So far this year, more than 150 bills that were designed to expand the scope of practice for nurse practitioners, nurse anesthetists, physician assistants, optometrists, pharmacists, psychologists and others have been defeated.
With a series of four substantial policy actions taken at the 2025 AMA Interim Meeting this week in National Harbor, Maryland, the House of Delegates has strengthened the AMA’s capacity to fight scope creep and defend the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
Safeguarding laser surgery
Among the state bills put forward to expand nonphysicians’ scope of practice are proposals that would allow nonphysicians such as optometrists to perform surgery, including laser surgery.
The AMA already had policy specifying that laser surgery should only be performed by individuals either licensed to practice medicine and surgery or within those categories of practitioners licensed by states to perform surgical services.
This policy should, however, be modified “to more clearly align with AMA policy on surgery, physician-led care and the definition of physician,” according to an AMA Board of Trustees report whose recommendations were adopted at the Interim Meeting.
To that end, delegates modified existing AMA policy to say that laser surgery should only be performed by:
- Licensed physicians—defined as individuals who have a doctor of medicine, doctor of osteopathic medicine or a recognized equivalent physician degree and who would be eligible for an Accreditation Council for Graduate Medical Education residency—who meet appropriate professional standards.
- Those categories of practitioners who are appropriately trained, credentialed and currently licensed by the state to perform surgical services, and are working under the direct supervision of a physician who possesses appropriate training and privileges in performance of the procedure being supervised.
Delegates also modified existing AMA policy on surgery performed by optometrists to:
- Support legislation prohibiting optometrists from performing surgical procedures as defined by relevant AMA policies.
- Encourage state medical associations to support state legislation and rulemaking prohibiting optometrists from performing surgical procedures as defined by relevant AMA policies.
Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
Doula care in the physician-led team
“Doulas can play an important role in maternal care, as part of a physician-led care team, if they strictly adhere to their nonclinical support role,” according to an AMA Board of Trustees report whose recommendations were adopted.
“As part of this, especially if funding for doula services will be incorporated into Medicaid funding, it is imperative to ensure that doulas are required to undertake adequate training so that they can provide the necessary support to birthing individuals and their families within the scope of their support role,” the report says.
“There should be oversight of doula services that help ensure that doulas provide only nonclinical support, ensure that licensure is a required component of providing services, confirm that doulas are overseen by an appropriate disciplinary board, and [confirm] that doulas obtain liability insurance. Moreover, access to and payment for doula services should never compromise patient access to and payment for physician services.”
To support doula care programs, delegates adopted new policy to “recognize that access to doula services for pregnant and birthing individuals can have a positive impact on birth outcomes.”
The newly adopted policy says the AMA supports doula services when these professionals provide nonclinical peripartum and birthing support, and when such doulas:
- Possess registrations, licenses or certifications that include training specifically limited to nonclinical support and adhere to state certification requirements.
- Retain registrations, licenses or certifications that are continuously monitored and overseen by a disciplinary board within the state that the doula is certified and delivering services.
- Obtain liability insurance that has an adequate level of coverage.
- Fully disclose relevant training, experience and credentials to help patients understand the scope of nonclinical support the doula is qualified to provide.
- Work in partnership with a physician-led care team.
- Do not compromise access to physician care.
Ban deceptive ads on nonphysicians’ training
The AMA Truth in Advertising Campaign works to ensure that physicians and other health professionals clearly and honestly state their level of training, education and licensing. Patients deserve to have this information when in face-to-face encounters as well as when they read health care providers’ advertising, marketing and other communications materials.
Now the House of Delegates has acted to bolster this effort to address misleading advertising claims by universities offering educational programs aimed toward nonphysician providers that dismiss or even omit physician supervision. This has been seen, for example, in advertising training for pathologists’ assistants, according to a resolution introduced by the College of American Pathologists.
To help head off deceptive advertising in accredited allied health professional, nonphysician graduate programs, delegates adopted the resolution, which creates new AMA policy to “support state and national medical societies to advance ‘truth and transparency’ legislation, inclusive of accredited allied health professional, nonphysician graduate education programs, to instill transparency in nonphysicians’ scope of practice and training under the direction of a licensed physician.”
The delegates also directed the AMA to advocate legislation and refinements to truth-and-transparency laws to prohibit production and dissemination of deceptive advertising and marketing materials by accredited allied health professional, nonphysician graduate programs. These requirements should:
- Prohibit deceptive, misleading or false advertising inclusive of professional titles and scope of the allied health professional completing the program.
- Require that the advertised course of study at such programs is clearly consistent with applicable state laws and well-established and widely accepted medical standards for allied health professionals’ training, certification and scope of practice.
- Mandate all advertising materials include clear and unambiguous statements that clarify the requisite levels of physician supervision for nonphysician, allied health professionals that will complete the program.
Study nonphysician providers’ specialty switching
In a separate action, delegates took action on the growing phenomenon of physician assistants and nurse practitioners who move between specialty areas of care.
The newly modified policy says the AMA will continue to support research:
- On the workforce, including surveys by state medical and nursing boards, that specifically focus on gathering information on nurse practitioners and physician assistants practicing in specialty care, their certifications, alignment of their certification to their specialty, and whether they have switched specialties during their career.
- That evaluates the impact of specialty switching by nurse practitioners and physician assistants on the cost and quality of patient care.
Read about the other highlights from the 2025 AMA Interim Meeting.
