Feb. 12, 2021: Advocacy Update spotlight on the state of scope expansion in the states

As state budgets tighten as a result of the COVID-19 pandemic, there has been a balancing act of trying to expand care without expanding spending. This has led to a troubling trend of bills seeking to expand the scope of practice of nonphysician specialties in dangerous ways that would compromise patient safety by allowing nonphysicians to perform tasks they have not been adequately trained to perform.

The AMA’s state Advocacy Resource Center remains actively engaged in defending the practice of medicine and a patient’s right to a physician. Some legislative updates include:

The AMA urged Mississippi lawmakers to oppose H.B. 1303, which would allow advanced practice registered nurses (APRN) to practice without any physician involvement and allow nurse practitioners who meet certain requirements to serve as the collaborating/consulting provider for all four types of APRNs: “[s]uch a move is not permitted in any other state and sets Mississippi on a crash course toward worsening health outcomes and higher costs,” James L. Madara, MD, AMA CEO and executive vice president wrote in letters (PDF) to Lieutenant Governor Herbert Hosemann and Senator Hob Bryan, chair, Senate Health and Human Services Committee.

Noting the vast difference in education and training of nurse practitioners compared to physicians, as well as the distinct difference in education and training among nurse practitioners and other APRNs, makes this move particularly dangerous since “nurse practitioners do not have the education and training to practice without physician supervision themselves and certainly do not have the education and training to supervise other APRNs beyond their own scope,” Dr. Madara wrote.

The letter also addressed claims that H.B. 1303 is necessary to increase access to care in rural areas. “This promise has been made in many other states, but it has not proven true,” said Dr. Madara. “In reviewing the actual practice locations of primary care physicians compared to nurse practitioners and other APRNs, it is clear, that physicians and APRNs tend to practice in the same areas of the state. This is true even in those states where nurse practitioners can practice without physician involvement.” Unfortunately, H.B. 1303 passed the House on Feb. 3. The bill is now headed to the Senate Public Health and Welfare Committee. The AMA will continue to stand firm with Mississippi State Medical Association in letting lawmakers know this is a dangerous path forward.

In letters to Senator Bryan and Lieutenant Governor Hosemann (PDF), the AMA also expressed its opposition to Mississippi H.B. 1302, which would allow optometrists to perform surgery. “Patient safety and quality of care demand that patients be assured that individuals who perform invasive procedures have appropriate medical education and training. Optometrists do not have the education, training, or experience to perform any type of surgery, including surgery involving the eye or tissues surrounding the eye,” wrote Dr. Madara. Like H.B. 1303, this bill also passed the floor of the House on Feb. 3 and is headed to the Senate where it will be taken up in the Public Health and Welfare Committee.

In response to legislation in Alaska that would allow naturopaths to prescribe medications, perform surgery and use the term “physician,” the AMA sent a letter (PDF) expressing deep opposition. “Taken together, these three elements in S.B. 38 would set Alaska on a dangerous path by allowing naturopaths to prescribe medications and perform surgery without the education and training to do so and then mislead the public of their qualifications by allowing them to use the term ‘physician,’” wrote Dr. Madara.

The AMA sent a letter (PDF) expressing opposition to S.B. 169/H.B. 182 in Maryland, companion bills that would alter the term podiatrist to “podiatric physician” throughout the Maryland Annotated Code. In the letter, Dr. Madara stated, “As patients are asked to navigate an increasing number of health professionals in the health care system, all with varying levels of education, training and certification, the AMA believes it is more important than ever for clarity in titles, so patients clearly understand who is providing their care. Allowing podiatrists to use the term “podiatric physician” only serves to further confuse an increasingly confusing system.” Dr. Madara also stated, “The AMA believes the term ‘physician’ should only be used by those who have a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.” This bill has been introduced and defeated in the Maryland legislature for a number of years, but as is common with scope of practice legislation, the sponsor continues to bring it forward year after year.

The AMA voiced strong opposition to H.B. 1163 (PDF) pending before the House Health and Human Services Committee in South Dakota, which would allow physician assistants to diagnose, treat and prescribe substances without any physician involvement. As drafted H.B. 1163 replaces physician supervision with a weakened definition of collaboration and the bill specifically states, such collaboration must occur with a physician or another physician assistant and is only required for physician assistants with less than 520 practice hours. “These parameters are woefully inadequate to maintain patient safety and place South Dakota apart from any other state in the nation.” Currently 40 states require physician supervision of physician assistants and eight require physician assistants to have a collaborative practice agreement with a physician. This committee will likely vote on H.B. 1163 in February.

• Feb. 12, 2021: National Advocacy Update