BILL ANALYSIS                                                                                                                                                                                                    







         ----------------------------------------------------------------------- 
        |Hearing Date:April 25, 2011        |Bill No:SB                         |
        |                                   |380                                |
         ----------------------------------------------------------------------- 


                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                          Senator Curren D. Price, Jr., Chair
                                           

                          Bill No:        SB 380Author:Wright
                        As Amended:April 7, 2011 Fiscal:    Yes

        
        SUBJECT:   Medicine.  Continuing education:  nutrition course.
        
        SUMMARY:  Requires all practicing primary care physicians and all 
        other physicians and surgeons who provide care or consultation for 
        chronic diseases to complete a mandatory continuing education (CE) 
        course of seven credit hours in the subject of nutrition and lifestyle 
        behavior for the prevention and treatment of chronic diseases by 
        December 31, 2016.

        Existing law:  

        1)Establishes the Medical Board of California (MBC) to regulate 
          physicians and surgeons.  Requires the physicians and surgeons 
          fulfill 50 hours of CE every two years. 
        
        2)Requires, on and after July 1, 2006, all CE courses to contain 
          curriculum which includes cultural and linguistic competency in the 
          practice of medicine.  (Business & Professions Code (BPC)  
          2190.1(b)(1))
        
        3)Requires all general internists and family physicians who have a 
          patient population of which over 25% are 65 years or older to 
          complete at least 20% of all mandatory CE hours in a course in the 
          field of geriatric medicine or the care of older patients. (BPC  
          2190.3)
        
        4)Requires all physicians and surgeons to complete a mandatory CE 
          course in the subjects of pain management and the treatment of 
          terminally ill and dying patients.  States that this is a one-time 
          requirement of 12 credit hours within the required minimum, as 





                                                                         SB 380
                                                                         Page 2



          specified.  (BPC  2190.5)
        
        This bill:

        1) Requires all practicing primary care physicians and all other 
           physicians and surgeons who provide care or consultation for 
           chronic diseases to complete a mandatory CE course in the subject 
           of nutrition and lifestyle behavior for the prevention and 
           treatment of chronic diseases.  Requires this CE course to be a 
           one-time requirement of seven credit hours within the required 
           minimum established by regulation, to be completed by December 31, 
           2016.

        2) Requires, for physicians and surgeons who are licensed on and after 
           January 1, 2012, to complete the CE requirement within four years 
           of their initial license or by their second renewal date, whichever 
           occurs first. 

        3) Allows the MBC to verify completion of this requirement on the 
           renewal application form.

        4) Exempts physicians and surgeons practicing in pathology or 
           radiology specialty areas or physicians and surgeons who do not 
           reside in the State of California from the requirements of this 
           bill. 

        5) States legislative findings and declarations on the rise in the 
           number and the health care costs of chronic diseases.

        FISCAL EFFECT:  Unknown.  This bill has been keyed "fiscal" by 
        Legislative Counsel. 

        COMMENTS:
        
        1. Purpose.  The  California Academy of Preventive Medicine  is the 
           Sponsor of this measure.  The Sponsor states that "lifestyle and 
           nutrition changes can improve treatment outcomes once chronic 
           diseases develop, and they have also been proven outstandingly 
           effective for prevention of diabetes, coronary heart disease, 
           osteoporosis, and several types of cancer, among other diseases.  
           But most physicians have not been provided with this information, 
           and most have not been taught the techniques they need to help 
           their patients adopt healthier lifestyles and diets.  Over recent 
           years, medical guidelines from the most prestigious national 
           advisory panels for treatment of hypertension and high cholesterol, 
           have been revised to recommend that physicians should start with 





                                                                         SB 380
                                                                         Page 3



           diet and lifestyle changes before prescribing medication.  However, 
           most physicians are either not doing this, or not doing so 
           effectively, because they have not been coached on what to tell 
           patients and how to help them through such changes.  The main 
           thrust in medicine over the last 50 years has been to go straight 
           to medication and from there to surgery to treat the major killer 
           diseases.  Yet these treatments may be unnecessary, and less 
           effective, than changing unhealthy habits and improving lifestyle 
           and diet.  Lifestyle and nutrition, are not only an alternative to 
           other treatments, they must be combined with medication and surgery 
           for the latter to even be effective.  Additionally, the  Author  
           states that education is the key to preventing and treating many 
           diseases and reducing health care costs for state government.  
           Since medical school students receive fewer than twenty contact 
           hours of nutrition instruction during their entire medical school 
           careers, this measure aims to bridge the gap by requiring 
           physicians to fulfill CE courses on nutrition and lifestyle 
           behavior. 

        2. Background.  Physicians and surgeons must complete 50 hours of CE 
           courses to renew their license every two years.  Generally, the MBC 
           does not mandate the courses that must be taken but they must be 
           relevant to the licensee's area of practice.  However, there are 
           certain courses that are required to be taken by specific 
           licensees.  For example, physicians and surgeons are required to 
           complete CE courses in cultural and linguistic competency, pain 
           management, and the treatment of terminally ill and dying patients. 
            These required CE courses, similar to the requirements of this 
           bill, are one-time course requirements. 

        3. Related Legislation.   SB 747  (Kehoe), pending in the Senate 
           Appropriations Committee, requires physicians and surgeons, among 
           other practitioners, to take at least one continuing education 
           course that provides instruction on cultural competency, 
           sensitivity, and best practices for providing adequate care to 
           lesbian, gay, bisexual, and transgender persons on and after 
           January 1, 2013, as specified.  

        4. Arguments in Support.  The  Physicians Committee for Responsible 
           Medicine  states that since nutrition is not an area of focus in 
           medical training, there is a need to require physicians to take CE 
           courses that focus on nutrition and lifestyle changes.  The  Center 
           for Science in the Public Interest  (Center) indicates that poor 
           diet is a major cause of chronic diseases, but physicians rate 
           their nutrition knowledge as insufficient and more than half of 
           graduating medical students described the time reserved for 





                                                                         SB 380
                                                                         Page 4



           nutrition education as inadequate.  In addition, the Center states 
           that less than half of primary care physicians provide patients 
           with nutrition counseling. 

        5. Arguments in Opposition.  The  California Orthopaedic Association  , 
           the  California Medical Association  and the  California Academy of 
           Family Physicians  oppose mandating CE courses and believe that 
           physicians and surgeons must have the flexibility to choose the CE 
           courses that are relevant to their practice and specialty.  
           Additionally, the  California Orthopaedic Association  states that 
           the mandated CE requirement should instead be included in the 
           medical students' curriculum.

        
        SUPPORT AND OPPOSITION:
        
         Support:  

        California Academy of Preventive Medicine (Sponsor)
        American College for Lifestyle Medicine
        Center for Science in the Public Interest
        Physicians Committee for Responsible Medicine
        Dr. John McDougall, MD (individual)

         Opposition:  

        California Academy of Family Physicians
        California Medical Association
        California Orthopaedic Association


        Consultant:Rosielyn Pulmano