Jerry Kopel

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 reduced fee.

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 prescribe medication.

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.

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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.)

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