Advocacy in action: Fighting scope creep

There is certainly room for improvement in the U.S. health system, but allowing nonphysicians such as nurse practitioners (NPs) or physician assistants to diagnose and treat patients without any physician oversight is a step in the wrong direction. The best way to support high-quality care and lower costs is to keep physicians as the leader of the health care team (PDF).

Compared with nurse practitioners, physicians have 20 times more clinical training. And while all physicians get vital hands-on instruction, 60% of NP programs are mostly or completely online. 

Expanding nonphysicians’ scope of practice also increases costs. For example: 

• X-ray ordering rose 441% among nonphysicians. 
• Nonphysicians needed twice the number of biopsies to screen for skin cancer. 
• Patients were 15% likelier to get an antibiotic from a nonphysician. 
• 6.3% of NPs prescribed opioids to more than half of their patients, compared with 1.3% of physicians. 

And patients prefer physician-led care (PDF), with: 

• 95% saying it’s important for a physician to be involved in their diagnosis and treatment. 
• 91% agreeing that a physician’s education and training are vital for optimal care. 
• 75% saying they would wait longer and pay more to be treated by a physician. 

Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. That’s why the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety, and it’s why fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians. 

In addition, the AMA’s Truth in Advertising campaign helps ensure patients can answer the simple question, “Who is a doctor?”, the AMA believes that all health care professionals—physicians and nonphysicians—should be required to accurately and clearly disclose their training and qualifications to patients. 

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In strong collaboration with our state medical association and national medical specialty society partners, the AMA has: 

• Achieved more than 100+ state-level victories to date in 2023 in strong collaboration with our Federation of Medicine partners. 
• Struck down legislation allowing physician assistants to practice independently without physician oversight in Arizona, Colorado, Louisiana, Maryland, New York, Oklahoma and South Dakota. 
• Stopped bills that would have expanded scope of practice for advanced practice registered nurses (APRNs) in Kentucky, Louisiana, Mississippi, Missouri, Tennessee, Virginia and Wisconsin. 
• Defeated legislation that would have allowed optometrists to perform surgery in Alabama, Utah and Washington.
• Beat pharmacist-prescribing bills in Alabama and Louisiana and psychologist-prescribing bills in Hawaii and Washington. 

The AMA is: 

• Pushing the U.S. Department of Veterans Affairs to reject implementation of inappropriate scope of practice expansions through its Federal Supremacy Project to develop national standards of practice for 50 health care occupations, including physicians, APRNs and others. 

Learn more about how the AMA successfully fights scope-of-practice expansions that threaten patient safety. 

• Recently adopted AMA policy on scope of practice. 
• Health Workforce Mapper: Customize and visualize the geographic distribution of physicians and nonphysician clinicians at a state or county level. 
• AMA members can access hundreds of scope-of-practice advocacy tools, including issue briefs, model legislation, state law charts and detailed data modules.

Visit AMA Advocacy in Action to learn more about the advocacy priorities the AMA is actively working on.

The AMA works to generate support for policies critical to the nation’s health care system—and we can’t do it without your help. Learn more about ways to get involved with AMA advocacy.