Scope of Practice

3 tips for proactive physician approach to stop scope creep

Tanya Albert Henry , Contributing News Writer

AMA News Wire

3 tips for proactive physician approach to stop scope creep

Mar 1, 2024

It turns out that “prevention is the best medicine” is also sound advice for staving off inappropriate expansion of nonphysicians’ scope of practice.

While nurse practitioners, physician assistants, psychologists or other nonphysician providers have worked relentlessly to advance so-called scope creep legislation at the state level, the AMA, state medical societies and national specialty societies have pushed back to educate lawmakers and the public about how such measures can increase health care costs, compromise health care quality and put patients at risk. Indeed, the AMA helped defeat more than 100 such bills last year.

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But experts gathered at the 2024 AMA State Advocacy Summit told attendees that physicians don’t always have to be in a reactive mode when nonphysicians seek to practice independent of physician supervision. Physicians can be proactive by:

  • Electing physicians to state and federal offices.
  • Talking to legislators and getting to know your representatives, locally and in Washington.
  • Passing truth-in-advertising laws that boost transparency by informing patients about the education and credentials of the health professionals treating them.

The issue certainly is not going away. An AMA survey showed that 86% of medical association staffers put scope of practice at the top of their legislative priority list this year.

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.

It’s important that patients know whether the person treating them is a physician or nonphysician, said the expert panelists who spoke at the State Advocacy Summit session on scope of practice.

The Georgia Alliance for Patient Protection—with help from an AMA Scope of Practice Partnership grant—was able to pass a truth and transparency law that stops nonphysicians from misappropriating titles. The law says that “deceptive or misleading terms or false representations includes, but not limited to, the use of titles, terms or other words that misstate, unfairly describe, falsely hold out, falsely detail, falsely imply the health care practitioner's profession skills, training, expertise, educational degree, board certification, licensure, work or services offered, or medical field, unless the practitioner is a physician."

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Dermatologist Alexander Gross, MD, previously served on the board of directors of the Georgia Alliance for Patient Protection.

“This is a great law. It requires that the person who's providing the care inform the patient of what their credentials are,” said Dr. Gross, an incoming member of the American Academy of Dermatology’s board of directors.

Further, the law requires that nurse practitioners and physician assistants who have doctoral degrees to tell patients—at each contact and each point of service—that they are nurse practitioners or physician assistants with a doctor degree.

They “have to tell the patient, ‘I'm not a physician,’” Dr. Gross said. “This is the way that we can inform our patients with regard to who they're seeing.”

The AMA Truth in Advertising Campaign has resources (PDF) to support state legislative and regulatory campaigns aimed to ensure that health care professionals clearly and honestly state their level of training, education and licensing whether it is a face-to-face encounter or in advertising, marketing or other communication materials.

Dr. Gross said electing physician legislators is another important way to help fight expanding scope of practice because they will understand these issues better than nonphysician legislators.

“Nobody understands our issues like other physicians,” he said. “I’m guessing that a lot of legislators don’t understand what the short-term and downstream ramifications of scope of practice expansions are.”

In addition to electing physician lawmakers, it’s important that physicians get to know those representing them at the state and federal levels.

Working with the legislators and the Indiana State Medical Association, Indiana passed a law in 2023 that requires EDs to have a physician on site.

The law “came through the work of individuals working together,” said family physician Rebekah Bernard, MD, whose latest book is Imposter Doctors: Patients at Risk. “Everyone working in this room: you can make a difference.”

Fight scope creep