California warily watches ‘not-a-doctor’ wording in Senate bill

New “not-a-doctor” wording tucked into a seemingly unrelated bill pending in the California legislature has caught the eye of optometry’s advocates in that state.

SB-1451 focuses primarily on nurse practitioners, dental hygienists and other groups of health care providers in short supply in the state. However, the bill also contains amendments as to who can use the titles of doctor and physician, letters or prefixes (such as Dr.), the initials M.D. or D.O., or any other terms or letters indicating or implying that they are a physician, a surgeon or both, according to an analysis accompanying the bill.

The bill, originally introduced in February, was amended April 22 and forwarded to the Committee on Appropriations. Across the country, the AOA and affiliates have successfully fought against efforts to limit the use of the Dr. title by doctors of optometry.

Members of the California Optometric Association (COA) are currently assessing its potential impact on optometry and considering the bill’s wide-ranging intentions. Last year, a potential fight over similar language was defeated.

“The bill amends the California Medical Practice Act and does not change the section of existing law that allows optometrists to use the term ‘Dr.’ as long as they use O.D., optometrist or OptD at the end of their names,” says David Redman, O.D., COA Advocacy Team chair. “However, we are seeking clarifying amendments to ensure that optometrists won’t be impacted.”

Adds Dr. Christopher Gee, COA president: “These ‘not-a-doctor’ bills are part of the American Medical Association’s national campaign to push back against legislation that expands access to health care by allowing providers to practice to the fullest extent of their license. In other states, bills have been targeted at optometrists directly. While the California bill author claims that this bill was introduced to address concerns about nurse practitioners who obtain doctorate degrees, we want to make sure optometrists are protected.”

COA seeks clarification

According to the bill analysis written by legislative committee staff, practice acts in the state allow the use of Doctor and Dr. in certain circumstances. For instance, under state law, acupuncturists, physical therapists, dentists, chiropractors, psychologists, naturopathic doctors and optometrists can call themselves doctors if they possess professional doctorates.

The analysis, submitted April 19, later adds:

“…the Author is proposing to amend the bill moving forward to clarify that licensees whose practice act authorizes limited use of the title are not prevented from continuing to do so.”

Challenging the challengers

Whether the language in some of the bills explicitly diminishes the role of doctors of optometry or not, the AOA and its affiliates have fought off these efforts.

AOA leaders view the emergence of state “not-a-doctor” bills as an attempt to derail optometry-centered scope modernization and expanded patient access.

Doctors of optometry have long been recognized by federal agencies as physicians. The Centers for Medicare & Medicaid Services did so in 1986. They also are referred to as physicians under Federal Employees Workers Compensation, as they are at rural health clinics and federally qualified health centers.

Despite that recognition, organized medicine and ophthalmology have opposed expansion of scope to doctors of optometry. The discriminatory not-a-doctor bills being exposed in a number of states are reminiscent of the American Medical Association’s (AMA’s) years-old campaign to build support for the “Sullivan Bill,” which was rejected in successive sessions of Congress. According to the AOA’s analysis, there are indications that the AMA also is resurfacing its “truth in advertising” campaign, which the AOA repeatedly resisted last year.

“It is really unfortunate that our colleagues in medicine want to downplay our degree to this extent and do it under the guise of patient protection, when it's really the patients who would suffer from this,” Johndra McNeely, O.D., chair of the AOA State Government Relations Committee, said in January. “We will always fight for our ability to use our degree to the highest level and to the benefit of patients."