MMA Weighs in on Scope of Practice Bills

February 22, 2024

This week, the MMA shared concerns with a pair of bills heard in the Senate Health and Human Services Committee that would alter the scope of practice for optometrists and pharmacists. 

The first bill, SF 659 (Maye Quade, DFL – Apple Valley), lifts existing statutory caps on the amount and type of medications an optometrist is allowed to prescribe, including the prescribing of oral antiviral drugs, steroids, and oral carbonic anhydrase inhibitors. 

In its letter to the committee, the MMA argued that optometric prescribing included in current statute serves a very important purpose in protecting the public. Optometrists are a critical part of the healthcare team and are well-trained to provide many health services related to eyes and eyesight.  

However, optometrists do not have the same training as physicians, specifically ophthalmologists. The MMA noted that an ophthalmologist receives training through medical school and residency that includes much more extensive instruction on the pharmacologic impacts of prescription drugs on the entire body, not just the eye. This extensive training gives ophthalmologists the experience necessary to safely prescribe drugs that can have significant side effects if used improperly. 

Sen. Alice Mann, MD, MPH, (DFL – Bloomington) offered an amendment, based on her bill, SF 3758, otherwise known as the Surgery by Surgeons bill, introduced to clarify the surgical scope of practice. The amendment would limit surgery by optometrists to safeguard against the most concerning health impacts related to surgical procedures involving the eye. The amendment was discussed, but not acted on because SF 659 was laid over for possible inclusion in a scope of practice omnibus bill. 

Another bill expanding the scope of practice for pharmacists, SF 1176 (Hoffman, DFL – Coon Rapids) was also heard and laid over for possible inclusion in the omnibus bill. 

The legislation would expand the authority of pharmacists and pharmacist technicians to initiate, order, and administer vaccinations for children aged 3 and older. Currently, they are allowed to administer flu and COVID vaccines to children aged 6, and other childhood vaccines above age 13. 

While the MMA opposed this expansion, we worked to add an amendment to raise the age for all vaccinations from 3 (as originally proposed) to 6. MMA President Laurel Ries, MD, shared her appreciation for this in her testimony on the bill and for one of the intentions behind the bill to raise vaccination rates among Minnesota’s children, but still shared concerns with the proposal. 

“This bill will result in fewer well-child visits and interfere with continuity of care,” Ries argued. “Under current law, children must go to their pediatrician, family physician, or other practitioner for their vaccinations. These practitioners have been treating these children and have access to their entire medical history. If they can get their vaccinations from a pharmacist or pharmacist technician, participation in well-child visits and check-up visits with their physicians will go down.” 

Eileen Crespo, MD, FAAP, president of the Minnesota Chapter of the American Academy of Pediatricians, echoed similar concerns that a pharmacist does not have the training to identify serious health issues. 

“Pediatric offices are where physicians have specialty training to identify important issues such as delayed development, evaluate growth looking at possible weight concerns such obesity or inadequate weight gain and lack of growth known as failure to thrive,” Crespo said in her testimony. “Children have vision, hearing and blood pressure screenings to identify issues early and intervene. Also, importantly, physicians assess parent or caregiver bonding and look for signs of possible child abuse or neglect. These important health issues are time-sensitive and missing them does a severe disservice to any child.” 

Neither SF 659 nor SF 1176 have been heard in a House committee.