BILL ANALYSIS Ó
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|Hearing Date:April 25, 2011 |Bill No:SB |
| |380 |
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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
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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
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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
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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