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#StopScopeCreep

Take action: California physicians, medical students and residents

Ask legislators: Vote “no” to the Nurse Practitioner Scope Expansion Bill AB890

Bill AB890 grants full practice authority to nurse practitioners (NP). This bill would remove critical patient protections by allowing NPs to practice without physician supervision.

What you can do

—Contact your legislator and tell them to vote “no.”

—Explain to your senator that the most underserved patients—in dense urban areas and rural areas of the state—deserve the care of a physician, not someone with less training. NPs have only 500 hours of clinical training—lengthwise, amounting to 6-7 weeks of physician residency training.

—Explain to your assembly member that AB890 is a different bill than when they voted in January; it breaks up team-based care, which has proven to be the best means of taking care of patients. 

—Share on your social media channels urging California legislators to vote no on AB890

—Follow the California Medical Association (CMA) @cmadocs on Twitter and retweet, comment and like CMA’s call to action on AB890: #cmadocs #CaLeg #NoAB890 #NoOnAB890 and don’t forget to share your stories.

Advocacy victories

#StopScopeCreep

For over 30 years, the AMA’s state and federal advocacy efforts have safeguarded the practice of medicine by opposing nurse practitioner (NP) and other nonphysician professional attempts to inappropriately expand their scope of practice.

75 plus scope of practice victories in 2019-2020

Over the last two years, the AMA secured over 60 state legislative victories stopping inappropriate scope expansions of nonphysicians. This work was done in strong collaboration with state medical and national specialty societies. Learn more (PDF).

Federal correspondence to lawmakers and regulators

Learn more about the AMA's recent actions:

Sign-on letter to Seema Verma urging CMS to sunset waivers involving scope of practice and licensure when the public health emergency concludes.
Comment letter to State Legislators (Kemp) encourages legislators to veto Senate Bill 321 (S.B. 321), which would allow advanced practice nurses (APRNs) to order diagnostic imaging studies. Such expansion would also increase health care costs and threaten the health and safety of patients in Georgia.
Sign-on letter to U.S. Dept. of Veteran Affairs as it relates to allowing nonphysician health care professionals in 32 specialties to operate “within the full scope of their license, registration, or certification” and rescind the Memorandum as it relates to encouraging all VA medical facilities to allow CRNAs to practice without physician oversight during the national health emergency.
Sign-on letter to Department of Health and Human Services responds to a proposal included in the Fiscal Year (FY) 2021 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) proposed rule, where CMS allows the use of nonphysician practitioners (NPPs) to perform the IRF services.

AMA's work in the courts

AMA Litigation Center filed an amicus brief with ASA in the New Hampshire Supreme Court. The brief asks that the court uphold a New Hampshire Board of Medicine decision that stops individuals from identifying themselves as anesthesiologists if they aren’t licensed as such.

Litigation Center is also helping Arkansas Medical Society in supporting Safe Surgery Arkansas’ efforts on a ballot initiative to reverse legislation enacted in 2019 allowing optometrists (non-physicians) to perform surgery. The ballot initiative brings the decision back to the voters.

Physician-led team-based care safeguarded

CMS did not finalize its proposal to amend the Inpatient Rehabilitation Facility (IRF) coverage requirements to allow non-physician health care professionals to perform certain duties that are currently required to be performed by a rehabilitation physician.

The AMA joined the American Academy of Physical Medicine and Rehabilitation in raising a unified voice with more than 120 state and specialty societies, patient groups and other stakeholders to oppose the proposal that would have had a detrimental impact on patient care and set a dangerous precedent for removing physician supervision requirements in other health care settings.

More than $2 million in grants awarded

The AMA recognizes the importance of the house of medicine working together, which is why it formed the Scope of Practice Partnership (SOPP) in 2006. Today, the SOPP is comprised of 105 national, state and specialty medical associations. The SOPP has awarded more than $2.2 million in grants to its members to fund advocacy tools and campaigns. 

Produced 100s of tools to fight scope expansion

The AMA is one of the only national organizations that has created more than 100s of advocacy tools for medicine to utilize when fighting scope expansion legislation and regulation including model bills, legislative templates, state laws analyses, issue briefs and more.

Demonstrated scope expansion does not equal expanding access to care

The AMA has created over 1,000 geomaps, along with the Health Workforce Mapper (members-only and non-members versions), to demonstrate that expanding scope does not equal expanding access to care.

For instance, AMA research shows the following:

—Nonphysician providers (such as NPs) are more likely to practice in the same geographic locations as physicians. This is true even in states that allow NPs to practice independently.
—Despite the rising number of NPs across the country, health care shortages still persist, even in states that allow NPs to practice independently.

Engagement with the FTC and administration

The AMA has proactively engaged the Federal Trade Commission (FTC) when necessary and responds to FTC enforcement against state licensure board actions related to scope of practice. In addition, the AMA is working with the administration to preserve physician supervision of nonphysician professionals in Medicare.

The AMA opposes a new declaration from the U.S. Health and Humans Services Department (HHS) that allows pharmacists and pharmacy interns to administer vaccines to children between three and 18 years old. 

Launched the AMA Truth in Advertising campaign

The AMA launched the Truth in Advertising campaign, which has been enacted in over 20 states, informing the public about who is and is not a physician. The campaign is designed to ensure patients clearly understand who is providing their health care.

In 2020, AMA worked with 38 states to defeat legislation that would inappropriately expand the scope of practice of nonphysicians that support TIA legislation.

Distributed educational wheels 

The AMA has distributed thousands of “Education Matters” wheels, to legislators and regulators across the country, that compare the education and training of physicians and nonphysicians.

Elimination of the APRN multistate licensure compact

After convening states and specialties, the AMA eliminated the 2015 Advanced Practice Registered Nurse Multistate (APRN) Licensure Compact by defeating every proposed state bill over the last two years. Unlike other health care professional Compacts, the APRN Compact would have circumvented state scope of practice laws.   

Key research & resources

#StopScopeCreep

The AMA’s research provides overwhelming proof that patients want physicians to lead their medical care and the advocacy roadmap.

—Four out of five patients prefer having physicians lead their health care team.
—Seventy-five percent of patients prefer to be treated by a physician.
—Ninety-one percent of patients said that a physician’s years of education and training are vital to optimal patient care, especially in the event of a complication or medical emergency.
—Physicians and nonphysicians practice in the same locations—largely in the highly populated areas of a state.

Resources that set the record straight for policymakers

Draw on issue briefs, model legislation, state bar charts and other resources for background on major topics related to scope of practice.