Advocates of expanding scope of practice for nonphysician providers often argue that doing so will ultimately result in greater access to health care and less expensive costs for patients.
But the argument is belied by the reality of practice patterns, according to Michael Suk, MD, JD, MPH, MBA, chair-elect of the AMA Board of Trustees. Data from the AMA Health Workforce Mapper has demonstrated, in state after state, that nonphysician providers tend to practice in the same areas as physicians.
Inappropriately expanding nonphysicians’ scope of practice does not improve access to care, noted Dr. Suk, professor and chair of the Musculoskeletal Institute and the Department of Orthopaedic Surgery at Geisinger health system.
In fact, scope creep such as nurse practitioners working without physician oversight, pharmacists making diagnoses, or optometrists performing surgery can lead to more expensive care compared with physician-led care teams.
"Sometimes people mistakenly believe that this will solve access problems when it comes to health care or ultimately try it as a way to save money," Dr. Suk said. "Several studies have shown that neither of those things are really true."
Dr. Suk discussed what concerns him about scope creep and how Geisinger has adopted physician-led care teams in a recent episode of “AMA Update.” Geisinger is a member of the AMA Health System Program.
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.
A primary difference between physicians and nurse practitioners or physician assistants is the level of training each receives. Dr. Suk reflected on his own educational experience to highlight the disparity.
"A physician goes through four years of university, typically," he said. "We then go to four years of medical school. Following which, in orthopaedic surgery – we do five years of training and oftentimes post-graduate fellowship training for another year."
By comparison, physician assistant programs are often less than three years in length after undergraduate studies do not have a residency requirement.
"It covers basic science, pharmacology, clinical medicine, behavioral science, but it's purposely set up so that they can continue on-the-job training under the supervision of a physician," he said. "Nurse practitioners are along a similar, shortened pathway in order to get their training."
Dr. Suk estimated that physician assistants get about 2,000 hours of supervised clinical practice as part of their training. Between medical school clinical rotations and residency training, he estimated physicians accumulate between 12,000 and 16,000 hours of patient-care experience.
Numerous studies have shown that nonphysician providers order more tests than physicians, which can lead to higher costs and potentially put patient safety at risk.
"Physician-led teams can ultimately help mitigate that trend," Dr. Suk said. "Ultimately, it's about teamwork."
Physician assistants and nurse practitioners play a critical role in patient care, Dr. Suk reiterated, but physician-led teams are the best way to provide health care to patients.
“At Geisinger, I think we really are a model of the team-based approach that really works very well,” he said. “We have physician-led teams. We have very careful supervision of those teams. We, actually, even as an academic environment, have created real synergies between physician assistants, nurse practitioners and our residents and students - helping to shape the future of physician-led team-based care.”
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