Make plans to join your fellow Wisconsin physicians for the 2023 Wisconsin Doctor Day, which will be held on Thursday, June 15th at Monona Terrace in Madison, WI. Learn first-hand how you can make a difference in the legislative process! CLICK HERE to view the agenda or CLICK HERE to learn more and to register.

Doctor Day is an annual, multi-specialty event bringing together Physicians and Medical Students from nearly 20 different physician organizations. The event features networking, educational sessions, and legislative meetings.

Earlier this month, a group of state legislators introduced a youth tanning bed safety bill (AB 241 / SB 261) that aims to help parents better protect their teenagers from the long-term health risks associated with indoor tanning, including skin cancers and serious eye damage. The bill would require parental or guardian consent for teenagers to use tanning beds.

From skin cancer to immune system impairment and severe damage to the external and internal structures of the eye and eyelids, the health hazards from UV radiation overexposure are clear. UV radiation is a proven human carcinogen, and the risk of future skin cancer increases significantly when adolescents intentionally expose themselves to artificial sources of UV rays. In fact, according to a recent per reviewed study, indoor tanning can increase user risk of developing squamous cell carcinoma by 58% and basal cell carcinoma by 24%. In addition, using tanning beds before age 20 can increase the chances of developing melanoma by 47%, and the risk increases with extensive use.

The legislation, which is supported by the Wisconsin Medical Society, Wisconsin Dermatological Society, Children’s Hospital of Wisconsin, and the Wisconsin Public Health Association, includes the following two main provisions:

• Requires 16- and 17-year-olds to provide written authorization from a parent or guardian before using indoor tanning equipment (current law prohibits adolescents under 16 from using tanning beds); and
• Prohibits tanning bed operators from advertising or promoting indoor tanning as free from risk or that it offers medical or health benefits.

On May 24, the Wisconsin Senate Health Committee held a public hearing on two critical bills being lobbied on by the Wisconsin Academy of Ophthalmology (WAO): Senate Bill 145, the Advanced Practice Registered Nurse (APRN) bill, and Senate Bill 143, the physician Truth-In-Advertising bill.

Of course, the Wisconsin “House of Medicine” – through the Wisconsin Medical Society – had a strong presence at the public hearing and articulately voiced our opposition to the APRN bill in its current form. The bill would implement extensive independent nursing powers for APRNs, including the authority to prescribe medications and the ability to practice independently without physician collaboration.

During the testimony on AB 145, the physician community made it clear that there is a path to a compromise on the bill with nursing stakeholders, but any agreement must include the following provisions:

• Require four years of real-world, team-based care experience before an APRN can advance to practice independently. Current law does not allow for independent practice.
• Include “Truth in Advertising” title protection language in the bill to help ensure patients better understand who is providing the care they need.
• Ensure that a physician specializing in pain medicine collaborates with independent APRN clinics (those not directly connected to a hospital or health care system) so that complex pain medicine for patients can be provided more safely.

As expected, the nursing community came out in full force to testify in favor of the bill. Their messaging was also predictable, as they spoke about their training, ability to fill gaps in the health care workforce, and the capacity of advanced practice nurses to practice independently. They said Wisconsin needs to catch-up with the 27 states that allow advanced practice nurses to practice without physician collaboration.

Throughout the hearing, which became heated at times as lawmakers peppered the physician community with hard-hitting questions, the “House of Medicine” remained composed, stressing the important role nurses play in a physician-led health care environment, but also insisting on the need to include critical patient safety guardrails in the legislation.

Although the hearing on the Truth-In-Advertising bill (SB 143) was a bit shorter, it was not necessarily less contentious. Thie bill, which would provide practical patent safety measures by restricting non-physicians from using certain words, terms, letters, or abbreviations that would characterize them as a physician, is “supported” by Wisconsin Nurses Association as part of a broader compromise on the APRN bill. However, testimony in opposition to the bill was offered by nurse anesthetists, chiropractors, and optometrists.

According to their comments, they believe the bill restricts them from communicating their health care experience, expertise, and services to patients. In fact, a chiropractor testifying alongside a representative from the Wisconsin Optometric Association, said optometrist are primary care providers – who routinely perform surgeries – and the legislation would not recognize their training, experience, and role in the health care system.

On the flip side, despite skepticism by several lawmakers on the committee over the need for the bill, the physician coalition provided strong comments, expressing the importance of the proposal for patients, who are often confused about the qualifications of different health care professionals. The legislation will allow them to better understand when they are receiving care from a physician or from a non-physician provider.

CLICK HERE to review the  written testimony the physician community – including the WMS, the WAO, and several other specialty physician groups – submitted to the committee.

Future editions of the WAO Advocacy Newsletter will provide members with on update on the status of both bills in the legislative process, as well as the results of ongoing negotiations with other stakeholders, lawmakers, and the Governor’s office.

Given the importance of quality eyesight, WAO partners with the American Academy of Ophthalmology on the EyeSmart campaign to share monthly eye health observances. Each month, we will focus our eye health awareness and education efforts on different topics.

Click here to read the May release.

Poster abstracts are now being accepted for the WAO Fall Symposium (September 29-30, 2023 at the Trade Hotel in Milwaukee, WI). Submissions will be accepted until July 31, 2023. You will be notified in early August via email if your poster is accepted. All research is eligible for consideration, including case reports. Wisconsin ophthalmology residents are most strongly encouraged to participate, but others are also welcome to submit abstracts. For questions regarding poster submission, please contact WAO@badgerbay.co.

Given the importance of quality eyesight, WAO partners with the American Academy of Ophthalmology on the EyeSmart campaign to share monthly eye health observances. Each month, we will focus our eye health awareness and education efforts on different topics.

Click here to read the April release.

Gov. Tony Evers recently highlighted initiatives in his 2023-25 biennial budget targeted at bolstering the healthcare workforce and addressing shortages of nurses, certified nursing assistants (CNA), and other healthcare professionals that are impacting Wisconsinites’ access to healthcare. The governor highlighted these initiatives during his visit to the University of Wisconsin (UW)-Eau Claire campus to host a roundtable discussion with nursing students about the workforce challenges facing the industry and the healthcare system as a whole.

Gov. Evers’s budget recommends providing UW-Eau Claire with up to $9.4 million through the Workforce Innovation Grant Program, which the governor is proposing to continue in his 2023-25 biennial budget, to support their efforts to alleviate workforce shortages in key fields like healthcare. In partnership with Mayo Clinic Health System in Northwest Wisconsin, this funding aims to help the university create innovative curriculum and clinical experiences to graduate more nurses, including adding six new degree programs in growing healthcare fields.

Gov. Evers included the following proposals in his budget bill to help bolster Wisconsin’s healthcare workforce:

• A $100 million investment in the Workforce Innovation Grant Program to grow the state’s healthcare workforce. The grant program, previously funded with federal COVID relief dollars, provides grants to regional organizations to design and implement innovative plans that help solve the state’s workforce challenges.

• $22.5 million over the biennium to establish a separate, ongoing Innovation grant program for healthcare employers to engage in improved recruitment and retention of long-term care providers.

• $10 million over the biennium for the Wisconsin nurse educators program, which provides incentives for nursing professors to stay in Wisconsin to teach the next generation of nurses.

• $8 million for the WisCaregiver Careers program, which aims to address the shortage of CNAs in the state by supporting the recruitment, training, and retention of individuals to care for nursing home residents across Wisconsin.

• $5 million in supplemental funding for the Worker Advancement Initiative to provide grants to local workforce development boards to connect individuals to healthcare-related opportunities and to support efforts by technical colleges and nursing schools to reduce barriers to graduation and assist students in pursuing health-related careers.

• $7 million over the biennium for a new psychiatry residency program through the Medical College of Wisconsin.

• $1.5 million for the Qualified Treatment Trainee grant program, which facilitates the licensure and certification of individuals obtaining or already possessing a graduate degree in psychology, counseling, marriage and family therapy, social work, nursing, or a closely related field.

Although the Legislature plans to rewrite the governor’s budget bill from the ground up over the next few months, they are expected to keep some of the proposals recommended by Evers. It is also important to point out that lawmakers understand the need to address the state’ healthcare workforce shortage.

As Wisconsin lawmakers grapple with the state’s workforce shortage crisis in the health care sector – and across all industries – they are focusing much of their attention on proposals to overhaul parts of the state’s occupational licensing process. Their effort stems from the lengthy licensing delays at the Department of Safety and Professional Services (DSPS) – the state agency responsible for credentialing health care and other professionals – that is unfortunately worsening the growing labor crunch.

One occupational licensing bill (Assembly Bill 144) lawmakers are working on would require the state to grant preliminary occupational credentials to health care professionals. More specifically, the legislation, which has strong support from the health care community, requires DSPS to grant a preliminary credential to an individual who has met all the requirements for a permanent credential, including having completed all education, training, and supervised experience requirements.

An applicant for a preliminary license must also: 1.) Attest that they do not have a disqualifying arrest or conviction record; 2.) Verify that the position they have been hired for is within the scope of their practice; and 3.) Confirm that they have applied for a permanent credential. Finally, the health care employer that hired the applicant must verify that the individual has – to the best of the health care employer's knowledge – completed the required education, training, and supervised experience necessary for a permanent credential. 

In addition to AB 144, please find below an overview of several other occupational licensing bills being considered by the Legislature:

• Assembly Bill 135 / Senate Bill 135
  This legislative proposal would create a process for individuals who hold a license, certification, registration, or permit that was granted by another state to apply for and receive a reciprocal credential in Wisconsin.

• Assembly Bill 143 / Senate Bill 160
  This bill would prohibit the state from requiring an applicant for one of the following health credentials to pass a statutes and rules examination as a condition of licensure or certification: 1.) Advanced practice nurse prescribers; 2.) Substance abuse counselors and clinical substance abuse counselors; 3.) Respiratory care practitioners; 4.) Occupational therapists and occupational therapy assistants; 5.) Pharmacists; and 6.) Professional counselors. The bill allows the state to require an applicant to affirm that they have read and understand the statutes and rules that apply to their professional practice.

• Assembly Bill 204 / Senate Bill 193
  Under current law, a two-year renewal period applies to numerous health credentials administered by the WI Department of Safety and Professional Services. This bill revises each two-year renewal period in health professions to four-year renewal periods. Where required by current law, the bill also doubles the corresponding credential's continuing education requirement.

Although the APRN bill (SB 145 / AB 154) did not include truth-in-advertising language sought after by the Wisconsin physician community,  Sen. Rachel Cabral-Guevara – a sponsor of the APRN bill and Chair of the Senate Health Committee – has introduced a separate physician title protection bill (SB 143).

While the WAO, the Medical Society, and most other physician groups support SB 143, it is concerning that the language was not included as part of the APRP bill. The fear is that the Legislature could pass the APRN bill first and ultimately fail to approve SB 143. However, Sen. Cabral-Guevara has said she would hold a public hearing on the Truth-In-Advertising and the APRN bill at the same time.

Please find below an analysis of the Truth-in-Advertising legislation:

• Under current Wisconsin law, no individual can use or assume the title “doctor of medicine" or append to the person's name the letters “M.D." unless one of the following applies:
• • The individual possesses the degree of doctor of medicine; or
  • The individual is licensed as a physician in Wisconsin to practice medicine and surgery because they hold a medical degree from a medical school recognized by the World Health Organization.

In addition, only an individual holding the degree of doctor of osteopathy may use or assume the title “doctor of osteopathy" or append to the person's name the letters “D.O.".

• Senate Bill 143 would make the following change to current law:
• • No person, except a licensed physician, may use or assume the following words, letters, or terms in the person's title, advertising, or description of services:

As was reported in the March edition of the WAO Advocacy Newsletter, Advanced Practice Registered Nurse (APRN) legislation (SB 145 / AB 154) has been introduced that would authorize APRNs to prescribe medication and generally practice an expanded scope of care without direct physician supervision.

A public hearing bill on the bill is expected sometime in May, and the WAO along with the broader Wisconsin “House of Medicine” remain steadfast in their opposition to the bill. Unfortunately, the proposal largely ignores months of negotiations between stakeholders to find a workable agreement and does not include any of the "compromise" language Gov. Evers proposed in his 2023-25 Biennial Budget bill to ensure patient safety protections.

The physician community hopes to find a workable compromise on the bill that includes at the very least the following provisions:

• Truth-in-advertising (i.e., physician title protection) provisions that would prevent the use of specific words and terms in titles, advertising, and descriptions of services by medical professionals who are not physicians;

• An appropriate level of education and clinical experience required of APRNs prior to independent practice; and

• Requiring proper physician oversight of nurses who are providing pain management services.

CLICK HERE to review a “side-by-side” analysis of the bill that has now been introduced by lawmakers compared the APRN language Gov. Evers included in his state budget proposal.