Mar 12, 2014

Identity Theft

By Martha Leatherman, MD, Past President, Texas Academy of Psychiatry

Did I get your attention? It’s a real problem and affects people throughout the country, but the identity theft I’m talking about is the one you’re likely thinking about. The dictionary defines identity theft as “the fraudulent acquisition and use of a person's private identifying information, usually for financial gain.” I would like to propose another sort of identity theft that has been happening in American medicine for at least the last twenty years. It hasn’t made the news; it hasn’t been defined in our common vernacular; it hasn’t been declared a crime. That is because it has been widely accepted as a reasonable evolution of American medicine. The identity theft I’m talking about is the slow creep of para-professionals into the practice of medicine, and the use of the words “doctor,” and “physician” to mean things other than a professional who has devoted his life to studying medicine and has earned an M.D. or D.O.

The identity of “physician” has been stolen by the bureaucrats, the insurance companies, the legislators, and the special interests. We are now “providers” along with other “providers” such as acupuncturists, midwives, phlebotomists, and nurse aides. Often, these other providers allow patients to call them “Doctor.” Physicians graduate from medical school with tens of thousands of dollars worth of debt, heavy malpractice premiums, and expectations of perfect performance, but are paid not much more than the nurse practitioners they work alongside.

In another life, probably during the days of dinosaurs, physicians administered injections, drew blood, performed EMGs, and took vital signs. Now, many physicians do not even take a history from their patients. Increasingly, nurses and nurse practitioners counsel patients, perform procedures, take histories, write prescriptions, and make “diagnoses.” Nurse aides answer medical questions and perform minor procedures. Patients increasingly feel that they are getting their real medical care from paraprofessionals, and that the actual physician is little more than a figurehead. Physicians are boxed into algorithmic medicine and are required to follow the flowcharts devised by bean counters who are more interested in demographic outcomes than in what is best for an individual patient. Our work is digitized, analyzed, and criticized, but no one has ever captured the art that is medicine, and in trying, they are turning us into technicians.

This is identity theft. The professional identities of thousands of physicians have been stolen, and we have been left with identities we never wanted. The stereotype of a medical school applicant’s answer to “why do you want to be a doctor?” was always “because I want to help people.” It’s a stereotype because it was true of so many of us, and by “helping people,” we meant getting to know them and their families. We meant having our patients bestow on us a level of trust and caring that few are privileged to share with anyone. The television character Marcus Welby, M.D. is an icon because his character represents something that people long for, but now rather than being seen as helping, caring, professionals, we hear patients complain that “the nurse did all the work” and “the doctor spent less than three minutes with me.”

What does this have to do with the Texas Academy of Psychiatry? The Academy, along with our colleagues in the Texas Society of Psychiatric Physicians and other member organizations of the Federation of Texas Psychiatry have consistently worked to protect the professional identity of Texas psychiatrists. From the halls of the Capitol building in Austin to the bowels of regulatory agencies and insurance commissions, members of organized psychiatry work to protect physicians and our patients from expanding scope of practice by non-physicians as well as from the practice of medicine by legislative fiat. The Texas Academy of Psychiatry remains a professional organization of physicians who work together to network, educate, and support each other as we navigate the changing landscape of medical practice today.

We need your support to continue our work. Obviously, we have a lot to do and a lot to learn. Please join us.

This article appeared in the February/March 2014 issue of Texas Psychiatrist. Reprinted with permission.

Mar 3, 2014

DPS Announces Interim Plan to Renew Controlled Substance Permits

On Jan. 1, renewal of controlled substances registration (CSR) permits issued by the Texas Department of Public Safety (DPS) should have become part of physicians' biennial online medical license renewal with the Texas Medical Board (TMB). TMA advocated passage of House Bill 1803 by Rep. Bill Callegari (R-Katy) and Sen. Joan Huffman (R-Houston) to ease the administrative hassle and red tape on physicians when they renew their CSR permits, and to avoid interruptions in patient care and in physicians' practices due to inadvertent expirations.

Under the law, permits valid on Jan. 1 would automatically extend to the date of the physician's next state medical license renewal. At that time, the CSR permit would be valid for two years for a $50 fee.

TMB reports that it had completed the work necessary to implement HB 1803 by Jan. 1, including developing data-sharing capabilities that allow information to flow electronically to DPS for processing. DPS wasn't prepared, however, by Jan. 1 to allow for the two-year permit and to synchronize the expiration of the permit with the physician's license renewal date.

In the past, physicians have had problems when DPS didn't process renewals in a timely manner, before the CSR permit's expiration. When physicians are unable to renew their CSR permits, they can't prescribe medications. A physician's ability to prescribe medications hinges on possession of a valid CSR, which is necessary to obtain a permit from the Drug Enforcement Administration.

Just as critical, a physician whose CSR permit lapses faces (at least) temporary suspension of hospital privileges, as maintaining current certifications is a requirement to retain medical staff privileges in Texas.  

To address concerns among physicians and to ensure DPS is ready to begin processing CSR renewals, TMA has been meeting with department officials and TMB representatives. DPS told TMA in February that it will take at least six weeks to implement necessary changes to its processing system and to verify test data.

As an interim solution, DPS officials say they'll begin synchronizing the CSR expiration date with the TMB expiration date "in the near future." To ensure physicians don't experience any disruption in their controlled substances prescribing authority or place medical staff privileges at risk, DPS has posted the following information on its Controlled Substances Search and Verification System website:  

  • CSRs that currently expire in February 2014 or March 2014 will automatically be renewed by DPS with a temporary one-year expiration date. The renewal will be completed before expiration without the renewal application and associated fee. No action is required by the physician. The information on the Controlled Substances Search and Verification System will be updated.
  • Programming changes are under way at DPS to implement the statutory requirement to synchronize the CSR expiration date with the TMB expiration date.
  • Upon completion of the synchronization, the information on the Controlled Substances Search and Verification System will be updated, and new CSR certificates will be mailed to each affected practitioner.

Visit the DPS Regulatory Services webpage for updates and additional information as it becomes available.