Medical Board Seeks Comments on Practice “Drift”

The North Carolina Medical Board held a meeting in Raleigh on Wednesday night to discuss the development of a new position statement on what is being referred to as practice “drift.” You can read more about these efforts in the Summer 2010 issue of the Forum.

Practice drift is a term that describes the outflow of physicians from areas in which they were trained into new areas of practice. The Board has noted a small but increasing number of physicians “drifting” outside their formal areas of training, and recognizes that the evolution of physician practice is not necessarily negative but may be cause for developing guidelines.

A variety of stakeholders participated in this week’s meeting, including representatives from professional liability insurance companies and a balanced representation of  both primary care and specialty physicians.

The Committee’s aim is to produce a draft Position Statement on Practice Drift for consideration by the full Board. Thomas Hill, MD is chairing the effort and encourages stakeholder feedback. The deadline to submit comments to the Medical Boardis Monday, November 1, 2010. The Board is hopeful to have a draft available for comment at their January 2011 meeting.


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  • Speaking for the Cosmetic Physician( which the name in itself implies an evolution/drifting of medicine),drifting is a natural response to the advancement of medicine and technology.
    Such as the advent of tumescent anesthesia making many cosmetic and non cosmetic procedures much safer, office based, and far less risk to the patient. Not to mention the decrease in cost and recovery time for the patient. The procedures are also done with advance new technology, such as laser lipo. This training is not found in traditional residency programs. With all the advancement in cosmetic lasers/procedures( fractional resurfacing, radio frequency body sculpting, laser hair removal, endovenous ablation, tattoo removal,dermal fillers and neuromodulators, etc)…. there are no residency training programs to teach and train the aspiring cosmetic physician. This training must be aquired by attending courses and shadowing those who have mastered this advance technology.

  • Gregory M. Swank, MD, FACS

    I am very concerned about the physicians “drifting” outside of their scope of practice into areas in which they have little or no training. This is of particular concern regarding invasive, surgical procedures. In such cases, I believe this is “negative”, and has the potential to place our patients’ safety at risk. Physicians (or their extenders) should not perform surgical procedures unless they have hospital privileges to perform the same procedures. Again, this is a patient-safety issue, and one bad outcome can impact the medical profession as a whole.

  • andy morfesis

    What does drift mean: I started surgery training 1979. Since then, every five years there is a total evolution of care. We are now in the latest stage of “minimal” surgery where we are talking about ablation of breast tumor by ultrasound guided cryo unit, and gall bladder surgery with 2 mm ports, treatment of appendicitis with antibiotics etc. “drift” is a lawyers’ or administrators’ word; we were trained to do educate ourselves and that is what it means to have a degree like M.D. and to be board certified. In fact, with the emergence of EMR it is foreseeable that clinical research can move out to the university to whereever there are competent practitioners; any attempt to stop this or regulate this will slow the profession’s ability to give higher quality service for potentially less cost to society. I would interpret such attempts as the sinister product of a desire to stop “progress”. I do believe that our current method of regulating practice is inefficient: this mirrors the debate about how to edit scientific journals; this is not new ground. As regards general surgery, I consider this to be “primary care” of surgery and difficult to define.

  • Practice Drift is a natural process of evolution of the practice of medicine and surgery. Only the Board certified MD/DO physicians should be allowed to perform any procedures or provide medical services for which he/she has received appropiate training and education,regardless of their initial residency training or cerification. There is no need to further Fragment already fragmented and subspecialized medical care of a human.
    Any Physicians scope of practice should be based on not only his or her education, training and board certification status, but also his/her competancy in perfoming procedures or providing quality care.
    We should focus on the proper training of a MD/DO who wants to enhance his/her scope of practice. We should also work toward a common goal of providing competent quality care based on best of our ability, regardless of our speciality.

  • shepard hurwitz

    Can you give a few examples of what is meant by drift? Are there any existing guidelines for practitioners to expand their scope of practice?
    Several ABMS sepcialty boards are considering recognition of a practice focus in areas that have no special training- e.g HIv/ARC patients.

    • Amy Whited

      Part of the Board’s process in developing this position statement will be defining what “practice drift” actually is. Right now the Board is referring to practice drift as a term that describes the outflow of physicians from areas in which they were trained into new areas of practice. Examples could include but are definitely not limited to a physician practicing in an emergency room or urgent care setting while his or her residency was completed in another specialty area, or a physician practicing at a medical spa/dermatology center when not formally trained as a dermatologist. The Board is looking for feedback and examples of instances that you might consider practice drift before developing this position statement so that all perspectives can be considered when writing the draft.

  • Lin Church MD

    Nothing new, ay? Gyns trying to be helpful have drifted into primary care for years, now legitimized by the Legislature as a woman’s “right”. All of us have done similiarly due to preceived need and ability despite little training to do so. This is a true Pandora’s box, y’all. Your energy would best be spent in working much harder to meet the people’s real need, trained and Boarded primary care physicians. This will only happen if fair compensation attracts students, a subject that you perceive to be both beyond your bailiwick and hopelessly political. Good luck!