Scope of Practice

New Jersey rejects bill to weaken doctors’ role as care team leaders

Kevin B. O'Reilly , Senior News Editor

What’s the news: Lawmakers in New Jersey this week opted against moving forward with legislation that would have allowed advanced practice registered nurses (APRNS) to prescribe without any physician oversight. The legislation (Senate bill 1961 and the identical Assembly bill 854) would have also given APRNs full signatory authority, meaning they could have signed off on any document requiring a physician signature by law.

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The New Jersey Senate’s health committee moved the bill to the floor in June 2019, but the state’s physicians were able to persuade lawmakers against taking up the bill to weaken the physician-led health care team during the 2018–2019 legislative session that closed Monday. Most states do not allow APRNs to prescribe independently.

The AMA Scope of Practice Partnership gave the Medical Society of New Jersey a grant to support its efforts to defeat the legislation. In 2019 alone, the AMA State Advocacy Resource Center worked with 35 states and secured more than 50 victories on scope-of-practice issues. That includes Mississippi Gov. Phil Bryant’s decision to maintain Medicare’s physician-supervision requirements for certified registered nurse anesthetists.

Learn more about AMA efforts on scope of practice.

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Why it matters for patients and physicians: The difference in the education and training of physicians and other health professionals is vast. Physicians complete between 10,000 and 16,000 hours of clinical education and training—that’s four years in medical school and another three to seven years of residency training. By comparison, APRNs complete between 500–720 hours of clinical training after two or three years of graduate-level education.

Thirty-five states representing more than 85% of the U.S. population require some physician supervision or collaboration of nurse practitioners, one type of APRN.

The issue of doctors’ leadership role within the health care team also is surfacing at the federal level, where the Centers for Medicare & Medicaid Services (CMS) has requested information pursuant to a presidential executive order that aims, in part, to weaken physician supervision requirements.

Patients “deserve care led by physicians—the most highly educated, trained and skilled health care professionals,” says a letter to CMS Administrator Seema Verma from the AMA and nearly 100 other organizations representing hundreds of thousands of doctors nationwide. A physician-led care team is especially needed in the management of medically vulnerable Medicare patients.

“We cannot and should not allow anything less,” says the letter, which notes that four out of five patients prefer that doctors lead their health care team. That preference for the physician-led care team rises to 86% among patients with one or more chronic conditions.

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What’s next: Implementing President Trump’s executive order policies would require a combination of congressional and regulatory actions. The administration is at the beginning of the regulatory process. The AMA will actively engage the administration on these and other issues outlined in the executive order.

Meanwhile, the 2020–2021 New Jersey legislative session opened Jan. 16.

Each year, in nearly every state, nonphysician health professionals lobby state legislatures and regulatory boards to expand their scope of practice. While some scope expansions may be appropriate, others definitely are not.

Through resources, research and the Scope of Practice Partnership, the AMA has what you need to advance your scope of practice advocacy agenda.