Policy Tag: Scope of Practice

Adopted by the 61st WMA General Assembly, Vancouver, Canada, October 2010 and
reaffirmed with minor revisions by the 215th Council session (on line), Cordoba, Spain, October 2020

PREAMBLE

From the beginning of their studies and throughout their professional careers, physicians acquire the knowledge, training and competence required to treat their patients with the utmost skill and care.

Physicians determine the most accurate diagnosis and the most effective treatment to cure illness, or alleviate its effects, taking into consideration the overall condition of the patient.

Pharmaceutical products are often an essential part of the treatment approach. In order to make the right decisions in accordance with the ethical and professional principles of medical practice, the physician must have a thorough knowledge and understanding of the principles of pharmacology and possible interactions among different drugs and their effects on the health of the patient.

The prescribing of medication is a significant clinical intervention, which should be preceded by multiple, integrated processes to assess the patient and determine the correct clinical diagnosis. These processes include:

  • Taking a history of the current condition and past medical history;
  • The ability to make differential diagnosis;
  • Understanding any multiple chronic and complex illnesses involved;
  • Taking a history of the medications currently being administered successfully or previously withdrawn and also being aware of possible interactions.

Inappropriate drug prescription without proper knowledge and accurate diagnosis may cause serious adverse effects on the patient’s health. In view of the possible serious consequences that may result from an inappropriate therapeutic decision, the WMA affirms the following principles on high quality treatment and ensuring patient safety.

The WMA reiterates its support to its statements on the Relationship between Physicians and Pharmacists in Medicinal Therapy and on Biosimilar Medicinal Products.

PRINCIPLES

  1. Prescription of drugs should be based on a correct diagnosis of the patient’s condition and should be performed by those who have successfully completed a curriculum on disease mechanisms, diagnostic methods and medical treatment of the condition in question.
  2. Prescriptions issued by physicians are vital for ensuring patient safety, which in turn is critical for maintaining the relationship of trust between patients and their physicians.
  3. Although nurses and other healthcare workers cooperate in the overall treatment of patients, the physician is the best qualified individuals to prescribe independently. In some countries, laws may allow for other professionals to prescribe drugs under specific circumstances, generally with extra training and education and most often under medical supervision. In all cases, the responsibility for the patient’s treatment must remain with the physician. Each country’s medical system should ensure the protection of public interest and safety in the diagnosis and treatment of patients. If a system fails to comply with this basic framework due to social, economical or other compelling reasons, it should make every effort to improve the situation and to protect the safety of the patients.

Adopted by the 51st World Medical Assembly, Tel Aviv, Israel, October 1999
revised by the 61st WMA General Assembly, Vancouver, Canada, October 2010
and reaffirmed with minor revisions by the 215th Council session (online), Cordoba, Spain, October 2020

 

PREAMBLE

The goal of pharmacological treatment is to improve patients´ health and quality of life. Optimal pharmacological treatment should be safe, effective and efficient. There should be equity of access to this kind of treatment and an accurate and up-to-date information base that meets the needs of patients and practitioners.

Pharmacological treatment has become increasingly complex, often requiring the input of a multi-disciplinary team to administer and monitor the chosen therapy. In the hospital setting the inclusion of a clinical pharmacist in such a team is increasingly common and helpful. The right to prescribe medicine should be competency based and ideally the responsibility of the physician.

Physicians and pharmacists have complementary and supportive responsibilities in achieving the goal of providing optimal pharmacological treatment. This requires communication, respect, trust and mutual recognition of each other’s professional competence. Access by both physicians and pharmacists to the same accurate and up-to-date information base is important to avoid providing patients with conflicting information.

Physicians and pharmacists must provide quality service to their patients and ensure safe use of drugs. Therefore, collaboration between these professions is imperative, including with respect to the development of training and in terms of information sharing with one another and with patients. It is necessary to keep an open and continued dialogue between physicians’ and pharmacists’ representative organizations in order to define each profession’s respective functions and promote the optimal use of drugs within a framework of transparency and cooperation, all in the best interests of patients.

The Joint Statement on Counterfeiting Medical Products of the World Health Professions Alliance (WHPA) states that physicians and pharmacists share the same priority of identifying, investigating and eliminating counterfeit medicines, in which both physicians and pharmacists play a crucial role.

Patients are best served when pharmacists and physicians collaborate, recognizing and respecting each other’s roles, to ensure that medicines are used safely and appropriately to achieve the best outcome for the patient’s health.

 

THE PHYSICIAN’S RESPONSIBILITIES

  1. Diagnosing diseases on the basis of the physician’s education and specialized skills and competence.
  2. Assessing the need for pharmacological treatment and prescribing the corresponding medicines in consultation with patients, pharmacists and other health care professionals, when appropriate.
  3. Providing information to patients about diagnosis, indications and treatment goals, as well as action, benefits, risks and potential side effects of pharmacological treatment. In the case of off-label prescriptions the patient must be informed about the character of the prescription.
  4. Monitoring and assessing response to pharmacological treatment, progress toward therapeutic goals, and, as necessary, revising the therapeutic plan in collaboration with pharmacists, other health professionals and, when appropriate, caregivers.
  5. Providing and sharing information in relation to pharmacological treatment with other health care practitioners.
  6. Leading the multi-disciplinary team of health professionals responsible for managing complex pharmacological treatment.
  7. Maintaining adequate records for each patient, according to the need for therapy and in compliance with legislation respecting confidentiality and protecting the patient’s data.
  8. Where practically possible, actively participating in establishing electronic drug delivery systems within their workplace and supporting those systems with their professional knowledge.
  9. Maintaining a high level of knowledge of pharmacological treatment through continuing professional development.
  10. Ensuring safe procurement and storage of medicines that the physician is required to supply or permitted to dispense.
  11. Reviewing prescription orders to identify interactions, allergic reactions, contra-indications and therapeutic duplications.
  12. Reporting adverse reactions to medicines to health authorities, in accordance with national legislation.
  13. Monitoring and limiting, where appropriate, prescriptions of medications that may have addictive properties.
  14. Documenting adverse reactions to medicines in the patient’s medical record.

THE PHARMACIST’S RESPONSIBILITIES

  1. Ensuring safe procurement, adequate storage and dispensing of medicines in compliance with the relevant regulations.
  2. Providing information to patients, which may include the information leaflet, name of the medicine, its purpose, potential interactions and side effects, as well as correct usage and storage.
  3. Reviewing prescription orders to identify interactions, allergic reactions, contra-indications and therapeutic duplications. Concerns should be discussed with the prescribing physician but the pharmacist should not change the prescription without consulting the prescriber.
  4. Discussing medicine-related problems or concerns with regard to the prescribed medicines when appropriate and when requested by the patient.
  5. Advising patients, when appropriate, on the selection and the use of non-prescription medicines and the patient’s management of minor symptoms or ailments. Where self-medication is not appropriate, advising patients to consult their physician for diagnosis and treatment.
  6. Participating in multi-disciplinary teams concerning complex pharmacological treatment in collaboration with physicians and other health care providers, typically in a hospital setting.
  7. Reporting adverse reactions to medicines to the prescribing physician and to health authorities in accordance with national legislation.
  8. Providing and sharing general as well as specific medicine-related information and advice with the public and health care practitioners.
  9. Maintaining a high level of knowledge of pharmacological treatment through continuing professional development.

Adopted by the 50th World Medical Assembly, Ottawa, Canada, October 1998
revised by the 60th WMA General Assembly, New Delhi, India, October 2009 and
the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE 

The medical workforce is essential to healthcare systems. To meet the present and future health needs of the global populations, adequate healthcare services in all fields of medicine should be provided. This requires ensuring sufficient numbers of trained physicians in all countries taking into consideration evolving populational healthcare needs as well as physicians’ right to international mobility, while preserving the well-being and safety of both patients and physicians.

Population growth in many parts of the world, combined with ageing populations in other regions point toward an increasing shortage of physicians. Comprehensive and extensive medical workforce planning on both the national level and the international levels is therefore essential, within an ethical coordinated global framework, as recommended in WHO Global Code of Practice on the international Recruitment of Health Personnel. In this regard, the WMA reaffirms its Statement on Ethical Guidelines for the International Migration of Health Workers, and its Resolution on Task shifting in dealing with the significant global shortages of medical workforce [1].

Inadequate working conditions and the lack of support to the medical workforce has exacerbated the workforce shortage situation causing physicians to leave their home countries. This phenomenon occurred especially during the COVID-19 pandemic, which has renewed focus on physicians’ well-being and safety.

In this regard the WMA reaffirms its policies on Bullying and Harassment within the Profession, Physician well-being, Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence, Workplace Violence in the Health Sector, Epidemics and Pandemics, the Medical Profession and COVID-19, Digital Health, as well as Augmented Intelligence in Healthcare, Gender Equality in Medicine and Medical Education.

Thriving both professionally and personally is critical for the medical workforce to carry out their vital responsibilities, and to ensure quality healthcare services.

The World Health Organization (WHO) has developed several instruments that support the medical workforce, and acknowledge the global urgency to support and protect health personnel, in particular:

 

RECOMMENDATIONS

The WMA stresses the need for comprehensive and gender equal measures to guarantee physicians’ well-being and safety via an adequate working environment, including in emergency contexts, and emphasizes on the employer’s responsibility to ensure it.

The WMA calls on the following stakeholders to:

WHO and other relevant international entities

  1. strengthen the management of the medical workforce through international cooperation and consensus;
  2. provide timely data and information to guide the international and national efforts on medical workforce recruitment and retention;
  3. identify the skills, knowledge and ways of working that the evolving workforce will require in the future.

Academic institutions

  1. ensure that the education, training and development of the medical workforce meets the highest possible standards, including student support, and that they are carried out with solidarity, consideration and mutual respect;
  2. conduct and publish research on the impact of working conditions of physicians on the quality of healthcare services provided, and on the effectiveness of interventions aimed at ensuring workplace safety;
  3. include clinical informatics and digital health literacy in medical training and education to ensure the workforce is equipped with the skills and knowledge to harness existing and emerging technologies, in accordance with the principle of confidentiality, to improve health outcomes.

Governments / Health authorities

  1. guarantee the ethical international recruitment of health personnel, considering the rights, obligations and expectations of source countries, destination countries and migrant health personnel, in reference to WHO Global Code of Practice on the International Recruitment of Health Personnel;
  2. develop and implement Positive Practice Environments in health care settings in line with the World Health Professions Alliance (WHPA) campaign in order to increase physician retention;
  3. establish an appropriate monitoring and reporting mechanisms at institutional and system level, to document deviations from best practices for healthcare workplaces, e.g. unacceptable working conditions, shortage of staff and equipment. Such a database should be made available to professional organizations and other relevant stakeholders;
  4. ensure that appropriate and safe patient to physicians’ ratios are maintained between the populations and the medical workforce at all levels, including mechanisms to align supply with population healthcare need, and address access to care in rural and remote areas, based on evidence-based workforce planning, accepted international norms and standards where these are available, and in accordance with the WMA Statement on Access to Healthcare;
  5. directly address the obligations of hospitals’ commercial management and/or representative organizations to ensure safe and healthy working conditions;
  6. allocate sufficient financial resources for the education, training and development of the medical workforce to meet the health needs of the entire population in the country in reference to the WMA Statement on Medical Education;
  7. combat discrimination and foster inclusive policies for physicians and personnel from foreign countries;
  8. adequately engage and collaborate with medical professional bodies on the development and implementation of policies impacting on medical practice, such as policies around Universal Health Coverage, reimbursement, and allocation/distribution of medical personnel, in accordance with the WMA Declaration of Seoul on Professional Autonomy and Clinical Independence;
  9. adequately invest in the recruitment and retention of the needed medical workforce via the improvement of working conditions, including:
    • provision of fatigue management and safe rostering practices, including consideration of a maximum of weekly working hours for physicians in all health care establishments to prevent burnout and sustain motivation,
    • access to appropriate facilities, equipment, treatment modalities, etc.
    • adequate support from other trained healthcare professionals,
    • protection from harassment, violence, workplace stress, stigma and forced labour,
    • access to career development opportunities at all professional levels, including promotion of equity, inclusion and diversity,
    • adequate professional support and fair remuneration.
  1. in partnership with health professions’ organisations, timely anticipate potential imbalances between the supply and demand of medical workforce in order to assess future needs in human resources and design plans to meet those needs;
  2. address telemedicine in the contractual responsibilities of recruited physicians while recognizing the diverse needs of the medical workforce by enabling greater work-life balance, through flexible and remote working where clinically appropriate;
  3. develop transparent memoranda of understanding between countries where migration of physicians is an issue of concern.

WMA constituent members

  1. promote WHPA Positive Practice Environments campaign to create health care settings that are high quality and supportive workplaces;
  2. advocate for governments to develop policies to support the recruitment of physician candidates from within their own countries;
  3. actively advocate for the protection of physicians from harm, while promoting adequate working and living conditions;
  4. work with the government to devise appropriate policies addressing multidisciplinary practice;
  5. promote regular evaluation and improvement of the workforce planning solutions’ impact and effectiveness.

 

[1]Terminology:
– The term “medical workforce” in the text refers to physicians.
– According to WHO Health Workforce-related terminology:
“Health workforce” refers to health workers considered collectively.
“Health workers” are all people primarily engaged in actions with the primary intent of enhancing health.