8 things we learned about scope creep this year

This year saw hundreds of bills introduced across the nation to inappropriately expand scope of practice for nonphysician providers such as nurse practitioners, advanced practice registered nurses, optometrists, psychologists, naturopaths, pharmacists, physician assistants, athletic trainers and—yes—even music therapists.

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. Find out how the AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.

New research, some aided by the AMA Health Workforce Mapper but much it conducted by physicians and experts outside the AMA, is reshaping our understanding of how scope of practice expansions affect health system costs, care quality and more.

Here are eight things we’ve learned this year.

1. The cost of scope creep starts in the millions

   1. Ninety-five percent of U.S. voters believe it's important to have a physician involved in diagnosis and treatment decisions. Two recent studies show that this type of physician-led, team-based care also is—contrary to the rhetoric—more cost-effective and beneficial than care provided independently by nonphysician providers. 

2. Nurse practitioners are suing for right to use the “doctor” label

   1. Three nurse practitioners who earned doctorates of nursing practice sued the state of California, saying that they have earned the right to tout themselves using the term “doctor.” The nurse practitioners claimed a California statute that only allows California-licensed allopathic and osteopathic physicians to use the terms “doctor” and “Dr.” was unconstitutional. The law has been on the books since at least 1937 to avoid patient confusion over the level of education their health professionals have achieved.

3. The difference between physicians and nurse practitioners is huge

   1. When considering the potential negative effects on quality and safety of proposed scope of practice changes that would give nurse practitioners more latitude to practice independently, that is the place to start.
   2. Nurse-practitioner programs generally last two to four years, however, some nurse practitioners can get their degree in as little as 18 months after becoming an RN. Online-only programs are allowed.
   3. Physicians, by contrast, must complete four years of medical school to earn a degree as an MD (a doctor of medicine) or a DO (doctor of osteopathic medicine). There are no online medical schools. Plus, physicians spend another three-to-seven years in a residency program to hone their skills.

4. Doctors wish patients knew these basics about scope of practice

   1. There are activities and duties that a person licensed to practice as a health professional is permitted to perform. This is called scope of practice, as explained in this entry in the AMA’s What Doctors Wish Patients Knew™ series.
   2. While every health professional has an essential role to play in caring for patients, the high-stakes field of medicine demands the leadership that comes with the education, experience and acumen of a fully trained physician. As part of a physician-led team, though, other health professionals can—and do—help deliver safe and high-quality care to patients.

5. Future physicians are seeing the impact of scope creep

   1. The role that a medical student will play on the care team will evolve into one of increasing expertise and execution as they complete four years of medical school, plus three to seven years of residency, including 12,000–16,000 hours of clinical training. But how will that role—and patient care—be shaped by the growing practice role of nonphysician providers such as physician assistants and nurse practitioners?
   2. Nurse practitioners, for example, complete as little as two years of graduate level education, have no residency requirement, and complete just 500–750 hours of clinical training. As future physicians, medical students have a unique vantage point on the issue of scope of practice expansion. Three rising fourth-year medical students offered their insights on why it matters for their future in the field of medicine.

6. A VA effort threatens to undermine state scope of practice standards

   1. A yearslong Department of Veterans Affairs (VA) effort called the Federal Supremacy Project threatens to override state scope of practice laws and doesn’t put veterans first.
   2. “This project concerns me because I believe veterans—my shipmates—will receive lower quality of care if this project is implemented,” said Jesse M. Ehrenfeld, MD, MPH, AMA president and a former Navy commander who receives his care through the Veterans Health Administration.

7. Emergency departments must be led by physicians

   1. At the 2023 AMA Annual Meeting, the House of Delegates directed the AMA to advocate the establishment and enforcement of legislation or regulations that ensure only physicians supervise the provision of emergency care services in an emergency department.
   2. The AMA is collaborating with relevant stakeholders including state and specialty societies to oppose legislation or regulation allowing pharmacists to test, diagnose and treat medical conditions—a scope of practice expansion that was introduced in 17 states this year.

8. Physician teamwork helps block bad scope of practice bills

   1. State medical associations have partnered with the AMA and national medical specialties to oppose and defeat more than than 100 state legislative proposals to inappropriately expand the scope of practice for nonphysicians.
   2. The AMA Scope of Practice Partnership is a coalition of 109 state medical associations, national medical specialty societies and osteopathic organizations. Since its launch in 2007, the partnership has awarded more than $3.5 million in grants to member organizations to fund advocacy tools and campaigns. This year, the AMA boosted its annual support of the partnership to $300,000 and supported 14 state medical societies with grants—up from seven in 2022.

Find out in detail why education matters to medical scope of practice, with information on:

• Nurse practitioners compared with physicians.
• Physician assistants compared with physicians.
• Nurse anesthetists compared with anesthesiologists.
• Psychologists compared with psychiatrists.
• Naturopaths compared with physicians.

Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA works on.

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