Scope of Practice

Letting APRNs order diagnostic imaging could worsen overuse

Kevin B. O'Reilly , Senior News Editor

What’s the news: The Medical Association of Georgia  and the AMA are urging Georgia Gov. Brian Kemp to veto a state Senate bill that would allow advanced practice registered nurses (APRNs) to order CT scans, MRIs and other advanced diagnostic imaging because the move is likely to “increase health care costs and threatens the health and safety of patients in Georgia.” 

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In a letter to Kemp, AMA Executive Vice President and CEO James L. Madara, MD, noted multiple studies finding that one type of APRN—nurse practitioners (NPs)—order more diagnostic imaging than do doctors.

“For example, a study in the Journal of the American College of Radiology which analyzed skeletal x-ray utilization for Medicare beneficiaries from 2003 to 2015 found ordering increased substantially—more than 400% by nonphysicians, primarily nurse practitioners and physician assistants during this time frame,” Dr. Madara wrote.

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Meanwhile, a study published in JAMA Internal Medicine shows that, following an outpatient visit, NPs ordered more diagnostic imaging when compared with primary care physicians. The study’s authors “opined this increased utilization may have important ramifications on costs, safety and quality of care. They further found greater coordination in health care teams may produce better outcomes than merely expanding NP scope of practice alone,” Dr. Madara noted.

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Why it’s important: Each member of the physician-led health care team has an important role to play, working together to drive improvements in patient care. But the skill sets of the APRNs and other health professionals “are not interchangeable with that of fully trained physicians,” Dr. Madara wrote to Kemp.

NPs have no requirement for residency training and obtain about 500–720 hours of clinical training. “By sharp contrast, physicians complete four years of medical school plus three to seven years of residency, including 10,000–16,000 hours of clinical training,” Dr. Madara wrote. He also noted that NPs and primary care doctors tend to practice in the same large urban areas, thus belying the argument expanding APRNs’ scope of practice will increase access to care in rural or underserved areas.

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

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