New York assembly bill potentially sows division in health care

A bill introduced in the New York State Assembly on May 1 is potentially burdensome and discriminatory to doctors of optometry and echoes a burst of not-a-doctor bills around the country.

Bill A10009 (also S09214 filed May 6) enacts the health care professional transparency act which its sponsors say prohibits health care professionals from using deceptive or misleading advertising when the provider is named in the ads and establishes a statewide public awareness campaign to improve transparency and understanding about health care practitioners. However, the New York State Optometric Association (NYSOA) is seeking to clarify the intent of the bill with the sponsor. NYSOA’s concerns over the bill:

• It forces all nonphysician professions to restate all information, already public information, in each exam encounter, as well as other administrative requirements.
• It redefines terminology such as residency and certification.
• It requires state regulatory agencies to launch a statewide public awareness campaign with input only from specified groups, not including nonphysician professions. (Doctors of optometry can’t legally call themselves physicians under state law.)

The bill echoes not-a-doctor bills that have sprung up in state legislatures around the country, but it does try to discredit any nonmedical professions in its attempt.

“Our major concern with this bill is that it intends to drive a wedge in the health care community at a time when it is of utmost importance for us all to utilize our collective advanced training and knowledge to repair and mend the already fragmented health care system,” says Marina Su, O.D., NYSOA president. “This bill also alleges that non-physician health care practitioners are not transparent, when in fact, our licensing, qualifications, education and professional achievements are all already public information and available for our patients and the public to see. 

“In addition, this bill creates unnecessary administrative burden and costs on any health care facility, many of which are owned by physicians themselves,” Dr. Su adds. “As a result, the bill not only creates a false impression that there is a problem with transparency, but also seeks to overburden our health care system rather than focus on advancing access to quality patient care.”

Fighting off challenges to optometry

Whether the language in some of the bills explicitly diminishes the role of doctors of optometry or not, the AOA and its affiliates are wary of the not-a-doctor bills and have fought off their passage. AOA views the emergence of state “not-a-doctor” bills as an attempt to derail optometry-centered scope modernization and expanded patient access.

In 2023, not-a-doc bills were introduced in California, Connecticut, Florida, Massachusetts, Tennessee, Texas, Wisconsin and North Carolina. Through the efforts of affiliate associations and AOA, those efforts were thwarted.

They reemerged in 2024—defeated in Florida and pending in Tennessee and California. Mobilizing their members, AOA and affiliates view the emergence of state not-a-doctor bills as an attempt to derail optometry’s successful scope modernization and expanded patient access. The 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 AOA’s analysis, there are indications that the AMA also is resurfacing its “truth in advertising” campaign, which affiliates and AOA have repeatedly defused.

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

“We still do not know exactly who is behind this legislation, but we can clearly see that there is an intention to discredit, discriminate and belittle anyone who did not go to medical school,” says Ken Sorkin, O.D., NYSOA legislative chair. “There is already various published data on workforce shortages in all specialties and areas of medicine, which suggests an impending public health crisis in caring for our aging and expanding population. 

“This is the time where we should be looking for solutions to provide collaborative, comprehensive and advanced care to our patients by utilizing all of the expertise and training of all health care professions,” Dr. Sorkin says. “We all do our part in caring for the whole patient. There are already so many barriers and stigma attached to the health care system from the patient’s perspective. A bill like this would fragment our health care system further and create even more barriers and block access to care that will ultimately end up hurting those patients we serve. It is really disheartening to see that we have to expend time and resources in addressing the actions of these individuals who attempt to push through this type of legislation, rather than focusing on improving the greater and real issues at hand.”

What’s next?

The bill has drawn the displeasure of other health care providers in the state—it does not single out optometry. However, under the justification section of a memo accompanying the bill, it reads:

“Patients, potential patients and the general public are increasingly confused about the licensure, education, and training of individuals who provide them care. A recent survey conducted by the American Medical Association's Scope of Practice Partnership revealed that 44 percent of patients believe it is difficult to identify who is a licensed medical doctor and who is not by reading what services they offer, their title and other licensing credentials in advertising or other marketing materials. This survey found 54 percent of patients incorrectly believe an optometrist is a medical doctor; and 35 percent of patients believe a nurse with a ‘doctor of nursing practice’ degree is a medical doctor.”

Further, a section on patient encounters lays out how a health care practitioner with a doctoral degree and identifying themselves as doctors in a clinical setting must “clearly state that they are not a medical doctor or a physician” among other requirements.

New York’s optometrists are mobilizing and are seeking clarification on the bill’s intent.

“We are already approaching the lead sponsor on the bill to understand where this is coming from to best determine the true motive,” Thomas Cote´, MBA, executive director, NYSOA, says. “Since we are not the only profession listed on this bill, we are also communicating with the other professions to better understand their experiences and responses after reading this bill. And frankly, we also welcome open dialogue with our physician colleagues, especially those with whom we work side-by-side in the same clinic or hospital setting, to ascertain the ‘why now’ over such a bill and how a bill like this would benefit our patient communities, especially when it is divisive and can potentially create more mistrust in medicine and the health care system that many patients already may have.”

Pivotal to grassroots advocacy is the AOA’s State Government Relations Committee (SGRC) Regional Advocacy Meetings where advocates, affiliate leaders and volunteers meet to compare playbooks for statehouse advocacy strategies. Save the date for the 2024 SGRC Regional Advocacy Meetings: 

• SGRC Regional Advocacy Meeting Eastern
  Aug. 9-10 | Charlotte, N.C. 
   
• SGRC Regional Advocacy Meeting Central
  Sept. 13-14 | Dallas, TX 
   
• SGRC Regional Advocacy Meeting Western
  Oct. 4-5 | Seattle, WA

Affiliate advocacy teams are encouraged to join any one of the three regional meetings. Visit the event pages above for more information about joining these highly interactive meetings.