what barriers to practice can you think of?

  1. Ok so lets exclude MD colaberation, and being listed on insurance pannels, and dea registration limitations what other barriers do you experience in your state? Here are 3 that came to my mind today.

    In California I am alowed to have my own practice within an organized health care system. But there are some limits to what I can do....

    I can order laboroatory exams and do moderatly complex and PPM exams but if I had a clinic with no MD I can't get my laboratory license they exclude NPs and PAs from being laboratory director. So a solo practice can't do a UA or wet mount let alone a blood glucose. Unless a MD is director or my lab.

    I can order xrays and imaging studies but it has to be a MD, DO, DPM, or DC overseeing the x-ray machines since they are the only ones who can have a supervisor and operator license from the state. (That is how the radiologic health branch defines license of the healing arts) well at least I can still use ultrasound but sorry no chest x-rays or bone density exams.

    I can diagnose and manage ocular pathology such as glaucoma and dialate eyes for an exam yet but only MD/DO or OD can give an rx for glasses or contacts. Yet refraction is taught to optometric and opthalmic medical assistants in a one year program.

    I am not trying to say that we should be able to do anything but some of these rules seem strange to me. Any other and any other states?

    Jeremy
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