Physician-led care is best prescription for health of nation – American Medical Association

Report on Proposed U.S. Healthcare Legislation and its Implications for Sustainable Development Goal 3

Executive Summary

This report analyzes pending United States federal legislation (H.R. 3164 and S. 2426) which proposes to expand the scope of practice for pharmacists to include diagnostic and treatment services. The analysis is framed within the context of the United Nations Sustainable Development Goals (SDGs), with a primary focus on SDG 3: Good Health and Well-being. The legislation is found to be in direct conflict with the principles of ensuring access to high-quality, safe, and effective healthcare services, as outlined in SDG Target 3.8. The report concludes that physician-led care models are more aligned with achieving SDG 3 and recommends alternative solutions for addressing healthcare workforce shortages.

Alignment with SDG 3: Good Health and Well-being

The core objective of SDG 3 is to ensure healthy lives and promote well-being for all at all ages. The proposed legislation, by allowing pharmacists to diagnose and treat illnesses, raises significant concerns regarding the quality and safety of patient care, potentially undermining progress toward this goal.

Challenges to SDG Target 3.8: Universal Access to Quality Healthcare

SDG Target 3.8 calls for access to quality essential health-care services. The proposed expansion of pharmacists’ duties presents several risks to this target:

• Compromised Diagnostic Accuracy: Permitting “test-and-treat” authority without a comprehensive physical examination or access to a patient’s full medical history increases the likelihood of misdiagnosis or delayed diagnosis of serious underlying conditions.
• Fragmented Patient Care: The legislation promotes siloed care, which is contrary to the integrated, patient-centered approach necessary for high-quality outcomes.
• Patient Safety Risks: Shifting diagnostic responsibility to professionals without the requisite clinical training places patients at unnecessary risk, particularly vulnerable populations such as older patients with complex health profiles.

Educational and Training Disparities in Relation to SDG 4: Quality Education

The efficacy of a healthcare system is fundamentally linked to the educational standards of its workforce, a principle related to SDG 4. The distinction in training between physicians and pharmacists is substantial and prepares them for distinct, non-interchangeable roles.

Comparative Analysis of Professional Training:

1. Physician Training Pathway:
   • Completion of a four-year bachelor’s degree.
   • Four years of medical school.
   • Three to seven years of accredited residency training.
   • Accumulation of 12,000 to 16,000 hours of direct clinical experience.
2. Pharmacist Training Pathway:
   • Two to three years of undergraduate prerequisites (bachelor’s degree not required).
   • Four years of pharmacy school.
   • Approximately 1,740 hours of patient-care activities, focused on medication management.
   • No mandatory residency or extensive training in differential diagnosis or physical examination.

This disparity highlights that pharmacists’ education, while expert in pharmacology, does not provide the broad diagnostic and clinical decision-making foundation essential for primary care, a cornerstone of achieving SDG 3.

Alternative Strategies and SDG 17: Partnerships for the Goals

Proponents of the legislation often cite physician shortages as justification. However, alternative, more sustainable solutions that align with SDG 3 and SDG 17 (Partnerships for the Goals) are available. A coalition of over 80 physician organizations, in partnership with the American Medical Association (AMA), advocates for policies that strengthen the healthcare system without compromising quality.

Recommendations for Strengthening the Health Workforce:

• Invest in Physician Training: Support bipartisan legislation such as the Resident Physician Shortage Reduction Act to increase the number of Medicare-supported medical residency positions, directly addressing the root cause of physician shortages.
• Promote Physician-Led Team-Based Care: Reinforce collaborative care models where physicians lead teams of healthcare professionals, including pharmacists, who operate within their specific areas of expertise. This approach leverages partnerships to enhance patient outcomes safely and effectively.
• Uphold Transparency and Accountability: Continue initiatives like the AMA’s Truth in Advertising campaign to ensure patients are fully aware of the qualifications of their healthcare provider, empowering them to make informed decisions and upholding the principle of quality care.

Analysis of SDGs in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article is centered on ensuring patient health and safety. It argues that physician-led care is essential for high-quality medical diagnosis and treatment, which is a core component of this goal. The debate over the scope of practice for pharmacists versus physicians directly relates to the quality and safety of healthcare services provided to the population.
2. SDG 10: Reduced Inequalities
   • The article mentions that proposals to expand pharmacists’ roles are often a response to “significant—and growing—physician shortages in areas of high need, especially rural communities.” This highlights the inequality in access to qualified healthcare professionals based on geographic location. The discussion addresses the need to find appropriate solutions to reduce this healthcare access gap.
3. SDG 8: Decent Work and Economic Growth
   • The article discusses the development of the healthcare workforce, a key component of a robust economy. It advocates for specific legislation, the “Resident Physician Shortage Reduction Act,” to “grow the physician workforce.” This relates to creating and sustaining high-skill jobs and ensuring the healthcare sector has the necessary human resources to function effectively.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services.
   • The article’s main argument is about maintaining the quality of healthcare. It expresses concern that allowing pharmacists to diagnose and treat illnesses could lead to “misdiagnoses or underappreciation of the severity of illness,” thereby compromising the quality of care patients receive. The AMA’s position is that physician-led care is integral to “high-quality patient care.”
2. Target 3.c: Substantially increase health… recruitment, development, training and retention of the health workforce.
   • The article directly addresses this target by advocating against expanding the scope of practice for nonphysicians as a solution to workforce shortages. Instead, it proposes a direct solution to increase the number of physicians by urging Congress to pass the “Resident Physician Shortage Reduction Act,” which would “significantly raise the number of Medicare-supported graduate medical education positions.”
3. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all…
   • This target is relevant through its connection to equitable access to services. The article acknowledges the problem of physician shortages in rural areas, which creates a barrier to quality healthcare for those populations. By advocating for solutions that increase the number of physicians, the article implicitly supports efforts to ensure that people in underserved communities are not excluded from high-quality, physician-led medical care.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Health Worker Density and Distribution (Implied Indicator for Target 3.c)
   • The article points to “significant—and growing—physician shortages in areas of high need, especially rural communities.” The number of physicians per capita, especially the disparity between urban and rural areas, is a key indicator for measuring the health workforce challenge.
2. Number of Medical Graduates/Residency Positions (Specific Indicator for Target 3.c)
   • The article explicitly supports the “Resident Physician Shortage Reduction Act,” which aims to “raise the number of Medicare-supported graduate medical education positions.” The count of these positions serves as a direct, measurable indicator of efforts to expand the physician workforce.
3. Standards of Professional Training (Qualitative Indicator for Target 3.8)
   • The article provides specific data points to contrast the training levels: physicians complete “12,000 and 16,000 hours of clinical training” after medical school, while pharmacists complete “1,740 hours of ‘patient-care activities'” in pharmacy school. These hours serve as an indicator of the depth and rigor of clinical training, which the article links to the quality of care.
4. Patient Preference and Satisfaction (Indicator for Target 3.8)
   • The article cites a specific statistic: “95% of U.S. voters recently said it is important to have a physician involved in diagnosing and treating them.” This percentage is a direct indicator of public trust and preference regarding the quality and leadership of their healthcare.

4. Summary Table of SDGs, Targets, and Indicators

Source: ama-assn.org