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Date Updated: November 9, 2011

Health System Reform Policies


Policy: Uniform standards should apply to all clinicians entitled by professional practice statutes to provide the same or similar services. Licensing bodies responsible for monitoring the quality of healthcare professionals should collaborate within each profession and across professional and geographic boundaries.

When healthcare services are more accessible and available to all individuals in the United States, it will be critical that the total health professional workforce be allocated and utilized in an efficient and effective way. Any new system for high-quality healthcare will require an overlay of coordination and integration of services. One model of this concept, the “medical home,” is designed to provide a coordinating hub for each individual’s healthcare needs. In order to achieve a high level of integration of care, it is imperative that a common approach to the determination of proficiency across the continuum of a patient’s interactions with the system be applied to all the healthcare professionals involved.

In the United States, the scope of professional services is defined in laws regulating professional practice adopted by state legislatures and administered by the appropriate licensing authorities. As a result, the scopes of practice for different healthcare professionals may vary considerably across geographic boundaries. Also, some of the components of a healthcare profession’s defined scope of practice may overlap with components of other healthcare professions’ scopes of practice. The NBME does not take a position on the appropriate scope of practice for any specific profession; rather, we support determination of scope of practice by relevant authorities using an evidence-based and “patient-centered” model.

When relevant authorities have determined that clinicians with different professional and educational backgrounds are entitled to provide some of the same or similar services, patients receiving such similar services from these professionals should reasonably assume that each clinician providing these services is competent to provide them. A system that employs common standards and common measures of competence for the same services would help provide this assurance to patients. It might include assessments of knowledge, clinical skills, communication and interpersonal skills, and/or patient care for health professionals who are entitled by law to provide similar patient care services, with unique assessment for those components of scope of practice unique to each profession. Uniform initial and continuing licensure examination components for healthcare professionals who provide similar care for patients combined with unique assessment components related to the unique aspects of scope of practice is one possible pathway for achieving this.

Such a collaborative approach would require joint effort across all health professions and their licensing authorities, both within professions across geographic boundaries and across professional boundaries. In those instances where scope of practice overlaps, those collaborative structures that evolve should be delegated the power and authority for the ongoing monitoring of professionals, using uniform standards. The collaborative structures should include representation of each relevant health profession on oversight and policy groups, standard review groups, and assessment development groups. In a new healthcare system that mandates coordination and integration of care, decisions about which combinations of health professionals can best meet the needs of patients will be more feasible if a coordinated, common assessment approach, based on evidence of performance and ongoing measurement of outcomes and quality, is in place.

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