In This Issue:
From your Medical Board
 |
|
To Medical Board Licensees & guests:
|
First of all, I personally want to thank those of you who sent me various forms of media to express condolences for the passing of my wife of 52 years from Leukemia In March. They were a collective source of strength and comfort.
Secondly, the medical board wants to acknowledge and thank the tireless efforts of the many, many health professionals who have spent endless hours on patient care and are currently riding out the ravages of the Covid-19 Pandemic. The total social and economic impact of this terrible incident will remain for years.
The past several weeks have been a very busy and active at the State Capitol where the budget was finalized and passed along with a few policy bills. The legislature has until May 29th to adjourn Sine Die; however, the legislature has completed hearing what legislation they planned to hear this legislative session two weeks early. Per resolution, Friday, May 15th, was the last day of this legislative session. If needed, the legislature can return to session at any point before May 29th at 5:00p.m.
With the upheaval of the pandemic early this year, this legislative session was definitely not what anyone expected and very few bills ultimately made it through the process compared to a normal year. The final status of several tracked legislation is below.
Some key medical legislation:
SB 1278 by Sen. Rader, Sen. Bullard and Rep. Echols dealing with electronic prescription requirements was not heard before adjournment.
SB 1915 by Sen. David and Rep. Pfeiffer dealing with Physician Assistants passed the Senate by a vote of 43-1 and has been signed by the Governor.
SB 1525 by Sen. Pugh and Rep. Chad Caldwell dealing with clean up language to move forward with the MD & DO Medical License Interstate Compact. Signed into law by the Governor.
HB 2587 by Rep. Lepak, Rep. Sean Roberts, Sen. Daniels and Sen. Bullard dealing with protections for persons with disabilities. Also known as the non-discrimination act. Signed into law by governor.
HB 2588 by Rep Sean Roberts, Sen. Daniels and Sen. Bullard sets out requirements against depriving vulnerable individuals of life-preserving care in guardianship cases.
“Confusion Supervision” of PAs & ARNPs
1. Current [Non-Covid] Rule: 4 PAs & 2 ARNPs
2. Proposed Rule passed by Board but stalled in the legislature: Total of 6 of any combination of PAs and ARNPs
3. Governor Executive Order [Covid Pandemic] No limit of PAs & ARNPs who can be supervised.
Back to Top
On March 17, 2020, Oklahoma Governor Kevin Stitt signed an Executive Order allowing the issuance of Temporary (90-day) Oklahoma licenses for holders of equivalent licenses in other states. This applies to both MDs and Allied Medical Professionals. Any holder of a current, valid license in good standing in another US state may apply for an equivalent Critical Need license in Oklahoma. The licensee must complete a short application form which is verified by OSBMLS usually within one or two business days. The Critical Need license is good for ninety days from date of issuance. So far, Oklahoma has issued 1,337 Critical Need licenses: 927 to MDs and 410 to other Allied Professionals.
Another provision of the Executive Order was to extend the expiration dates of individuals whose licenses expire during this crisis. Currently, any license in good standing that expired since March 31, 2020 has been extended to June 14. If necessary, that date can be extended by the executive order. Individuals may renew without a late penalty if they meet the standard renewal requirements for their license. This does not extend the term of a renewed license for the following year (the expiration date will revert back to the original month and year), so it is still recommended for individuals to renew their licenses on time whenever possible.
Back to Top
The Oklahoma State Legislature has changed the relationship between physicians and Certified Registered Nurse Anesthetists (CRNA) from supervision to collaboration.
Governor Kevin Stitt signed the measure, SB 801, on May 7. It went into effect immediately.
The new law allows CRNAs to administer anesthesia “in collaboration with a medical doctor, an osteopathic physician, a podiatric physician or a dentist licensed in this state and under conditions in which timely on site consultation by such doctor, osteopath, podiatric physician or dentist is available.”
SB 801 defines collaboration as an agreement between the physician/dentist performing or directly involved in the procedure and the CRNA “working jointly toward a common goal providing services for the same patient. This collaboration involves the joint formulation, discussion and agreement of the anesthesia plan by both parties, and the collaborating physician/dentist performing the procedure or directly involved with the procedure and that collaborating physician shall remain available for timely onsite consultation during the delivery of anesthesia for diagnosis, consultation, and treatment of medical conditions.”
The new collaborative status is the culmination of years of efforts and negotiations by physician and nursing groups.
The law is endorsed by Oklahoma State Medical Association, Oklahoma Osteopathic Association, Oklahoma Society of Anesthesiologists and Oklahoma Association of Nurse Anesthetists.
Back to Top
While the COVID-19 crisis continues to escalate, another national epidemic appears to be abating.
According to the latest figures from the Centers for Disease Control (CDC), overall overdose deaths declined by 4.1 percent from 2017 to 2018, the last year for available data.
Deaths related to prescription opioid overdoses fell by 13.5 percent. The CDC attributes the decline in part to efforts to improve opioid prescribing practices and the expansion of access to naloxone to treat opioid ODs.
Deaths attributed to heroin use declined by 4 percent during the same period.
The bad news is that overdose deaths due to synthetic opioid use continue to rise. Excluding methadone, synthetic opioid deaths increased by 10 percent from 2017 to 2018. The CDC attributes the increase to the use of illicitly manufactured fentanyl.
The CDC works with the Department of Health and Human Services (HHS) to respond to and prevent drug overdoses. The HHS Five Point Strategy to combat overdoses is to provide better treatment, better data, better research, better pain management and increased assess to naloxone.
Back to Top
Physicians are human. They face the same vagaries of aging and illness as anyone else.
A primary function of the Oklahoma State Board of Medical Licensure and Supervision (Oklahoma Medical Board) is to ensure that all its licensees practice competently throughout their careers. This is particularly important as the stress of modern medical practice causes burnout in some physicians and nearly half of doctors are at or near retirement age. Indeed, the latest statistics from the American Association of Medical Colleges note that 27 percent of physicians are between 55 and 64 years of age and 15 percent are over 65.
Oklahoma Administrative Code Section 435:10-7-5 provides specific criteria for reviewing physician competency.
Oklahoma physicians required to demonstrate continued competence to the Oklahoma Medical Board are those who are more than 75 years of age; who have had recent significant illnesses or medical events which could affect their ability to practice with reasonable competency; or those who have been subject of letters of complaint or concern submitted to the Board from persons in the doctor’s sphere of influence.
Most competency reviews, including for all physicians who have reached 75 years of age, will begin with an interview with the Oklahoma Medical Board Secretary, a physician, who will recommend if additional action or investigation is necessary.
Physicians under further competency review may be asked by the Oklahoma Medical Board to submit to physical, psychological or psychiatric examinations and take SPEX or other examinations in order to evaluate clinical competency and demonstrate proof of successful completion of adequate Continuing Medical Education.
Physicians who successfully complete the competency review process “may be re-evaluated no less frequently than five-year intervals as deemed necessary by the Board.”
Back to Top
The Committee of Interns and Residents (CIR) has proposed a Resident Bill of Rights to help physicians in training “feel more empowered.”
CIR is a national residency union of more than 17,000 members.
The goal of the document is to encourage resident physicians to advocate for themselves and when dealing with residency program directors, hospital administrators, the Accreditation Council for Graduate Medical Education and state and federal legislatures.
The Resident Physician Bill of Rights has nine points:
- A living wage to provide support of families and reduction of educational debt.
- The right to provide the best care possible to patients and act in the best interests of our communities.
- Maximum 80 hour work week, not an average and including nonclinical tasks.
- Time off for sickness and seeking healthcare, including paid parental leave, without pressure to leave it unused.
- Recognition as fulltime workers and a right to unionize.
- Transparency, standardization and due process from all institutions and employers whose decisions may effect a resident physician’s career.
- Access to mental health services without scrutiny or stigmatization.
- Equal access to learning and career development.
- Adequate hospital staffing and support
The CIR mission is to “unite and empower resident physicians to have a stronger voice within hospitals. With a growing, nationwide union of residents and fellows, we garner more negotiating power and support for our patients, and our communities. We use our collective voice to advicate for cost-effective, high quality health care for all.”
Back to Top
For the first time in history, all allopathic and osteopathic graduates participated in this year’s National Resident Matching Program (NRMP).
The Accreditation Council for Graduate Medical Education is now the primary accreditation source for all graduate medical programs. This is the culmination of efforts begun in 2014 to establish a single accreditation system for MD and DO graduates.
There were a record high 40,000 total applicants for 37,000 first year residency positions in 2020, an increase of 6 percent over last year due largely to an increase of over 1,000 osteopathic applicants from 2019.
Over 19,000 U.S. allopathic graduates, 6,500 U.S. D.O. graduates and some 5,000 U.S. citizen international medical graduates submitted program choices. International Medical Graduates accounted for the rest of the applicants.
RMP noted about 90 percent of OB/GYN residency slots were filled by U.S. MD and DO graduates as were about 80 percent of pediatric and psychiatry positions. Slightly more than 60 percent of new family medicine and neurology residents are U.S. graduates. About 58 percent of internal medicine slots went to U.S. graduates.
Back to Top
A study recently published by the Cochrane Library finally offers scientific proof of the effectiveness of Alcoholics Anonymous (AA) and Twelve Step Facilitation (TSF) programs in treating alcohol use disorder.
Since its founding in 1935, AA, notoriously private by definition, has been difficult for traditional medicine to study and evaluate causing some to be skeptical of it.
A 2006 Cochrane study on AA using a relatively small sample proved inconclusive. The updated study reviews 27 investigations which included over 10,500 people.
The new study found that “clinically delivered TSF interventions designed to increase AA participation usually lead to better outcomes over the subsequent months and years in terms of producing higher rates of continuous abstinence.”
The study found that 42 percent of AA participants remained completely abstinent for a year compared 35 percent receiving other treatments including Cognitive Behavioral Therapy (CBT). The effect is achieved by fostering increased AA participation.
The study also found considerable health care cost saving benefits for AA and related Twelve Step clinical programs designed to increase AA participation.
While the study certifies AA’s effectiveness, it recognizes that it doesn’t work for everyone. Mutual health groups, medication, psychotherapy and residential care remain other options.
Back to Top
|
