrist may use the title "Doctor" or "Dr" it he or she follows it as
"Doctor of Podiatric Medicine" or DPM" or "practice limited to treatment
of the foot and ankle".
Malpractice insurance for podiatrists who perform surgery should be
doubled, similar to the same DORA decision regarding all physicians
under the medical statute.
A volunteer license, states DORA, should be provided at a reduced fee
for those podiatrists who are no longer charging for services.
DORA reports "podiatrists in Colorado who are closing their practice
often call the division to request a license at a reduced fee because
they are interested in giving back to the community by providing care at
clinics for the indigent or the working poor. However there is no such
license type available ".
Reduced malpractice insurance premiums are consistent with those offered
by COPIC to other physicians working at no cost to patients.
Podiatry licenses tend to be more expensive that other licenses. The
Sunset report shows 195 active and six inactive podiatrist licenses for
the fiscal year ending June 30,2008.
The medical and podiatry bills should move forward together so that
there is no conflict in the final revisions of each. There are 18 DORA
recommendations for changes in the podiatry statute.
(Jerry Kopel served 22 years in the Colorado House.)