State Licensing Boards Research Articles

Can Regulation Solve the Opioid Crisis?

Lynn S. Muller, JD, BA-HCM, RN, CCM, is a nurse attorney, independent professional case manager, and managing partner of Muller & Muller. She is an adjunct professor in the MSN and DNP programs at Saint Peter's University of New Jersey. Lynn is a registered nurse and a board-certified case manager with extensive nursing and case management experience. Her law practice includes defense of health care professionals before the state licensing boards, consultant on such issues as regulatory compliance and accreditation, civil litigation, Wills, Trusts and Estates, and Family law. Lynn is the author of numerous articles and the legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and the second edition of the CMSA Core Curriculum for Case Management (as well as the third edition, released in 2016). Lynn is a contributor to the CMSA Career & Knowledge Pathways Project and CMSA Standards of Practice for Case Management. She is a former commissioner for CCMC and a past president of the NJ Chapter of CMSA. Suzan B. Inci, BA, RN, started her academic career in Rutgers University, where she received her Bachelor of Arts Degree in Psychology and Political Science. Following a family tragedy, she realized her true calling was nursing, received her RN and is now a candidate in the MSN Program at Saint Peters University of New Jersey. Suzan is Shift Coordinator for a small community hospital on a medical-surgical floor. When Suzan is not in school, you will find this busy mother of three with her beautiful children and studying. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, 15 West Main St, Ste C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice.Do you have a question or issue you would like addressed here?Questions are always welcome. We encourage all readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected]. If you have an idea you would like to discuss, send your contact information by e-mail and you will be contacted via your preferred method.The authors report no conflicts of interest.

Disciplinary Actions by State Professional Licensing Boards: Are They Fair?

This study examines 14,900 disciplinary actions by the professional licensing boards for attorneys, CPAs, and physicians in four states from 2008 through 2014. It was found that both attorneys and physicians are disciplined at a rate at least seven times that of CPAs. While the majority of disciplinary actions are for misconduct directly related to the professional practice, nearly 14% of sanctions were the result of “social crimes” such as failure to pay child support or student loans, driving under the influence, and general unprofessional conduct. The severity of licensure sanctions varied with the cause for discipline, but was inconsistent both within and between jurisdictions. These results raise important questions about the purpose and performance of state licensing boards and possible reasons for inequitable treatment. Additionally, the widespread and severe sanctions for conduct not related to the professional practice suggest that moral turpitude clauses may violate both equal protection and prohibitions on excessive fines.

Effects of primary care physician density, urologist presence, and insurance status on stage of diagnosis for urologic malignancies

ObjectiveTo evaluate effects of PCP density, insurance status, and urologist presence on stage of diagnosis for urologic malignancies. Cancer stage at diagnosis is an important outcome predictor. Studies have shown an inverse relationship to primary care physician (PCP) density and insurance coverage with stage of cancer diagnosis. MethodsData was obtained from OK2Share, an Oklahoma Central Cancer Registry, for bladder, kidney, and prostate cancer from 2000 to 2010. Physician data was obtained through the State Licensing Board. The 2010 national census was used for population data. High PCP density was defined as greater than or equal to the median value: 3.17 PCP/10,000 persons. Chi-square and multivariate logistic regressions were used to analyze effects of PCP density, insurance status, and urologist presence on advanced stage diagnosis. Results27,086 patients were identified across 77 counties. As PCP density increased by 1 PCP/10,000 persons, the odds ratios (OR) of an advanced stage at diagnosis were 0.383, 0.468, 0.543 for bladder, kidney, and prostate cancer respectively. Compared to private insurance, being uninsured had OR of 1.61 and 2.45 respectively for kidney and prostate cancers. The OR of an advanced stage diagnosis for bladder and prostate cancer were 3.77 and 1.73, respectively, in counties with a urologist. ConclusionsIncreased PCP density and insurance coverage reduced the odds of an advanced diagnosis. Implementation of policies to improve access to healthcare including through increasing PCP density and reducing the number of uninsured patients should result in diagnosis at an earlier stage, which will likely improved cancer-related outcomes.

Diagnosis Dangerous: Why State Licensing Boards Should Step in to Prevent Mental Health Practitioners from Speculating Beyond the Scope of Professional Standards

This Article reviews the use of mental health experts to provide testimony on the future dangerousness of individuals who have already been convicted of a crime that qualifies them for the death penalty. Although this practice is common in many states that still retain the death penalty, it most frequently occurs in Texas because of a statute that makes it mandatory for juries to determine the future dangerousness of the defendant they have just found guilty. Both the American Psychiatric Association and the American Psychological Association have protested the use of mental health professionals in this setting because there are no scientifically valid methods to make these predictions for people who face long periods of incarceration in maximum-security prisons. Existing models of prediction consider the behavior of individuals in the free world. Moreover, the Supreme Court has upheld these predictions of dangerousness in capital sentencing hearings on the grounds that neither of the protesting professional organizations actually license mental health professionals. Therefore, this Article suggests that these state licensing boards be held responsible for assuring mental health professionals do not testify beyond the scope of medical support or evidence. In so doing, it analyzes cases in which health care professionals, in general, have been held responsible by state licensing boards for testimony that is beyond what is acceptable practice in that profession.

Active Engagement in APA Called Remedy to Burnout

Back to table of contents Previous article Next article Professional NewsFull AccessActive Engagement in APA Called Remedy to BurnoutMark MoranMark MoranSearch for more papers by this authorPublished Online:28 Jul 2017https://doi.org/10.1176/appi.pn.2017.8a16AbstractSuicide deaths of medical students, residents, and physicians have brought the subject of physician well-being to public attention and turned the issue into an acute one for organized medicine.Burnout—the phenomenon of mental exhaustion and emotional depletion—is experienced and understood by physicians perhaps more so than many other professionals. When physicians talk about burnout, other physicians—that is, you—know what they are saying. That’s why Psychiatric News will be featuring commentary over the next year from APA members offering their unique perspectives on burnout, wellness, and resilience. Experts from the recently appointed APA Work Group on Physician Wellness and others who have a special insight on the subject will provide personal accounts of their experience of burnout and strategies for maintaining wellness and resilience, and offer knowledgeable commentary about research, treatment, and institutional and health system approaches to dealing with the problem.“Burnout is pervasive in modern medicine,” said APA President Anita Everett, M.D., who has made the subject a priority of her presidential year. She noted that a December 2015 report in Mayo Clinic Proceedings found that in 2014, roughly 54 percent of the physicians surveyed had at least one symptom of burnout. When compared with 2011, rates of burnout among physicians were higher in 2014, and satisfaction with work-life balance was lower (41 percent versus 49 percent).Everett added that many aspects of modern American medicine—with its cumbersome electronic health records, excessive productivity quotas, limits on the time physicians can spend with each patient, loss of professional autonomy, and excessive documentation requirements—have become sources of professional dissatisfaction. Some stressors adversely affect psychiatrists uniquely: limited resources, high work demands, and patient violence. “Most of us have felt some degree of compassion fatigue in our careers,” she said. “Some of us may have even experienced deep and pervasive episodes of burnout that have had an impact both on our practice of medicine and on our home lives.”Tragically, Everett noted, suicides by medical students, residents, and physicians have brought the subject of physician well-being to public attention and turned the issue into an acute one for organized medicine.Everett believes the subject of burnout—powerfully impacting the professional lives of APA members—is ripe for address by professional organizations like APA. And active engagement of members in the organizational life of APA can be a strong deterrent to burnout, she believes. “Involvement in a professional society can empower members, providing a sense of collegial community and a venue for re-embracing the passion that caused us to want to be physicians in the first place,” she said.The Psychiatric News series will begin in the next issue with a report from work group chair Richard Summers, M.D., on the town hall discussion on burnout that was held at APA’s 2017 Annual Meeting in San Diego. Other subjects to be addressed in coming issues include evidence-based interventions for physicians with depression, perspectives on burnout and resilience from senior psychiatrists, efforts to promote medical student wellness, incorporation of mindfulness training into professional practice, ACGME efforts around the issue of wellness and burnout, physician mental health issues and state licensing boards, and organized-medicine and institutional-level approaches to preventing and treating burnout. Everett said she believes the Psychiatric News series will be a popular feature and one that members will look forward to from one issue to the next. “It is my hope that the series will provide real tools that our members can use in their daily professional lives to stay healthy and to remain passionate about the vital work we do with our patients,” she said. ■ ISSUES NewArchived

AMA Calls on Licensing Boards to End Discrimination for MH Treatment

AMA Calls on Licensing Boards to End Discrimination for MH Treatment

Ethical and Intrapsychic Issues in Ending a Practice

Ethical and Intrapsychic Issues in Ending a Practice

Community Clinicians and the Veterans Choice Program for PTSD Care: Understanding Provider Interest During Early Implementation.

In 2014, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program (VCP) to provide reimbursement for community-based care to eligible veterans. Inadequate networks of participating providers may impact the utility of VCP for veterans with posttraumatic stress disorder (PTSD), a complex condition occurring at lower frequency among civilians. To compare characteristics and attitudes of community-based primary care and mental health providers reporting interest or no interest in VCP participation during early implementation; and to examine perceptions and experiences of VCP among "early adopters." Cross-sectional surveys with 2 samples: a stratified random sample of mental health and primary care prescribers and psychotherapists drawn from state licensing boards (Community Sample); and a stratified random sample of prescribers and psychotherapists identified as VCP-authorized providers (VCP-Authorized). Five hundred fifty-three respondents in the Community Sample and 115 in the VCP-Authorized (total, n=668; 21.1% response). Surveys assessed provider and practice characteristics, attitudes to VA and VCP, and experiences and satisfaction with the VCP; an open-ended survey item assessed providers' reasons for interest or lack of interest in VCP participation. Few providers reported VCP participation during this period. Interest in VCP participation was associated across provider groups with factors including being a veteran and receiving VA reimbursement; currently providing treatment for PTSD was associated with interest in VCP participation among psychotherapists, but not prescribers. Developing networks of VCP providers to serve Veterans with PTSD is likely to require targeting more receptive provider groups, reducing barriers to participation, and more effectively communicating the value of VCP participation to providers.

The Personal Toll Of Practicing Medicine.

A physician and lifelong patient reflects on her truncated career and why the health of experienced doctors needs protection.

The Clinical Fellow Licensure Conundrum

The Clinical Fellow Licensure Conundrum

A Comparison of Telemental Health Terminology Used Across Mental Health State Licensure Boards

Mental health care professional shortage areas fall across the United States (Rural Assistance Center, 2015). According to the Health Resources and Services Administration, there is an immediate need for approximately 4,000 mental health providers nationwide (Kaiser Family Foundation, 2014). According to the Bureau for Labor Statistics (2014), the mental health counselor workforce is not distributed in proportion to the need. The National Institute of Mental Health (2014) estimated 43.6 million adults aged 18 or older in the United States suffered from some form of mental illness in the past year. Many individuals' mental health needs go untreated due to gaps in resources or delivery of services (Brown, 1998; Gibson, Morley, & Romeo-Wolff, 2002; Modai et al., 2006).The U.S. government has demonstrated a strong commitment to the development, promotion and integration of technology-assisted care into the U.S. health care system through ongoing work in telemental health (Godleski, Nieves, Darkins, & Lehmann, 2008; National Center for Telehealth & Technology, 2011, 2015; Pruitt & Woodside, 2015). In addition, the government has issued numerous grants for telemental health and other health services for license reciprocity (U.S. Department of Health and Human Services, Health Resources and Services Administration, 2015), established the Office for the Advancement of Telehealth, and published the 2015 Treatment Improvement Protocol (Substance Abuse and Mental Health Services Administration, 2015).Pruitt, Luxton, and Shore (2014) stated that home-based telemental health has several important benefits for both patients and clinical practitioners including improved access to services, convenience, flexibility, and potential cost savings (p. 340). Policymakers and advocates view telehealth technology as particularly promising given the continuing shortage of mental health clinicians and long travel distances to obtain care (Lambert, Gale, Hansen, Croll, & Hartley, 2013).With advancements in technology and the availability of the Internet, mental health care providers have sought new ways to integrate technology into practice (Maheu, Pulier, Wilhelm, McMenamin, & Brown-Connolly, 2005), including implementing technology in scheduling appointments, distributing assessments and providing treatment services. Using Internet-based videoconferencing, mental health care providers can easily connect with clients without requiring in-office meetings (Baker & Bufka, 2011). Some individuals will not or cannot seek mental health services when inperson services are needed; therefore, the in-person treatment process becomes a treatment barrier (Bensink, Hailey, & Wootton, 2006). According to Brown (1998), some individuals fail to seek mental health services due to geographical restrictions. Other individuals may struggle with physical health restrictions, preventing them from seeking traditional, in-office services. Mental health conditions such as panic disorder (Klein, Richards, & Austin, 2006), agoraphobia and eating disorders (Zabinski, Celio, Wilfley, & Taylor, 2003) may restrict individuals from receiving traditional services. Using Internet-based services, mental health practitioners can reach clients who are in rural locations, who are seriously ill or who do not seek traditional counseling.While the use of technology increases access to care, the technology itself creates new, unique challenges and potential risks for mental health providers (Baker & Bufka, 2011). Fifteen years ago, Riemer-Reiss (2000) discussed utilizing distance technology in mental health practice, listing foreseeable concerns for practitioners. More recent publications (Barnett & Kolmes, 2016a, 2016b) present similar concerns and questions for mental health providers. Counselors must attain competency in working with special populations or in specific practice areas, including the use of telemental health services (Baker & Bufka, 2011; Barnett & Kolmes, 2016a, 2016b). …

Brief of Amici Curiae Texas Professors Specializing in Health Law and Health Policy, Teladoc Inc. v. Texas Medical Board (5th Cir.)

Brief of Amici Curiae Texas Professors Specializing in Health Law and Health Policy, Teladoc Inc. v. Texas Medical Board (5th Cir.)

What’s New in the 2016 Ethics Code?

What’s New in the 2016 Ethics Code?

The Growing Regulation of Conversion Therapy

Conversion therapies are any treatments, including individual talk therapy, behavioral (e.g. aversive stimuli), group therapy or milieu (e.g. "retreats or inpatient treatments" relying on all of the above methods) treatments, which attempt to change an individual's sexual orientation from homosexual to heterosexual. However these practices have been repudiated by major mental health organizations because of increasing evidence that they are ineffective and may cause harm to patients and their families who fail to change. At present, California, New Jersey, Oregon, Illinois, Washington, DC, and the Canadian Province of Ontario have passed legislation banning conversion therapy for minors and an increasing number of US States are considering similar bans. In April 2015, the Obama administration also called for a ban on conversion therapies for minors. The growing trend toward banning conversion therapies creates challenges for licensing boards and ethics committees, most of which are unfamiliar with the issues raised by complaints against conversion therapists. This paper reviews the history of conversion therapy practices as well as clinical, ethical and research issues they raise. With this information, state licensing boards, ethics committees and other regulatory bodies will be better able to adjudicate complaints from members of the public who have been exposed to conversion therapies.

Reducing Disparities in the LGBT Community.

Jayne Skehan, MSN, RN, is Director of Pediatric Cardiology at Morgan Stanley Children's Hospital at New York Presbyterian Hospital in New York City. In addition to this role, she is a per diem Administrator at Mount Sinai Medical Center in Harlem. Ms Skehan received her Bachelor of Science in Nursing degree from the College of New Rochelle, New York, and her Master of Science in Nursing degree from Mercy College, Dobbs Ferry, New York. Ms Skehan has experience in Emergency Room, Pediatric Cardiology, and Operating Room management. She is currently a DNP candidate at Saint Peter's University in Englewood Cliffs, NJ. When Ms Skehan is not doing school work, she is a community advocate, donating her time to food pantries and community services. Her goal is to teach nursing upon completion of her doctoral degree. Lynn S. Muller, JD, BA-HCM, RN, CCM, is Nurse Attorney, independent case manager, and managing partner of Muller & Muller. She is Adjunct Professor in the MSN and DNP programs at Saint Peter's University of New Jersey. Lynn is a registered nurse and certified case manager with extensive nursing and case management experience. Her law practice includes defense of health care professionals before the state licensing boards, consultant on such issues as regulatory compliance and accreditation, civil litigation, Wills, Trusts and Estates, and Family law. Dr Muller is the author of numerous articles and the legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and the second edition of the CMSA Core Curriculum for Case Management (as well as the third edition, expected to be released in 2016). Dr Muller is a contributor to the CMSA Career & Knowledge Pathways Project and Standards of Practice. She is as a former commissioner for CCMC, a past president of the NJ Chapter of CMSA. Address correspondence to Jayne Skehan, MSN, RN, 15 Hudson, Irvington, NY 10533 ([email protected]). Case Management (CM) Matters is your opportunity to have your voice heard. We welcome articles some, in a less formal format than other journal departments, stories, practice tips, reflections, and revelations. How has CM changed you? How have you affected the lives of others? First-time and seasoned authors are welcome. Inquiries, questions, comments, and manuscripts should be submitted via e-mail to: [email protected] or by mail to Lynn S. Muller, 15 West Main St, Suite C, P.O. Box 164, Bergenfield, NJ 07921-0164. Do you have an idea for an article but would like to discuss it, provide your contact information in an e-mail and you will be contacted by your preferred method. The author reports no conflicts of interest

Early Signs

Early Signs

PD17-12 PRIMARY CARE PHYSICIAN DENSITY AND INSURANCE STATUS ON STAGE OF DIAGNOSIS FOR UROLOGIC MALIGNANCIES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II1 Apr 2016PD17-12 PRIMARY CARE PHYSICIAN DENSITY AND INSURANCE STATUS ON STAGE OF DIAGNOSIS FOR UROLOGIC MALIGNANCIES Kristy Nguyen, Marshall Shaw, Sarah Maness, Sanjay Patel, and Kelly Stratton Kristy NguyenKristy Nguyen More articles by this author , Marshall ShawMarshall Shaw More articles by this author , Sarah ManessSarah Maness More articles by this author , Sanjay PatelSanjay Patel More articles by this author , and Kelly StrattonKelly Stratton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1177AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cancer stage at diagnosis is an important indicator of outcome. Previous studies have shown an inverse relationship to primary care physician (PCP) density and stage of cancer diagnosis. This study evaluated PCP density and insurance status for urologic malignancies in Oklahoma to test the hypothesis that increased PCP density would still be associated with lower stage disease even in a state with a generally low PCP density. METHODS OK2Share, the Oklahoma State Department of Health database, was accessed for Prostate, Kidney, and Bladder cancer diagnoses from 2000-2010. Each was stratified by county, insurance type, and stage at diagnosis. Advanced stage was defined as the presence of regional or distant disease; in-situ results were not included. Age was restricted to 20-85+ years old. The number of PCPs was determined by using the Oklahoma State Licensing Board for active internal medicine and family medicine physicians by counties. Population data was obtained through the 2010 national census. High PCP density was defined as anything greater than or equal to the median value: 3.17 PCP/10,000. RESULTS 34,783 patients were identified across 77 counties of which 36 were considered high PCP density. Logarithmic regression showed that as the PCP density increases by 1 PCP/10,000, the odds ratios (OR) of having an advanced stage at diagnosis were 0.383, 0.468, 0.543 for bladder, kidney, and prostate cancer respectively. In high PCP density areas, Medicare coverage reduced the likelihood of having advanced bladder or prostate cancer (OR: 0.67 and 0.68 respectively) but increased the likelihood of advanced kidney cancer (OR: 1.46) compared to private insurance. Being uninsured had a higher likelihood of advanced kidney and prostate cancers (OR: 1.61 and 2.45 respectively) compared to having private insurance. CONCLUSIONS This study confirms previous studies finding increases in PCP density reduced the odds of advanced cancer stage at diagnosis. Insured patients also had reduced odds of advanced stage at diagnosis. Implementation of policies to improve access to healthcare, through increasing PCP density and insuring patients may result in improved cancer-related outcomes through diagnosis at earlier cancer stage. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e403 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Kristy Nguyen More articles by this author Marshall Shaw More articles by this author Sarah Maness More articles by this author Sanjay Patel More articles by this author Kelly Stratton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

State psychology licensure questions about mental illness and compliance with the Americans with Disabilities Act.

State licensing boards have obligations to protect the public from impaired professionals and to protect the rights of professionals applying for licensure. Competently functioning professionals who have or have had a mental health diagnosis or are being treated for a mental health condition should not be screened out, according to the Americans with Disabilities Act (ADA). A review of case law shows applicable precedents from discrimination among physicians and lawyers but not, to date, among psychologists. An examination of psychology licensure application materials from all 50 states and the District of Columbia revealed that some states, particularly Alaska, Arkansas, Colorado, Florida, Georgia, Kentucky, Missouri, Montana, and New Hampshire, include language that might screen out professionals with lived experience who are currently functioning competently. For comparison, we review a sample of licensure applications for physicians and lawyers and find a similar pattern. Five of the present authors offer ourselves and other published authors as examples of competent licensed psychologists who have lived with mental illnesses. We conclude with recommendations for more inclusive language and protection of confidentiality. (PsycINFO Database Record

Deciding whether to refer a colleague to a physician health program.

Physicians should exercise caution in referring a possibly impaired colleague to a physician health program (PHP), given that PHPs work closely with their state medical societies or licensing boards but often receive little oversight.

Advocacy

Lynn S. Muller, RN, BA-HCM, CCM, JD, is a nurse attorney and managing partner of Muller & Muller. She is a CCM with extensive nursing and case management experience. Her practice includes family law, wills, trusts and estates, defense of health care professionals before the state licensing boards, as well as transactional and consulting work for practitioners and health care companies on such issues as regulatory investigation and compliance. Lynn is an adjunct professor in the Doctor of Nursing Program at Saint Peters University, where she teaches Legal and Ethical Parameters of Advance Practice Nursing and Health Policy and Politics. She is the author of numerous articles in professional journals and is the author of the legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and the second edition of CMSA Core Curriculum for Case Management. She is a former commissioner of CCMC, past president of the NJ Chapter of CMSA. Address correspondence to Lynn S. Muller, Esq., Muller & Muller, 15 West Main Street, Suite C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics they would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected].