Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK.

BACKGROUND: Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Part of that task is to control what health professionals do, or their scope of practice. Ideally, this involves the application of evidence-based professional standards of practice to the tasks for which health professional have received training. There are different jurisdictional approaches to achieving these goals. METHODS: Using a comparative case study approach and similar systems policy analysis design, we present and discuss four different regulatory approaches from the US, Canada, Australia and the UK. For each case, we highlight the jurisdictional differences in how these countries regulate health professional scopes of practice in the interest of the public. Our comparative Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis is based on archival research carried out by the authors wherein we describe the evolution of the institutional arrangements for form of regulatory approach, with specific reference to scope of practice. RESULTS/CONCLUSIONS: Our comparative examination finds that the different regulatory approaches in these countries have emerged in response to similar challenges. In some cases, 'tasks' or 'activities' are the basis of regulation, whereas in other contexts protected 'titles' are regulated, and in some cases both. From our results and the jurisdiction-specific SWOT analyses, we have conceptualized a synthesized table of leading practices related to regulating scopes of practice mapped to specific regulatory principles. We discuss the implications for how these different approaches achieve positive outcomes for the public, but also for health professionals and the system more broadly in terms of workforce optimization.

Workforce shortages in breast imaging: impact on mammography utilization.

OBJECTIVE: The objective of this study was to develop reliable forecasts of the future supply of radiologists and radiologic technologists practicing mammography under different assumptions about future introduction of new practitioners. In addition, this article includes basic mammography workforce statistics to provide a context for the forecasts. MATERIALS AND METHODS: The forecasts were developed using an age cohort flow model based on data provided by the American College of Radiology (ACR) on the numbers and age distribution of radiologists and on data provided by the American Society of Radiologic Technologists (ASRT) on radiologic technologists providing mammography services. RESULTS: The forecasts show that the current rates of production of new mammography professionals will result in dramatic reductions in mammography professionals per woman age 40 years old and older over the next 15-20 years. CONCLUSION: Unless the number of new mammography professionals entering practice every year increases beyond the current levels, there will be a growing gap between the supply of and demand for mammography professionals over the next two decades.

Adoption of oral health curriculum by physician assistant education programs in 2014.

PURPOSE: The purpose of the study was to describe inclusion of didactic and clinical instruction in oral health in physician assistant (PA) education programs in 2014. A previous study in 2008 found that PA education program directors generally understood the importance of teaching about the linkage of oral health with systemic health; yet, few programs had actually integrated oral health instruction into the PA curriculum. This study was undertaken to ascertain the number of PA programs teaching oral health topics and to evaluate the content of instruction and implementation strategies. METHODS: The study used a Web-based survey using a skip logic design that branched respondents based on inclusion or the absence of an oral health curriculum in the PA education program. The questions included predefined response options with the opportunity for narrative responses and comments. Analysis of survey data was completed using SPSS (IBM) and SAS (SAS Institute, Inc) and consisted mainly of frequencies and cross tabulations. RESULTS: There was greater inclusion of oral health curriculum in 2014 than in 2008 with most PA programs now providing didactic and clinical training in oral health. Stakeholders' efforts to engage PA program faculty with integration of oral health subject matter into core curriculum have resulted in wider availability of training for PA students in oral health promotion and prevention services. CONCLUSIONS: Efforts to equip PA faculty to teach oral health topics and clinical skills should continue as past efforts have resulted in wider integration of oral health subject matter into core PA curriculum.

The changing professional practice of physician assistants: 1992 to 2000.

BACKGROUND: Substantial changes in professional practice for physician assistants (PAs) occurred between 1992 and 2000. This paper describes a new professional practice index for the PA profession for 2000 that reflects current practice environments more accurately than did an index developed to reflect practice environments in 1992. In addition, the paper examines the relationships among the profession, its professional environment, and physicians, as well as the relationship between the PA profession and access to care for underserved populations. RESULTS: Comparisons of the 1992 professional practice index for the PA profession and indices for 2000 indicate that, collectively, the scope of practice of PAs increased significantly across the United States over the 8-year period. Variation of the index scores narrowed over the same period, suggesting that the 1990s were a period of convergence of professional practice across the 50 states. During this period the numbers of practicing PAs nearly doubled between 1992 and 2000, and in 2000 there were 5.8 practicing PAs per 100 physicians in active patient care in the United States. The professional practice index for the profession is positively correlated with the numbers of PAs per capita across the 50 states for both 1992 and 2000. CONCLUSION: Enabling legislation for PAs has been enacted in all 50 states and the District of Columbia over a 3-decade period. A period of consolidation and convergence of statutes and policies over the 1990s suggests that American medicine has endorsed the role of PAs. In spite of these findings, almost one third of states continue to have limited or restricted statutes for PA practice, mostly in the area of reimbursement.

A Dental Hygiene Professional Practice Index (DHPPI) and access to oral health status and service use in the United States.

PURPOSE: The purpose of this article is to summarize a larger study that developed a statistical index that defines the professional practice environment of dental hygienists (DHs) in the United States, and to determine the extent to which the index scores are related to the number of DHs and dentists, the utilization of dental services, and selected oral health outcomes across the 50 states. METHODS: A Dental Hygiene Professional Practice Index (DHPPI) defines the professional status, supervision requirements, tasks permitted, and reimbursement options for DHs in each of the 50 states and the District of Columbia, as of December 31, 2001. Spearman rank order correlations between the DHPPI and numbers of oral health professionals, utilization of oral health services, and oral health outcomes in the 50 states are also presented. RESULTS: The analyses revealed that: There are significant differences in the legal practice environments (as reflected in the DHPPI) across the 50 states and the District of Columbia. Between 1990 and 2001, the number of DHs per capita increased by 46% in the United States, while the number of dentists per 100,000 population increased by only 10%. The DHPPI was not significantly correlated with the number of DHs or dentists in the 50 states in 2001. The DHPPI was significantly positively correlated with the salaries of DHs in 2001. The DHPPI was also significantly and positively correlated with a number of indicators of utilization of oral health services and oral health outcomes. CONCLUSIONS: Both access to oral health services and oral health outcomes are positively correlated with the DHPPI. This suggests that states with low DHPPI scores would be logical candidates for revised DH practice statutes and regulations to accomplish these objectives.