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Calif. bills would let optometrists, nurses do more

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SACRAMENTO, Calif. (AP) — A Democratic lawmaker introduced a package of bills Wednesday to address an expected doctor shortage as California prepares to insure millions of new patients under the Patient Protection and Affordable Care Act (PPACA).

Sen. Ed Hernandez of West Covina said his bills would expand services that can be provided by nurse practitioners, optometrists and pharmacists in order to help alleviate a shortage of primary care physicians, particularly in rural areas and inner cities. The bills are Senate Bill 491, S.B. 492 and S.B. 493.

Hernandez, an optometrist, said his bills would allow nurse practitioners to see Medicaid and Medicare patients even if the doctors they work for do not.

Optometrists could check for high blood pressure, and pharmacists could order laboratory testing to detect diabetes.

“Here in the state of California, we have a capacity issue,” he said. “We have a workforce shortage.”

The California Medical Association opposes the bills, saying the move would create two classes of care, said spokeswoman Molly Weedn.

The group representing 35,000 doctors believes the state should focus on building more medical schools, adding residency slots and expanding programs that help doctors pay off student loans in exchange for working in underserved communities.

“Making sure that we’re utilizing everybody the best is the answer, not expanding scope of practice and changing job descriptions and moving pieces around,” Weedn said.

Starting in 2014, California will help millions of uninsured people gain access to health care in two key ways: Through a new insurance marketplace that will offer subsidies and tax credits to individuals and small business; and by expanding Medicaid, the federal-state health program for low-income people. The program is called Medi-Cal in California.

Hernandez, who unveiled his bills at a safety-net clinic in Sacramento, said the measures are not meant to replace doctors but to increase access to care for ethnic and poor communities as California’s health care system braces for a huge influx.

Since Feb. 10, at least 144 “scope-of-practice” bills have been proposed in 33 states, according to the National Conference of State Legislatures. The measures deal with how health care professionals can treat, diagnose and prescribe patients.

Debra Bakerjian, a nurse practitioner, said a third of states already allow nurse practitioners full practice authority, including Colorado, Maine, New Mexico and Washington. The move has allowed greater access to health care services and reduced delays, she said.

Dr. Francisco Aguirre, chief medical officer at WellSpace Health, said he supported the bills because he has a hard time recruiting physicians to accept less pay. He relies on nurse practitioners just as much as doctors to treat the poor.

“I worry about having enough providers to care for our patients,” Aguirre said. “I am hopeful that this legislation will increase the available pool of providers.”

Hernandez isn’t the only lawmaker trying to tackle the provider gap.

State Sen. Fan Pavley, D-Agoura Hills, has put forth S.B. 352, which seeks to expand services that physician assistants can provide.

A 2011 report by the Association of American Medical Colleges said California is likely to face a physician shortage in 2015. Only 16 of the state’s 58 counties have the recommended supply of primary care physicians.

The doctors association said there’s also a shortage of specialists in nearly half of the counties.