With 40 state legislatures having adjourned for the year, the tally is in on this year’s scope of practice activity, and it once again reflects nonphysicians’ relentless efforts to expand their legal authority to deliver care without doctors’ supervision.
As part of its long-running efforts to fight scope creep, the AMA is defending the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
Every year, the AMA works with state medical associations to defeat such legislation. The AMA has issued a detailed brief outlining 2025 state scope of practice legislative activity (PDF). So far this year, more than 150 bills that were designed to expand the scope of practice for nurse practitioners, nurse anesthetists, physician assistants, optometrists, pharmacists, psychologists and others have been defeated.
As detailed in the AMA’s issue brief, here are some highlights of how bills have fared with regard to various types of nonphysicians.
Nurse practitioners (NPs) have generally backed legislation to remove or weaken physician involvement in practice by nurse practitioners, or to expand what fits within a nurse practitioner’s scope of practice, for example ordering home health services or signing death certificates. Overall, 33 bills were defeated across 15 states.
Nurse anesthetists (CRNAs) continue to seek removal of physician direction, oversight, or supervision when providing anesthesia services or pain care. Twenty bills were defeated in 12 states.
Physician assistants (PAs) sought legislation to weaken or remove physician supervision or collaboration requirements for physician assistants. Twenty-two bills were defeated across 13 states.
Optometrists have sought legislation that would allow them to perform surgery or administer injections in the human eye. Eleven bills were defeated in eight states.
Pharmacists have pursued legislation that would allow them to diagnose and prescribe medications for patients, typically based on the results of a CLIA-waived test or for specific conditions, such as flu, strep throat and RSV—though in some cases for “minor conditions.” More than a dozen such bills in eight states were defeated.
Psychologists are pushing for legislation to give them prescribing authority or expand existing authority. Such bills were defeated in 11 states.
As detailed in the AMA’s legislative update, some bills expanding scope of practice for these various types of nonphysicians have passed in 2025, and other bills are stagnant or not yet technically defeated. Yet the track record shows the impressive impact that the AMA has had in working with state medical associations and national specialty societies to educate lawmakers and the public on the potential dangers of scope creep.
That includes engaging in Congress, where the AMA and 80 leading physician organizations have sounded the alarm about a bill that is gaining traction and would let pharmacists evaluate, diagnose and treat patients in cases that now require physician oversight. The bill’s passage would result in more misdiagnoses, as well as siloed, delayed and incomplete care, leading in turn to worse patient outcomes and higher health care costs.
Such advocacy resonates with patients, with an AMA survey of U.S. voters finding that 95% of respondents (PDF) said it is important to them for a physician to be involved in diagnosis and treatment decisions. Learn more with the AMA about what sets apart physicians and nonphysicians.
Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
Also, discover great resources from the AMA that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.
Stay up to date on fight against scope creep
See how the AMA defends against scope of practice expansions that threaten patient safety.
