How scope of practice expansion efforts were defeated in New York

Andis Robeznieks , Senior News Writer

AMA News Wire

How scope of practice expansion efforts were defeated in New York

Sep 6, 2023

State legislatures were inundated this year with inappropriate scope of practice bills seeking to allow—among may other things—nurse practitioners and physician assistants to practice without physician supervision, let psychologists prescribe drugs, permit optometrists to perform eye surgery, and allow pharmacists to treat illnesses.

Fighting scope creep

Patients deserve care led by physicians, the most highly trained health care professionals. The AMA fights for physician-led care nationwide at the state and federal levels.

The Medical Society of the State of New York (MSSNY) collaborated with numerous state specialty societies to defeat some 15 scope of practice expansions that were proposed in legislation or included in Gov. Kathy Hochul’s budget as she sought to extend “flexibilities” in physician assistant scope of practice that ended when the COVID-19 public health emergency expired. Her budget also included a proposal to let pharmacists order laboratory tests without physician coordination.

While MSSNY-specialty alliance fought successfully to remove those items from the governor’s budget, they were soon resurrected in the legislature as New York was one of about twenty states where bills to amend physician assistant practice requirements—including amending or removing requirements for physician supervision or collaboration—had been introduced.

New York was also one of more than 15 states where legislation was introduced to allow pharmacists to test and treat patients over the pharmacy counter without physician involvement.

Other scope of practice expansions introduced in the New York legislature this year included bills to give prescribing authority to psychologists, allow podiatrists to treat conditions of the ankle and leg, let PAs perform fluoroscopy without physician supervision, and permit certified registered nurse anesthetists to administer anesthesia with reduced physician oversight.

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Physician assistants “are invaluable members of the coordinated medical team, but they have far more limited education and training compared to what we received in medical school and residency,” MSSNY President Paul A. Pipia, MD, wrote in a letter to colleagues.

“Please remind your legislators that patients are best served by a team-based approach with a skilled physician overseeing and guiding care and urge them to oppose this legislation,” Dr. Pipia added in the letter.

In addition to having educating physicians on the benefits of physician-led, team-based care, MSSNY’s scope of practice success is attributable to a statewide communications campaign that was supported by a grant from the AMA Scope of Practice Partnership.

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.

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 support of the AMA Scope of Practice Partnership to $300,000 a year and supported 14 state medical societies with grants—up from nine in 2022.

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Battlefield widens with hundreds of scope-creep bills introduced

MSSNY used its grant to produce radio ads (MP3) that played throughout the state, alerting voters to the scope of practice expansion proposals and calling out the differences in education and training between physicians and nonphysicians such as physician assistants and pharmacists.

One radio ad highlighted the budget proposals that would allow physician assistants to practice independently and enable “big box pharmacy retailers to provide care without input from your trusted physician.”

“The best prescription for good health starts with your physician,” the ad said.

These radio spots were supplemented by promoted social media and ads placed in a frequently viewed Albany daily news digest highlighting the negative impact to patients when physicians are removed from the health care team.

The campaign against the psychologist prescribing bill, New York Senate Bill 66A, was bolstered by a letter to state legislative leaders from AMA Executive Vice President and CEO James L. Madara, MD.

“The AMA values the critical role psychologists play in our nation’s health care system, especially considering the increasing need for mental health services,” Dr. Madara wrote in the letter (PDF).

“However, we caution that granting prescriptive authority to psychologists is a misguided and dangerous solution for improving access to mental health services in New York.”

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Dr. Madara noted that family physicians and psychiatrists will have seven to 11 years of post-graduate clinical training before they enter the workforce and, compared with that, the clinical requirements the legislation called for amounted to no more than a “crash course in prescribing.”

“In short, psychologists have no medical training, and a course in prescribing does not constitute a medical education,” the letter adds. “The educational program proposed by this bill cannot substitute for seven to eleven years of training in sciences and the comprehensive education found in the medical model.”

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

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