Scope of Practice

Don’t expand scope of practice for already overworked pharmacists

Kevin B. O'Reilly , Senior News Editor

What’s the news: The AMA is opposing legislation (PDF) introduced in the U.S. House of Representatives that would inappropriately allow pharmacists to furnish services that would otherwise be covered if they had been provided by a physician, despite pharmacists not having the same extensive education and training as physicians.

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The bill is H.R. 1770, the “Equitable Community Access to Pharmacist Services Act,” which would allow pharmacists to test and treat patients for COVID-19, respiratory syncytial virus (RSV), influenza and potential future illnesses related to a public health emergency. It would also expand Medicare payment for pharmacists. 

The AMA opposed (PDF) legislation with the same title in the last session of Congress and, despite the modifications to the version introduced in the 118th Congress, the bill still expands pharmacists’ scope of practice in a manner that threatens patient safety. The bill, sponsored by Rep. Adrian Smith, R-Neb., and co-sponsored by Brad Schneider, D-Ill., has been referred to the House Energy and Commerce Committee.

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.

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Why it’s important: Pharmacists are well-trained as medication experts within an interprofessional team; however, their training in patient care is limited. Most of the Doctor of Pharmacy (PharmD) curriculum across the country consists of instruction in applied sciences and therapeutics.

Residency training is not required, and the overwhelming majority of pharmacists working in the community setting have not undergone residency training. Additionally, their limited “practice experiences” training is not focused on providing medical care to patients.

That’s why the AMA is especially concerned with new language in H.R. 1770 that would permit pharmacists to evaluate and manage patients for the testing or treatment of COVID-19, flu, RSV or streptococcal pharyngitis. 

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“While we greatly value the contribution of pharmacists to the physician-led care team, their training is not equivalent to the four years of medical school, three to seven years of residency training, and 10,000–16,000 hours of clinical training that is required of physicians,” AMA Executive Vice President and CEO James L. Madara, MD, said in a letter to Reps. Smith and Schneider. “In short, pharmacists do not have the education and training necessary to assume the role of a physician and this fact in isolation raises serious concerns about the underlying merits of this legislation.”

Additionally, pharmacists in the community setting report that they already have so much work to do that everything cannot be done well. Scope-of-practice expansions such as the one proposed in this bill only add further responsibilities to an overburdened pharmacist workforce and threaten patient safety due to their insufficient training in these activities. 

“The problem appears systemic,” Dr. Madara wrote in his letter, citing survey research showing that 91% of community pharmacists rated their workload as “high or excessively high.”

Pharmacists identified these as the most common “highly stressful” aspects of their professional lives:

  • Having so much work to do that everything cannot be done well.
  • Working at current staffing levels.
  • Fearing that a patient will be harmed by a medication error.

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For these reasons, Dr. Madara wrote, “it is inappropriate to authorize pharmacists to diagnose, prescribe or assume the role of a physician.”

While ensuring access to community-based health care is important, the solution is not having overworked pharmacists offer care that they are not trained to provide. 

Learn more: 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.

Physicians are trained to lead, and the AMA stands in strong support of physician-led health care teams. Over 90% of patients say that a physician’s years of education and training are vital to optimal patient care, especially in the event of a complication or medical emergency. 

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