Emergency departments (EDs) are a critical and increasingly strained gateway to healthcare in the U.S. They provided more than 155 million visits and accounted for over 17 million hospital admissions in 2025 alone, according to an AMA Council on Medical Service report whose recommendations were adopted at the 2026 AMA Interim Meeting.
Given the pivotal role of EDs in American healthcare, it is essential that patients get the clarity they deserve that when they enter an “emergency department” for care, they have immediate access to a physician for care, no matter the time of day.
Patient expectations for physician-led emergency care often don’t match up with staffing realities, particularly in rural and other low-volume hospitals. According to a 2021 poll, some 80% of patients said they most trusted a physician to lead their ED medical care, yet one in 13 EDs did not have one or more on-duty attending physicians at all times.
An increasing number of facilities, including EDs, are substituting physicians with nonphysician providers, the council’s report says, adding that the trend is “concerning because physician-led care provides a level of training, scope and clinical judgment that differs from care provided by nonphysicians.”
To support the healthcare system’s efforts to meet demand in the ED and also satisfy patients’ expectations for quality of care in that setting, the AMA House of Delegates adopted policy to support:
- The development of standardized emergency department descriptors that reflect a facility’s level of on-site physician coverage and available services, easily discernible by the prudent layperson, recommending that emergency care facilities without a dedicated on-site physician use these standardized ED descriptors to promote truth and transparency for patients.
- Limiting the designations “emergency department” and “emergency room” to facilities that meet Emergency Medical Treatment and Labor Act (EMTALA) requirements and provide 24/7 coverage by a qualified physician who is immediately available in person, and allowing any EMTALA-covered facility that meets those requirements to be classified as an emergency place of service for billing purposes.
- Requiring facilities without continuous on-site physician staffing to prominently disclose, through physical and online signage, that physicians are not continuously on duty and on-site, and support requiring advertisements for such facilities to include the same disclosure, consistent with Federal Trade Commission guidelines.
- Community engagement to improve the education of patients and allow other healthcare team members to promote efficient and site appropriate care.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
Working in close collaboration with more than 40 state medical associations and national medical specialty societies this year, the AMA has successfully blocked over 90 bills that would have inappropriately expanded the scope of practice for physician assistants, optometrists, pharmacists and more.
Who’s a physician? Signs, listings should be clear
Patients ought to be able to clearly identify and understand the qualifications and credentials of the individuals involved in their care. Yet studies have demonstrated that in clinical settings where both physicians and nonphysicians provide care, patients have been unable to determine whether they were evaluated or treated by a physician, a nonphysician or both.
To help further inform patients about who is delivering their care, the AMA modified existing policy to “advocate that, in all printed and electronic materials, signage, directories and listings in clinical departments, hospitals, healthcare facilities and similar settings, physicians be listed separately from nonphysicians and that this distinction be clear and unambiguous.”
Physicians should lead pain clinics
Interventional pain medicine is a physician specialty that requires completion of medical school, residency and a dedicated fellowship year devoted specifically to the diagnosis, risk stratification, image-guided procedural technique and longitudinal management of chronic pain. It is training that no nonphysician pathway requires or replicates, says a resolution introduced at the Interim Meeting.
Patients, though, are frequently unable to determine—from clinic names, advertising or signage alone—whether the professional diagnosing their pain condition, recommending a procedure, performing an invasive intervention or managing their follow-up care is a physician.
Add to that, certified registered nurse anesthetists (CRNAs) and other nonphysician providers in Kentucky and surrounding states are increasingly establishing and operating so-called "pain institutes,” which are freestanding pain clinics that independently diagnose, select and perform complex interventional pain procedures without onsite physician supervision. This is in direct conflict with the training, credentialing and safety standards required of physicians practicing in the specialty.
To address this trend, the AMA House of Delegates adopted policy to “oppose the independent, unsupervised establishment and operation of pain clinics, pain institutes or similar facilities by certified registered nurse anesthetists or other nonphysician clinicians, and oppose any expansion of scope of practice permitting the independent performance of complex interventional pain procedures consistent with AMA policy.”
Delegates also directed the AMA to:
- Call upon relevant state licensing and other state and federal regulatory bodies to investigate pain clinics reasonably suspected of allowing nonphysicians to practice outside applicable scope-of-practice laws, or including physician-oversight requirements, and to enforce, where applicable, laws requiring physician ownership of pain clinics.
- Advocate for enforceable transparency standards in advertising, clinic naming, informed consent and other patient-facing communications that clearly identify the credentials and roles of the clinicians responsible for diagnosis, procedural selection, procedural performance and longitudinal management.
Read about the other highlights from the 2026 AMA Interim Meeting.
