Scope of Practice

Physician teamwork helps block bad scope of practice bills

Andis Robeznieks , Senior News Writer

AMA News Wire

Physician teamwork helps block bad scope of practice bills

Oct 2, 2023

The Washington State Medical Association (WSMA) partnered with the AMA and national medical specialties to oppose and defeat a torrent of legislative proposals to inappropriately expand the scope of practice for nonphysicians.

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This included scope-expansion legislation for advanced practice registered nurses, optometrists, psychologists, naturopaths, pharmacists, physician assistants and other nonphysician providers such as athletic trainers and music therapists.

“Yes—music therapists,” said Sean Graham, WSMA director of government affairs, during an AMA webinar.

“I want to say thank you to the AMA Scope of Practice Partnership,” he added.

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.

“We were able to have some additional on-the-ground support on these scope of practice issues this year, and I know that we would've had very different outcomes without the grant, without the support from the AMA,” Graham said.

This year, the AMA boosted its annual support of the AMA Scope of Practice Partnership to $300,000 and supported 14 state medical societies with grants—up from seven in 2022.

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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In the AMA webinar, Graham described how the WSMA led the efforts on defeating general scope-creep legislation such as bills that would allow advanced practice registered nurses to practice without physician supervision while following specialty societies’ lead on specialty-specific bills such as allowing optometrists to perform surgical procedures.

Washington was 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.

Washington’s law was one of the more expansive of the test-and-treat bills proposed in state legislatures this year. It would have allowed pharmacists to prescribe for “short-term health conditions” including—but not limited to—urinary tract infections and unspecified “respiratory illness, condition, or disease.”

State legislatures also saw a sharp uptick in proposals to weaken physician-supervision requirements for physician assistants this year, with at least 22 such bills introduced in states across the country compared witht about 10 last year. WSMA’s advocacy helped to defeat this bill in Washington. 

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Most of the scope of practice expansion bills introduced in Washington were defeated, but not all scope battles in the Evergreen State took place in the legislative arena.

Last year, the WSMA helped persuade the Washington Board of Naturopathy that in-office abortions were beyond the scope of naturopaths. And in 2023—after a year of persistent advocacy from the WSMA, Washington State Urological Society, and the American Urological Association—the board ruled that vasectomies were also beyond the scope of practice for naturopaths.

A bill allowing naturopaths to prescribe controlled substances was introduced in the state Senate. It was referred to the Health and Long-Term Care Committee and never called for a vote.

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AMA Scope of Practice Partnership grants also helped support successful efforts to defeat inappropriate scope-expansion bills in Arizona and South Carolina.

The Arizona Medical Association defeated a half-dozen scope expansion bills and preserved patient access to physician-led care. This included bills that would have: 

  • Allowed nurse anesthetists to practice without the direction and presence of a physician.
  • Allowed psychologists to prescribe psychotropic medications.
  • Allowed pharmacists to test for and treat flu and respiratory infections.
  • Removed the prohibition on optometrists performing surgeries.

The AMA joined numerous other physician organizations in signing an American Society of Anesthesiologists letter opposing the nurse anesthetist bill. 

The South Carolina Medical Association, meanwhile, defeated several scope bills, including legislation that would have:

  • Removed physician-supervision requirements for nurse anesthetists.
  • Allowed advanced practice registered nurses to practice without any physician involvement.
  • Expanded physician assistants’ prescriptive authority.
  • Authorized physician assistants to use the title “physician associate.”

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