Us Healthcare Regulation

US Healthcare Provider Regulation 101

I often see statements that indicate that people are confused about the American health regulatory process. Specifically, there seems to be an assumption that MDs are government-regulated and that NDs are not. However, the regulation of NDs (and indeed of all health professions in the US) is modelled after that of MDs, which is carried out at the state level. The federal government does not license or set practice scope or standards for health providers. And (contrary to some assumptions), the American Medical Association (AMA) and other state and national health organizations are private groups, not governent organizations. Here are the facts:

  • The AMA (American Medical Association) is a private, non-profit, organization. This is true for all national (and state) organizations for health fields in America, including the AANP (American Association of Naturopathic Physicians) It’s important to note that these organizations do not grant licenses, and cannot remove them. Nor do they investigate complaints about individual doctors. In practice most if not all of them are basically trade organizations, whose main purpose is to advance the interests of the profession. (These should be distinguished from specialty groups such as the American Association of Family Physicians, which administer board exams to certify that a provider has received additional training in that specialty. )
  • The central (federal) US government does not license healthcare providers, does not set scope of practice, and does not enforce adherence to medical regulations. That is done by the individual states. The federal government does decide who can and cannot participate in nationally run healthcare programs (e.g. Veteran’s Administration-run medical programs for the military and Medicare and disability).
  • The federal government does set privacy regulations through HIPAA. Licensed healthcare providers are bound by HIPAA, including naturopathic physicians.
  • The states are responsible for all regulations related to licensing, scope of practice, and enforcement, for all healthcare providers. Being granted a license to practice in one state does not allow anyone, including MDs, to practice in another state. Some states have reciprocity, which means that they recognize each other’s medical licenses, at least for MDs and perhaps for DOs.
  • Scope of practice - what procedures a provider can carry out, prescribing privileges, etc. - is consistent across the states for MDs and DOs. It varies for nearly all other groups, including physician assistants, nurse practitioners and naturopathic doctors. These regulations are determined by the legislatures in individual states.
  • Diagnosing and treating medical ailments without an appropriate license is illegal across the United States.
  • Complaints against providers are investigated by state boards, comprised of members of the profession in question typically, as well as some non-members (this may depend on the state).

Regarding the regulation of medicines, European visitors may be surprised to know that the United States Pharmacopeia and National Formulary are private organizations, not government ones. These (as I understand it) establish “basics” for medications, such as manufacturing processes, what the medication contains, etc. Testing of medications is always done by the manufacturer, but the FDA is the one that grants a “yay” or “nay” to allow the medication to be used in the United States.

The American regulatory process has historically been a case of “growing from the bottom up” rather than “imposing from the top down”. Regulations historically are imposed, piecemeal, in reaction to problems rather than as preventive measures.