The Corporate Practice of Medicine in a Changing Healthcare Environment
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who is also a graduate of a nurse-midwifery
program. Nurse-midwives provide primary
healthcare service to women and newborns.
Under the supervision of a licensed physician
and surgeon, a certified nurse-midwife is
authorized to attend cases of normal childbirth
and to provide prenatal, intrapartum, and
postpartum care. Services include providing
basic gynecological care, ordering laboratory
tests, providing immediate care of newborns,
prescribing medications including birth control,
and signing birth certificates.
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Nurse
anesthetists are registered nurses who
administer anesthesia ordered by physicians
and other healthcare specialists. A nurse
anesthesia practice may include performing a
comprehensive physical, developing and
initiating a patient-centered plan of care,
ordering and administering drugs, and providing
pain management services.
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One approach some states are taking to meet
the increased demand for healthcare services is
to redefine, and often expand, the scope and
standards of practice for non-physician
practitioners. As of February 2013, there were
42 nurse-related scope-of-practice bills
proposed across 17 states, including Alabama,
Florida, Hawaii, Illinois, Indiana, Iowa, Michigan,
Mississippi, Missouri, Montana, Nevada, New
Mexico, New York, North Dakota, Oklahoma,
Oregon, and Virginia.
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The bills did not include
a prohibition against the corporate practice of
medicine.
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In California, two bills were introduced in 2015
to expand the scope of practice and allow these
medical professionals to perform their duties
without physician supervision. Senate Bill 323
(Hernandez), introduced in 2015, sought to
permit licensed nurse practitioners permission
to practice, without being supervised by a
physician and surgeon. Assembly Bill 1306
(Burke) would have granted an extended,
independent scope of practice – procedures,
actions, and administrative processes – to
certified nurse-midwives, eliminating the need
for supervision of a licensed physician or
surgeon. The nurse practitioner bill did not
include a corporate practice of medicine ban,
but the nurse-midwife bill did – meaning that
nurse-midwives would not be allowed to be
employed by non-exempted corporations (such
as hospitals). Both bills included language
prohibiting an employer from interfering with
the professional’s care of a patient, and both
bills would require these professionals to obtain
malpractice insurance.
In the discussion around these bills, some
stakeholders opposed a corporate practice of
medicine ban, arguing other non-physician
professionals already enjoy autonomy in their
practice without being subject to the ban. Nurse
anesthetists, for instance, practice
independently and may be employed by
corporations. In addition, no other state with
expanded scope of practice laws for nurse
practitioners bans hospital employment, or
employment by corporations.
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Proponents
of the ban argued that the expanded duties and
responsibilities would be similar to those of
physicians and surgeons, so nurse practitioners
and nurse-midwives should be subject to the
same ban.
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If the legislature expands the
scope of practice for these professions, it could
lead to an increase in the number of retail
clinics (such as one might find in a Target or
Rite-Aid) and medi-spas, both of which are
primarily staffed by nurse practitioners today.
Optical Medicine
Recent court decisions and legislation have
changed the way retail optical corporations can
do business in California while reinforcing the
ban on the corporate practice of medicine.
Retail opticians, such as Walmart, Costco,
Pearle Vision and LensCrafters, have operated
in California for decades. A registered
dispensing optician is defined in Business &
Professions Code, Section 2550 as an individual,
corporation or firm engaged in the business of
filling prescriptions for prescription lenses or
related products. They fill prescriptions on