what barriers to practice can you think of?

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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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