AMA opposes Wisconsin bill expanding scope of practice for physician assistants
In a recent letter (PDF) to Wisconsin lawmakers, the AMA voiced strong opposition to Wisconsin Assembly Bill 438 (AB 438), warning that the bill threatens patient safety and sows patient confusion. The legislation would allow physician assistants to practice without any physician involvement and change their title from "physician assistant" to "physician associate."
In the letter to Assembly Committee Chair Clint Moses, AMA CEO John Whyte, MD, MPH, emphasized that, “[a]llowing physician assistants to remove physicians out of the care team is the opposite of what patients expect and as such, we strongly encourage you to stand up for patients and oppose AB 438.” Dr. Whyte cited data from an AMA survey finding that 95% of U.S. voters believe physicians should be involved in medical diagnoses and treatment decisions, reinforcing the public’s expectation of physician-led care.
While acknowledging that physician assistants are valued for their contribution to the health care team, the AMA warns that AB 438 would effectively eliminate physicians from this model after physician assistants complete a threshold of clinical experience. The legislation would make Wisconsin one of only a few states loosening such collaborative requirements—in sharp contrast with the prevailing trend, where most state legislatures have recently defeated similar proposals.
AMA’s letter makes the point that physician-led care is crucial for delivering coordinated, cost-effective, and high-quality care to patients and highlights the sharp disparities in education and training between physicians and physician assistants. Specifically, it noted that physician assistants typically complete only 2,000 hours of clinical training with no residency requirement, while physicians undergo more than 12,000 hours of training during medical school and their three-to-seven-year residency program. Dr. Whyte also cited findings from a recent survey of physician assistants, in which all physician assistants reported practicing as part of a physician-led team and stated they valued this model of care for numerous reasons, including the safety of patients.
The AMA letter further explains that expanding physician assistant autonomy will not improve access to primary care in Wisconsin, as data finds that the percentage of physician assistants working in primary care is declining both statewide and nationally. For example, according to the American Academy of Physician Assistants, just 19.6% of physician assistants practice in primary care in Wisconsin. “Asserting that AB 438 will increase access to primary care is a false promise,” Dr. Whyte writes.
Additionally, the AMA letter opposes the language in the bill that would allow physician assistants to change their title to “physician associate.” The AMA states that this title change is unnecessary, likely to confuse patients, and will disrupt the existing health care infrastructure. Dr. Whyte points out that the term “physician assistant” has been around for decades and is commonly understood by patients, changing this title will undoubtedly lead to patient confusion and runs counter to the need for more transparency in the health care system that patients are seeking.
The AMA urges lawmakers to oppose AB 438 to protect the health and safety of patients and offers to work with Wisconsin Medical Society and the legislature on more effective solutions to address the workforce challenges in Wisconsin. These solutions include expanding access to telehealth, increasing graduate medical education positions, and providing loan repayment programs for physicians practicing in rural areas.
Legislation in New Mexico would inappropriately expand optometrist scope of practice
The AMA sent multiple letters to lawmakers in New Mexico opposing legislation that would allow optometrists to perform a wide range of complex eye surgeries, including letters to the House Judiciary Committee (PDF) and Senate Judiciary Committee (PDF). In both letters, AMA CEO John Whyte, MD, MPH, highlighted the importance of ensuring that only ophthalmologists, as the only physician on the eye care team, should be allowed to perform eye surgery.
The letters emphasize that while optometrists are important members of the eye care team, they are not medical doctors and do not have the extensive training necessary to assess and safely perform eye surgery. As Dr. Whyte explains, “[t]here is no substitute for the level of experience and education attained by a fully trained ophthalmologist when it comes to care and protection of the human eye.”
Dr. Whyte also warns that passage of House Bill (HB) 213 could further confuse patients about the difference between ophthalmologists and optometrists. Surveys show that over half of patients mistakenly believe that optometrists are medical doctors. The AMA stresses the need for greater transparency so patients have a clear understanding of the educational backgrounds and role of each profession. Passage of HB 213 risks increasing this misunderstanding.
Finally, the letter emphasizes that there is no evidence that passage of HB 213 will increase access to eye surgery for patients in New Mexico, including in rural areas.
In conclusion, Dr. Whyte urges lawmakers to prioritize patient safety, transparency, and public trust by voting “no” on HB 213. “Simply put, there is nothing more precious than your vision and who is allowed to perform surgery on your eye should be left to the physician member of the eye care team.”
Kentucky bill would remove physicians from level-IV trauma centers
In a letter (PDF) to members of the Kentucky House of Representatives, the AMA urged lawmakers to vote against Senate Bill 12 (SB 12), which would allow advanced practice providers to staff Level IV trauma centers without an on-site supervising physician.
The AMA outlined serious concerns with this proposal including threats to patient safety and the importance of having physicians present in emergency trauma settings where immediate evaluation and treatment are critical and can be lifesaving.
“We believe that removing the on-site presence of a physician from Level IV trauma centers is contrary to established standards and protocols and introduces unnecessary and serious risks to the safety of patients,” stated Dr. John Whyte, CEO, Executive Vice President.
Level IV trauma centers treat patients with acute and potentially life-threatening injuries or illnesses. In these critical and time-sensitive situations, remote physician supervision is insufficient. As the letter explains, “having a supervising physician on the other end of the phone or computer screen simply does not suffice. That is not what we consider to be high quality care, and it is not what patients expect or deserve, especially at a Level IV trauma center.”
The letter highlights the significant gap in education and training between physicians and advanced practice providers. For example, physicians complete 12,000-16,000 hours of clinical training during their four years of medical school and three-to-seven years of residency. By contrast, nurse practitioners complete just 500-750 hours and physician assistants complete only 2,000 hours, and neither profession completes a residency program. The AMA also notes in the letter that the vast majority of nurse practitioners and physician assistants lack specialty certification in emergency medicine. Only 1.1 percent of nurse practitioners and approximately four percent of physician assistants hold specialty certification in emergency medicine.
Ultimately, the AMA urges lawmakers to vote “no” on the bill. “Allowing advanced practice providers to be supervised by an off-site physician, as SB 12 proposes, puts patient lives in jeopardy. It is not just bad policy, it is unnecessarily reckless,” the letter states. “Kentuckians deserve the best that health care has to offer. Simply put, SB 12 is the opposite.”
