Download Regulation of Medical Practice: Legal Basis

THE REGULATION OF
MEDICAL PRACTICE
Miguel L. Noche Jr., MD
PRB of Medicine
Professional Regulation Commission
Outline of Presentation
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Legal basis for regulation
Objective of regulation
Classification of Physicians
Requirements for each classification
PMA as APO
Provisions in the Physician Act 2012
Weaknesses in our systems
Regulation of Medical
Practice: Legal Basis
1987 Constitution, Article II, Section 5
provides that:
“The maintenance of peace and order, the
protection of life, liberty and property, and
the promotion of the general welfare are
essential for the enjoyment by all of the
blessings of democracy”
“Police power of the state”
“General welfare clause”
Legal Basis
1987 Constitution, Article II, Section 15
“The State shall protect and promote
the right to health of the people and
as a policy instill health consciousness
among them”
Professional Regulatory
Board of Medicine: Legal
Basis
The Medical Act of 1959 (RA 2382)
Article I, Section 1. Objectives – This Act
provides for and shall govern:
(a) the standardization and regulation of
medical education
(b) the examination for registration of
physicians
(c) the supervision, control and regulation of
the practice of medicine in the Philippines
Legal Basis
RA 8981: The PRC Modernization Act of 2000
Section 9. Powers, Functions and
Responsibilities of the Various Regulatory
Boards
(a) To regulate the practice of the profession
(b) To monitor the conditions affecting the
practice….adopt such measures as may be
deemed proper for the enhancement of the
profession….maintain high professional
standards
Legal Basis
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The PRC and the Professional
Regulatory Boards are the only bodies
expressly created by law to regulate
the professions
The Professional Regulatory Board of
Medicine: supervision, control and
regulation of the practice of medicine
Clear Mandate for the
PRBOM
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To maintain high professional
standards
No compromises because physicians
deal with the health, and the lives of
patients
PRC Legal Division Statistics: Gross
negligence and incompetence (60% of
cases filed against physicians)
REGULATION OF
MEDICAL PRACTICE
Powers and Functions of the PRC and
the PRB’s
1. Quasi-legislative
2. Quasi-judicial
Quasi-legislative Power of
the PRB
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The power to make rules / policies /
resolutions, including the power to
interpret / construe or to give opinion
on matters pertaining to the
profession
Final approval by the Commission
Proper
Quasi-judicial Power of
the PRB
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Hear and investigate violations of
professional regulatory laws, rules
and regulations, Code of Ethics, etc.
Render judgment and impose
penalty in the form of reprimand,
suspension, revocation of certificate
of registration
The Professional Regulatory
Board of Medicine
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Formulated proposed revisions to the
pending Physician Act regarding
medical education, licensure
examinations, medical practice,
classification of physicians,
specialization requirements
Submitted to both Houses of Congress
REGULATION OF
MEDICAL PRACTICE
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Main Goal: ensure high quality of care for
the protection of the public; maintain high
professional standards
Methods:
Before entry: licensure exams
In practice: requiring credentials
requiring CPE
continuing assessment
enforcing regulatory laws
Guidelines
Classification
Requirement
General
Practitioner
Graduation from recognized
medical school, 1 yr Internship
Passing Licensure exam
Specialist
Graduation from accredited
residency training
Passing Certifying exam
Subspecialist
Graduation from accredited
subspecialty training
Passing Certifying exam
Clear Application of
Guidelines
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At end of medical school and internship, a
graduate may have acquired an academic
MD degree, but if he fails the licensure
exams, he cannot be a licensed MD (GP)
A physician may have finished residency
training, but if he fails the certifying exams,
he cannot qualify as a specialist
Recognition / Accreditation
Process
PRC
final approval
PRBOM
selects and recommends
PMA (APO)
Specialty Organizations / Certifying Boards
Training Programs
PMA as the APO
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Status/authority of the PMA emanate
from its being the professional
organization recognized and
accredited by the PRC and PRBOM
Met requirements for being the APO
Since Sept. 18, 1975
Accreditation No. 012
Implication
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Only specialty organizations, specialty
boards, training programs accredited
by the PMA are recognized by the PRC
and the PRB of Medicine
Therefore, specialty organizations and
specialty boards also possess and
wield regulatory functions in their own
disciplines
Implication
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If the certificate of accreditation of
PMA as the APO is suspended,
cancelled or not renewed, it will cease
to represent the profession of
medicine
Submitted to ASEAN MRA
Secretariat
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The following are the official
professional regulatory authorities
(PRA) for the practice of medicine
1. Professional Regulation Commission
2. Board of Medicine
3. Philippine Medical Association
Dilemma
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Our main responsibility as regulatory
bodies is to set a high standard and
maintain it to protect the interest and
safety of the public
On the other hand, we are dealing
with graduates of training programs
who have not passed the certifying
exams
Options
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Some of our colleagues are
recommending that we call them
“board-eligible” or give them titles like
“affiliate members”
This may be the easy part of the
problem
Main Problems
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Delineating their scope of practice
Placing a limit on what they can perform
(will they be allowed to perform specialty
procedures?)
Placing an effective monitoring system
Defining sanctions for violations
Recognizing the risk for patients
Facing the possibility of medicolegal
problems
International situation
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The requirements for becoming a
specialist is universal: undergoing
residency training and passing
certifying exams
At present, we are working on the
ASEAN MRA looking at the training,
core competencies, scope of practice
and certification of specialists
American Board of Medical
Specialties Website
Most important Provisions
of the Physician Act 2012
(SB 3137 Sen. Trillanes)
Art. V. Sec. 28. Disciplinary Sanctions
(k) Performing any act constituting the
practice of an area of medical
specialization without fulfilling the
specialization requirements
prescribed by the Board
Sanction: reprimand, suspension,
revocation
Most Important
Provisions
Art. VI, Sec. 39. Penalties
(9) Any registered and licensed physician or
medical specialist who shall use or
advertise any title or description
tending to convey the impression to the
general public that he/she is a specialist in
an area of medical specialization when
in fact he/she is not
Imprisonment: 1-5 years
Fine: P200,000-500,000
Most Important Provisions:
Article VI, Section 39.
Penalties
10. (b) when death occurs as a result of the
commission of the prohibited act in
paragraph (k) performing an act without
fulfilling specialization requirements, Sec.
28, the offense shall be considered as
qualified violation of this Act
 Punishable by life imprisonment
 Fine of 500,000 to 2M pesos
Very strong message
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Physicians should have the proper
education, training and certification
They can only perform procedures in
areas of practice where they have been
trained and certified
There are regulatory bodies governing the
practice of medicine
There are sanctions and penalties for
violating the regulatory laws
Weaknesses of our
systems
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At the level of medical schools
Weak regulation by CHED
Giving permits to open/operate
Computer school with college of
medicine
Poorly performing med schools
difficult to close down
Weaknesses
2. At level of students
 NMAT: cut-off score decided by
medical schools themselves
 Inappropriate use of a national
screening test
 Allows entry of students who may not
deserve to be admitted
Weaknesses
3. At level of practice of medicine (PRC, PRBOM, PMA)
 Physicians declaring and marketing themselves as
specialists
 Physicians forming unrecognized organizations
 Physicians misinterpreting the provisions of the
Medical Act that they can do anything once they
are licensed
 Physicians engaging in questionable practices
Weaknesses
4. At the level of continuing professional
development
 CME activities heavily subsidized by
drug companies
Weaknesses
5. At level of Philhealth
 Creation of the Tier 2 GP’s with
training
 Mainly for remuneration purposes
 Unintended consequence: conferring
an “official professional title”
Official Position of the
PRB of Medicine
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Clear basis for classification and
requirements
Creating precedents in the profession of
medicine is not good (will affect the other
45 professions under the PRC)
Between basic medical graduates and
specialists, the standards for specialists
should be higher.
Position of the PRB of
Medicine
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Bottomline:
Among all professions, the medical
profession should set the highest
standards
Cycle in the Amendment
of regulatory laws
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Medical Act of 1959
Physician Act of 2012 (?)
An interval of 53 years, so let’s not
wait for 2065 to introduce changes
We have to do what needs to be done
NOW!
Our legacy to the future generations
of physicians and to our people
Question
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Will you fly in an airplane handled by a
“pilot with training” but did not pass
his final certifying exams?
Summary of presentation
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Legal basis for the regulatory bodies
Objectives of regulation
Powers and functions of the regulatory
board
General guidelines on the classification
of physicians
Pertinent provisions of the Medical Act
Weaknesses of our systems
“The
roots of education are
bitter, but the fruit is sweet”
- Aristotle