BILL ANALYSIS Ó ----------------------------------------------------------------------- |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