COVID-19 doesn’t require end-run around scope-of-practice laws

Kevin B. O'Reilly , Senior News Editor

What’s the news: The AMA and 78 physician organizations are urging the Department of Veterans Affairs (VA) to step back on a memo encouraging all VA medical facilities to let certified registered nurse anesthetists (CRNAs) practice without physician oversight during the COVID-19 national health emergency.

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The issue goes beyond CRNAs, however. An April VA directive memorializes VA policy to let health professionals in 32 specialties practice across state lines and encourages facilities to allow health professionals to practice within the full scope of their license, registration or certification. The letter urges the VA to amend the directive to defer to state scope-of-practice laws.

“This combination in effect circumvents state scope of practice laws for the 32 health care professionals defined in the directive. Such a far-reaching expansion is overly broad, unnecessary and threatens the health and safety of patients within the VA system,” says the letter to VA Secretary Robert Wilkie.

Why it’s important: The VA, like many other health care organizations, has been forced by the pandemic to reevaluate its operations. The VA has canceled elective surgeries during COVID-19, and that has given the system the ability to put physicians and other health professionals where they are needed most. Because of that, the letter notes, “there are more than enough physicians to provide care and oversight during this time.”

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That makes “removing physician oversight requirements of CRNAs at the VA overly broad, inconsistent with the situation as it is unfolding outside of the VA, and unnecessary to address the immediate needs raised during the COVID-19 pandemic,” says the letter to Wilkie. “This action by the VA will only serve to disrupt continuity of care and cause confusion among health care teams and their patients.”

Learn more: The AMA and many other physician organizations also have spoken against a recent Centers for Medicare & Medicaid Services move that could undermine doctor supervision across medicine.

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