Scope of Practice

3 bills to expand scope for nurse practitioners die in committee

Tanya Albert Henry , Contributing News Writer

AMA News Wire

3 bills to expand scope for nurse practitioners die in committee

May 16, 2024

Mississippi patients can rest assured that any care they receive from advanced practice registered nurses will continue to be supervised by physicians.

After active opposition from the Mississippi State Medical Association and the AMA, lawmakers in the state House of Representatives killed three bills that would have allowed advanced practice registered nurses to practice without physician supervision. That includes a bill that would have let certified registered nurse anesthetists who had just graduated to independently administer anesthesia despite completing far less training in and out of the classroom than anesthesiologists.

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Before the bills died in committee, the AMA sent a letter to the chairman of the state House Public Health and Human Services Committee as well as the speaker of the House expressing “strong opposition” to House Bills 821, 1490 and 1652 and urging lawmakers to “stand up for patients and oppose” the bills.

“These bills significantly weaken the existing collaborative practice requirements found in Mississippi law and effectively remove physicians from the health care team altogether. Multiple studies have shown that doing so will worsen health outcomes for Mississippi patients and lead to higher costs—all without improving access to care in rural areas,” wrote James L. Madara, MD, the AMA’s CEO and executive vice president.

Patients don’t want to see bills like the ones proposed to become law, Dr. Madara wrote. He noted that 95% of U.S. voters who participated in a recent survey said it was important for a physician to be involved in their diagnosis and treatment decisions and 63% surveyed opposed allowing nurse anesthetists to perform anesthesia without physician oversight.

The AMA last year played a role in helping defeat 100 bills in state legislatures that threatened patient safety by proposing nonphysicians be allowed to engage in patient care that they aren’t trained to provide. Those working at state and national specialty medical associations ranked scope of practice issues their top legislative priority in 2024.

Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians.

Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.

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The Mississippi State Medical Association worked hard to ensure the bills did not become law. With support from the AMA, they engaged lawmakers and the public on the dangers of removing the physician safety net from the health care team, said Claude Brunson, MD, the association’s executive director.

They did this through billboards, radio spots and geofenced ads in and around the state capitol. There was also, among other things, a grassroots outreach campaign and a white-coat rally that included physicians, residents and medical students when members of the House Public Health and Human Services Committee debated the most egregious of the three bills.

Advanced practice registered nurses “practicing unsupervised in our state would inevitably create two systems of health care and put patients at risk,” Dr. Brunson said. “That would be particularly devastating in Mississippi because we have the unhealthiest population in the country.”

Dr. Brunson said a landmark study conducted by leaders at Mississippi’s Hattiesburg Clinic showed that per-member, per-month spending was $43 higher for patients whose primary health professional was a nonphysician instead of a doctor. That could translate to $10.3 million more in spending annually if all patients were followed by nonphysician providers, said the analysis from Hattiesburg Clinic, which is a member of the AMA Health System Program.

“We believe in and are committed to every patient in Mississippi receiving the safest and highest level of health care possible, and that is through a physician-led team,” Dr. Brunson said.

Learn more with Dr. Brunson about scope of practice trends in the Magnolia State in a recent episode of “AMA Update.” 

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There is a vast difference in training between physicians and nurses, the AMA’s letter to Mississippi lawmakers explained. Physicians must complete 12,000–16,000 hours of clinical training during medical school and residency. Meanwhile, nurse practitioners, the most common type of advanced practice registered nurse, attend a two- or three-year program, have no residency and complete 500–750 hours of clinical training.

In studies, nurses have said they do not always have confidence in their preparedness and ability to practice independently upon graduation. For example, one study found that “75% of nurse-respondents indicated they were either ‘not confident’ or only ‘somewhat confident’ in their ability to interpret basic skeletal radiographs,” Dr. Madara noted.

Meanwhile, a 2022 study examining care that nurse practitioners provided independently in Veterans Administration emergency departments  found that nurse practitioners used more resources than physicians, including X-rays, CT scans and formal consults and increased the cost of ED care by 7%, or about $66 per patient compared with physicians. Continuing to staff EDs with nurse practitioners at that rate would have a net cost of $74 million per year compared to staffing the emergency department with only physicians, the study found.

“While nurse practitioners are valuable members of the health care team, this study reinforces that they are not a replacement for a physician,” Dr. Madara wrote.

“Rather than support an unproven path forward, legislators should consider proven solutions to increase access to care and reduce health care costs, including supporting physician-led team-based care,” Dr. Madara wrote, encouraging lawmakers to work with the AMA and the Mississippi State Medical Association to find a path that would solve the state’s access to care problems. That would involve “

expanding coverage and payment for high-quality telehealth and state funding for graduate medical education to increase the physician workforce.”

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