AMA opposes West Virginia bill that would expand APRN and physician assistant scope of practice
In a letter (PDF) to West Virginia lawmakers, the AMA expressed strong opposition to West Virginia House Bill 4715, which would expand the independent practice authority of non-physicians and erode the physician-led care model that currently exists in West Virginia law. “Compelling evidence from multiple studies demonstrates that removing these requirements leads to worse patient outcomes, higher health care costs, and—contrary to proponents' claims—does not improve access to rural health care,” says the letter from AMA CEO John Whyte, MD, MPH.
The letter further emphasized that patients want physician leadership in their health care, citing survey data showing that 95% of U.S. voters believe it is important for a physician to be involved in their diagnosis and treatment decisions.
Dr. Whyte also emphasized that physician assistants and nurse practitioners are educated and trained to work as part of a physician-led team, and that they have only a fraction of the education and training as physicians. Highlighting data from a recent survey, Dr. Whyte pointed out “100 percent of physician assistants and 95 percent of nurse practitioner respondents stating that they practice as part of a physician-led team.” Respondents also reported high satisfaction working in physician-led teams, citing the ability to collaborate with physicians on complex and routine cases, the value of physician mentorship, and enhanced patient safety as key benefits.
The letter further noted that scope of practice expansions in other states have not resulted in increased access to primary or rural health care. In fact, “[d]ecades of data have shown that nurse practitioners and physician assistants tend to practice in the same areas of the state as physicians. This is true even in states that have expanded their scope of practice laws.”
Additionally, the letter urged lawmakers to consider the growing body of evidence that nurse practitioners and physician assistants practicing without any physician involvement results in worse patient outcomes while increasing overall health care costs. The letter stated, “Physician assistants and nurse practitioners tend to prescribe more opioids than physicians, order more diagnostic imaging, and have higher rates of utilization including visits to the emergency department and referrals to specialists than physicians—all of which increase health care costs.”
The AMA urged West Virginia lawmakers to oppose HB 4715 and instead pursue effective solutions such as telehealth expansion, increased medical education opportunities and loan repayment incentives for physicians in underserved areas.
AMA urges lawmakers to reject New Mexico bill expanding optometrist surgical authority
On Jan. 29, the AMA submitted a letter (PDF) to the chair and vice chair of the New Mexico House Health and Human Services Committee, expressing strong opposition to House Bill 213 (HB 213), which would grant optometrists the authority to perform a wide range of complex eye surgeries.
In the letter, AMA CEO John Whyte, MD, MPH, emphasized that the “proposed expansion poses significant risks to patient safety, sets a dangerous precedent for allowing non-surgeons to perform surgical procedures, and is not in the best interest of New Mexicans.”
The letter described the stark difference between the education and training of optometrists and ophthalmologists, stating, “[o]ptometrists are important members of the health care team, but they are not physicians and are not interchangeable with ophthalmologists.” The AMA further cautioned that optometrists are not medical doctors and do not have the comprehensive medical knowledge necessary to safely perform eye surgery.
In addition, Dr. Whyte highlighted patient confusion about the distinct roles of optometrists and ophthalmologists and cited a recent survey indicating that over half of patients mistakenly believe that optometrists are medical doctors (MDs or DOs). This data underscores the need for greater transparency and communication about the education, training and background of each profession—and the potential for further patient confusion should HB 213 become law.
Finally, AMA’s letter confirmed that “there is no demonstrable evidence that passage of HB 213 will increase access to eye surgery, including in rural areas” disputing an argument made by those in support of HB 213.
Dr. Whyte urged lawmakers to focus on patient safety, transparency, and public trust in voting “no” on HB 213. He concluded, “[s]imply 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.”
