This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0583a.HRS
DATE: 4/4/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 583 Health Care Practitioner Titles and Abbreviations
SPONSOR(S): Healthcare Regulation Subcommittee, Massullo
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 17 Y, 0 N, As CS Osborne McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners. The MQA works in conjunction with 22 boards and four
councils to license and regulate seven types of health care facilities and more than 40 health care professions.
An unlicensed individual may be subject to administrative action or criminal penalties if the individual states or
otherwise implies that he or she is a licensed medical professional. This may include the use of certain terms
or titles that the public generally associates with a specific medical profession. DOH does not license
specialties or sub-specialties based upon board certification, but current law does limit who can hold
themselves out as board-certified specialists.
Current law authorizes regulatory boards (or DOH) to discipline health care practitioners for violations related
to how they represent their professional identities, including:
Making misleading, deceptive, or fraudulent representations in or related to the practice of the
licensee’s profession; or
Failing to identify through writing or orally to a patient the type of license under which the practitioner is
practicing.
CS/HB 583 further regulates the way in which health care practitioners represent their professions.
The bill specifies the titles and abbreviations that health care practitioners may use in advertisements,
communications, and personal identification. Any unauthorized use of a title of abbreviation constitutes a
misleading, deceptive, or fraudulent representation by the health care practitioner.
CS/HB 583 requires any advertisement for health care services naming a practitioner to identify the profession
under which the practitioner is practicing, and the practitioner’s educational degree. The bill also requires
health care practitioners to wear name badges and establishes requirements for name badges and provides
exemptions. The bill directs each board, or DOH if there is no regulatory board, to establish rules determining
how practitioners must comply with this requirement.
The bill authorizes DOH or the boards, as applicable, to discipline any health care practitioner who violates the
preceding requirements.
The bill has an insignificant, negative fiscal impact on DOH, and no fiscal impact on local governments.
The bill provides an effective date of July 1, 2023.
STORAGE NAME: h0583a.HRS PAGE: 2
DATE: 4/4/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Health Care Practitioners Licensure and Regulation
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners.
1
The MQA works in conjunction with 22 boards and
four councils to license and regulate seven types of health care facilities and more than 40 health care
professions.
2
Each profession is regulated by an individual practice act and by ch. 456, F.S., which
provides general regulatory and licensure authority for the MQA. MQA is statutorily responsible for the
following boards and professions established within the division:
3
The Board of Acupuncture, created under ch. 457, F.S.;
The Board of Medicine, created under ch. 458, F.S.;
The Board of Osteopathic Medicine, created under ch. 459, F.S.;
The Board of Chiropractic Medicine, created under ch. 460, F.S.;
The Board of Podiatric Medicine, created under ch. 461, F.S.;
Naturopathy, as provided under ch. 462, F.S.;
The Board of Optometry, created under ch. 463, F.S.;
The Board of Nursing, created under part I of ch. 464, F.S.;
Nursing assistants, as provided under part II of ch. 464, F.S.;
The Board of Pharmacy, created under ch. 465, F.S.;
The Board of Dentistry, created under ch. 466, F.S.;
Midwifery, as provided under ch. 467, F.S.;
The Board of Speech-Language Pathology and Audiology, created under part I of ch. 468, F.S.;
The Board of Nursing Home Administrators, created under part II of ch. 468, F.S.;
The Board of Occupational Therapy, created under part III of ch. 468, F.S.;
Respiratory therapy, as provided under part V of ch. 468, F.S.;
Dietetics and nutrition practice, as provided under part X of ch. 468, F.S.;
The Board of Athletic Training, created under part XIII of ch. 468, F.S.;
The Board of Orthotists and Prosthetists, created under part XIV of ch. 468, F.S.;
Electrolysis, as provided under ch. 478, F.S.;
The Board of Massage Therapy, created under ch. 480, F.S.;
The Board of Clinical Laboratory Personnel, created under part III of ch. 483, F.S.;
Medical physicists, as provided under part IV of ch. 483, F.S.;
The Board of Opticianry, created under part I of ch. 484, F.S.;
The Board of Hearing Aid Specialists, created under part II of ch. 484, F.S.;
The Board of Physical Therapy Practice, created under ch. 486, F.S.;
The Board of Psychology, created under ch. 490, F.S.;
School psychologists, as provided under ch. 490, F.S.;
The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling, created under ch. 491, F.S.; and
Emergency medical technicians and paramedics, as provided under part III of ch. 401, F.S.
1
Pursuant to s. 456.001(4), F.S., health care practitioners are defined to include acupuncturists, physicians, physician assistants,
chiropractors, podiatrists, naturopaths, dentists, dental hygienists, optometrists, nurses, nursing assistants, pharmacists, midwives,
speech language pathologists, nursing home administrators, occupational therapists, respiratory therapists, dieticians, athletic trainers,
orthotists, prosthetists, electrologists, massage therapists, clinical laboratory personnel, medical physicists, dispensers of optical
devices or hearing aids, physical therapists, psychologists, social workers, counselors, and psychotherapists, among others.
2
Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year 2021-2022, p.
5. Available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/annual-report-2122.pdf (last
visited March 28, 2023).
3
S. 456.001(4), F.S; Id. STORAGE NAME: h0583a.HRS PAGE: 3
DATE: 4/4/2023
DOH and the practitioner boards have different roles in the regulatory system. Boards establish
practice standards by rule, pursuant to statutory authority and directives. DOH receives and
investigates complaints about practitioners, and prosecutes cases for disciplinary action against
practitioners.
DOH, on behalf of the professional boards, investigates complaints against practitioners.
4
Once an
investigation is complete, DOH presents the investigatory findings to the boards. DOH recommends a
course of action to the appropriate board’s probable cause panel which may include:
5
Having the file reviewed by an expert;
Issuing a closing order; or
Filing an administrative complaint.
The boards determine the course of action and any disciplinary action to take against a practitioner.
6
For professions in which there is no board, DOH determines the action and discipline to take against a
practitioner and issues the final orders.
7
DOH is responsible for ensuring that licensees comply with the
terms and penalties imposed by the boards.
8
If a case is appealed, DOH attorneys defend the final
actions of the boards before the appropriate appellate court.
9
Board Certification and Florida Licensure
DOH does not license health care practitioners by specialty or subspecialty; rather, practitioners
become board certified in specialties by private, national specialty boards, such as the American Board
of Medical Specialties (ABMS), the Accreditation Board for Specialty Nursing Certification, and the
American Board of Dental Specialties.
10
Current law limits which health care practitioners may hold themselves out as board-certified
specialists. An allopathic physician may not hold himself or herself out as a board-certified specialist
unless he or she has received formal recognition as a specialist from a specialty board of the ABMS or
other recognizing agency
11
approved by the allopathic board.
12
Additionally, an allopathic physician
may not hold himself or herself out as a board-certified specialist in dermatology unless the recognizing
agency, whether authorized in statute or by rule, is triennially reviewed and reauthorized by the
allopathic board.
13
Similarly, an osteopathic physician may not hold himself or herself out as a board-
certified specialist unless he or she has successfully completed the requirements for certification by the
American Osteopathic Association (AOA) or the Accreditation Council on Graduate Medical Education
(ACGME) and is certified as a specialist by a certifying agency
14
approved by the board.
15
A dentist may not hold himself or herself out as a specialist, or advertise membership in or specialty
recognition by an accrediting organization, unless the dentist has completed a specialty education
4
Department of Health, Investigative Services. Available at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/isu.html (last visited March 28, 2023).
5
Department of Health, Prosecution Services. Available at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/psu.html (last visited March 28, 2023).
6
S. 456.072(2), F.S.
7
Id. Professions which do not have a board include naturopathy, nursing assistants, midwifery, respiratory therapy, dietetics and
nutrition, electrolysis, medical physicists, and school psychologists.
8
Supra, note 5.
9
Id.
10
Examples of specialties include dermatology, emergency medicine, ophthalmology, pediatric medicine, certified registered nurse
anesthetist, clinical nurse specialist, cardiac nurse, nurse practitioner, endodontics, orthodontics, and pediatric dentistry.
11
The allopathic board has approved the specialty boards of the ABMS as recognizing agencies. See, Rule 64B8-11.001(1)(f), F.A.C.
12
S. 458.3312, F.S.
13
Id.
14
The osteopathic board has approved the specialty boards of the ABMS and AOA as recognizing agencies. See, Rule 64B15-
14.001(h), F.A.C.
15
S. 459.0152, F.S. STORAGE NAME: h0583a.HRS PAGE: 4
DATE: 4/4/2023
program approved by the American Dental Association and the Commission on Dental Accreditation
and the dentist is:
16
Eligible for examination by a national specialty board recognized by the American Dental
Association; or
A diplomate of a national specialty board recognized by the American Dental Association.
If a dentist announces or advertises a specialty practice for which there is not an approved accrediting
organization, the dentist must clearly state that the specialty is not recognized or that the accrediting
organization has not been approved by the American Dental Association or the Florida Board of
Dentistry.
17
Additionally, an advanced practice registered nurse may not advertise or hold himself or herself out as
a specialist for which he or she has not received certification.
18
By rule, the Board of Chiropractic Medicine (BCM) prohibits chiropractors from using deceptive,
fraudulent, and misleading advertising. The BCM permits chiropractors to advertise that he or she has
attained Diplomate status in a chiropractic specialty area recognized by the BCM. BCM recognized
specialties include those which are recognized by the Councils of the American Chiropractic
Association, the International Chiropractic Association, the International Academy of Clinical Neurology,
or the International Chiropractic Pediatric Association.
19
Professional Specialty Designations
Section 456.072, F.S., authorizes a regulatory board or DOH, if there is no board, to discipline a health
care practitioner’s licensure for a number of offenses, including but not limited to:
Making misleading, deceptive, or fraudulent representations in or related to the practice of the
licensee’s profession; or
Failing to identify through writing or orally to a patient the type of license under which the
practitioner is practicing.
Using a term designating a medical specialty unless the practitioner has completed a residency or
fellowship program accredited or recognized by the ACGME or the AOA in such specialty is not ground
for discipline under current law.
If the board or DOH finds that a licensee committed a violation, the board or DOH may:
20
Refuse to certify, or to certify with restrictions, an application for a license;
Suspend or permanently revoke a license;
Place a restriction on the licensee’s practice or license;
Impose an administrative fine not to exceed $10,000 for each count or separate offense; if the
violation is for fraud or making a false representation, a fine of $10,000 must be imposed for
each count or separate offense;
Issue a reprimand or letter of concern;
Place the licensee on probation;
Require a corrective action plan;
Refund fees billed and collected from the patient or third party on behalf of the patient; or
Require the licensee to undergo remedial education.
16
S. 466.0282, F.S. A dentist may also hold himself or herself out as a specialist if the dentist has continuously held himself or herself
out as a specialist since December 31, 1964, in a specialty recognized by the American Dental Association.
17
S. 466.0282(3), F.S.
18
S. 464.018(1)(s), F.S.
19
Rule 64B-15.001(2)(e), F.A.C. Examples of chiropractic specialties include chiropractic acupuncture, chiropractic internist,
chiropractic and clinical nutrition, radiology chiropractic, and pediatric chiropractors.
20
S. 456.073(1), F.S. STORAGE NAME: h0583a.HRS PAGE: 5
DATE: 4/4/2023
Effect of the Bill
CS/HB 583 further regulates the way in which health care practitioners represent their professions.
Professional Designations
CS/HB 583 specifies titles and abbreviations that may be used by allopathic and osteopathic
physicians, chiropractic physicians, podiatric physicians, dentists, anesthesiologist assistants, and
optometrists. The bill specifies that health care practitioners, regardless of whether they are specified in
the bill, may also use the titles and abbreviations used in their respective practice acts.
Advertisements
Current law authorizes licensure discipline for “deceptive or misleading terms or false representation”.
CS/HB 583 requires any advertisement for health care services naming a practitioner to identify the
profession and educational degree as related to the services featured in the advertisement.
For the purposes of the bill, an advertisement means any printed, electronic, or oral statement that:
Is communicated or disseminated to the general public.
Is intended to encourage a person to use a practitioner’s services or to promote those services
or the practitioner in general.
For commercial purposes, names a practitioner in connection with the practice, profession, or
institution in which the practitioner is employed, volunteers, or provides health care services.
Is prepared, communicated, or disseminated by the practitioner or with their consent.
CS/HB 583 requires any advertisement by a health care practitioner include the specific license under
which they are authorized to provide services, and restricts them to advertising with only the specific
titles and abbreviations they are authorized to use under the bill. The bill permits only allopathic or
osteopathic physicians, chiropractic physicians, podiatric physicians, and dentists to use the titles,
abbreviations, or medical specialties specified in the bill the bill, such as “dermatologist,” “oncologist,”
and “periodontist,” in advertisements.
The bill prohibits nonphysician health care practitioners from using the title “doctor” in any
advertisement, telehealth interaction, text message, or verbal communication without clearly specifying
that they are a “doctor of” their respective licensed profession.
License Display
The bill requires health care practitioners to wear a name tag displaying their name and profession
when treating or consulting a patient. The bill requires name badges to include the practitioner’s name
and profession, consistent with the naming conventions specified in the bill. This requirement does not
apply to a practitioner providing services in his or her own office if the practitioner prominently displays
a copy of his or her license in a conspicuous area of the practice so that it is easily visible to patients.
Discipline
Under the bill, failure to adhere to the provisions of the bill constitute grounds for discipline. The bill
directs each board, or DOH if there is no board, to develop rules determining how practitioners must
comply with the requirements of the bill.
The bill authorizes DOH or the boards, as applicable, to discipline any health care practitioner who
violates the preceding requirements.
The bill provides an effective date of July 1, 2023.
B. SECTION DIRECTORY: STORAGE NAME: h0583a.HRS PAGE: 6
DATE: 4/4/2023
Section 1: Creates s. 456.0651, F.S., relating to health care practitioner titles and abbreviations;
advertisements, communications, and personal identification.
Section 2: Amends s. 456.072, F.S., relating to grounds for discipline; penalties; enforcement.
Section 3: Provides an effective date of July 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
DOH may experience a non-recurring increase in workload associated with rulemaking, which can
be absorbed within current resources.
21
DOH may also experience an increase in workload and
costs associated with the enforcement of the provisions of this bill, which can be absorbed within
current resources.
22
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Health care practitioners in violation of the restrictions in this bill may be subject to disciplinary actions
and fines.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rulemaking authority to DOH and the relevant regulatory boards to
implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
21
Department of Health, Agency Analysis of House Bill 583 (2023), p. 6 (February 7, 2023).
22
Id. STORAGE NAME: h0583a.HRS PAGE: 7
DATE: 4/4/2023
By specifying titles and abbreviations applicable to a specialty or certification, it is unclear if other
recognized credentials earned by a health care practitioner may be used. For example, it is unclear if a
dentist who has completed advanced training in dental anesthesiology could refer to himself as a dental
anesthesiologist.
The DOH analysis of the bill notes that the use of “may” throughout the bill indicates a permissive
provision, implying some discretion, which may be difficult to enforce.
23
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On April 3, 2023, the Healthcare Regulation Subcommittee adopted a strike-all amendment and
reported the bill favorably as a committee substitute. The amendment:
Revised the definition of “advertisement,” and defined “educational degree,” practitioner,” and
“profession.”
Revised the list of titles which constitute misleading, deceptive, or fraudulent representation if
used by a practitioner without the necessary education and training.
Specified that a health care practitioner may use names, titles, designations, and abbreviations
as provided in their respective practice act.
Revised the list of titles, designations, and abbreviations that may be used by chiropractors,
podiatrists, dentists, anesthesiologist assistants, optometrists.
Outlined offenses which constitute grounds for disciplinary actions and provides exemptions.
Deleted provisions relating to practitioners licensed or certified under Ch. 464, F.S., the Nurse
Practice Act, and physician assistants licensed under Chs. 458 or 459, F.S.
The analysis is drafted to the amended bill as passed by the Healthcare Regulation Subcommittee.
23
Supra, note 21 at p. 4.