Scope of Practice

What physicians need to know about scope of practice expansion with Kimberly Horvath, JD [Podcast]


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AMA Update

What physicians need to know about scope of practice expansion with Kimberly Horvath, JD

Feb 2, 2023

In today’s AMA Update, Kimberly Horvath, JD, senior attorney with AMA’s Advocacy Resource Center, talks about scope of practice expansion in health care and the AMA’s efforts to address it on behalf of physicians at the state level. AMA Chief Experience Officer Todd Unger hosts.

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  • Kimberly Horvath, JD, senior attorney, Advocacy Resource Center, AMA

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The AMA is your powerful ally, focused on addressing the issues important to you, so you can focus on what matters most—patients.

Unger: Hello, this is the AMA Update video and podcast. Today we're talking about scope of practice expansion in the AMA's efforts to address this important issue on behalf of physicians and patients at the state level. I'm joined by Kimberly Horvath, a senior attorney with the AMA's Advocacy Resource Center in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Kim, it's a pleasure to have you back.

Horvath: Thanks, Todd. It's a pleasure to be here today.

Unger: Well, we just wrapped up the AMA's annual State Advocacy Summit. A key part of the agenda was focused on scope of practice. So before we dive into some of the specifics coming out of the meeting, let's talk a little bit about some of the basics. This is not a new issue to the AMA. We've been working on this for now 30 or more years, of course, at the state and federal levels. Why does this continue to be such a hot topic and priority for physicians and the AMA?

Horvath: Yeah, that's a great question, and I think, really, it comes down to the patients and ensuring that patients continue to have access to physician-led care. We know that patients want and expect physicians involved in their health care. In a recent survey, 95% of patients said they want physicians involved in their health care diagnosis and treatment decisions. So that's kind of the cornerstone of it all, right there.

We know that patients value the education and training of physicians and that they trust physicians to provide their medical care and that when patients go to the doctor, it's because they have a concern about their health. And they're looking for answers, and they're looking for a diagnosis and the right course of treatment. And it's very personal. Every patient is different, and physicians, because of their education and training, are trying to pick up those differences and nuances among patients and provide them that personal level of care that they want and expect.

It's also a priority for our partners at the state level. Every year, we do a survey with state medical associations and national specialty societies to gauge their legislative priorities for the year, and once again, scope of practice continues to top that list.

Unger: And, Kimberly, those differences that you referred to in terms of education and training are quite extensive. And to your point about state level, let's talk a little bit about that, wanting to start by talking about quick overview of which state legislatures are currently in session.

Horvath: Yeah. So currently, legislatures in 45 states are in session, with the remaining five states scheduled to begin in the next few weeks or months. Most of the states will wrap up by the end of June or before then, although a couple of states will continue their legislative sessions throughout the entire year. So as you can imagine, this is our busiest season as we track legislation that is being introduced across the country, including legislation on scope of practice.

Unger: So I'm imagining there's no small challenge there. It's like having 45 different fronts, so to speak, that you're looking at. What types of bills are we seeing right now?

Horvath: Yeah. So, unfortunately, we're seeing a number of scope bills, as I mentioned. We're closely following about 60 bills across the country just at this time. And, as I said, many states are just starting their sessions. So already tracking about 60 bills across the country and this includes anything from legislation that would allow pharmacists to prescribe medications to patients based solely on a test performed at the pharmacy. And this would include things like the flu, RSV, strep infections or urinary tract infections.

Very concerning for us, because pharmacists play an important role as medication experts on the health care team, but they're not trained like a physician. They don't attend medical school and they don't attain the clinical judgment to perform medical exams or diagnose patients. We're also tracking legislation on psychologists. Psychologists who have no medical training would like to prescribe psychotropic medications and are looking for that authority in some states.

We're also tracking legislation that would allow nurse anesthetists to provide anesthesia care without any physician involvement, and, of course, we're tracking legislation that would expand the scope of practice of nurse practitioners, other advanced practice registered nurses and physician assistants, and much of that legislation is really would, effectively, remove physicians from the health care team. And I'll just note that a lot of these bills, we actually saw last year and they were defeated. A lot of them are back again, but that's the work that we do. And our work continues.

Unger: So that's a pretty extensive list and a lot of concerns, and I think some folks might not be aware of how the AMA works at the state level on behalf of physicians. Can you describe the process of those kind of partnerships?

Horvath: Yeah. So I think it really falls into three buckets. One is providing tools and resources. So we have things like this—I'll do a little visual—our scope wheels, which provide an overview, a very quick glance, at the difference in education and training of physicians and non-physicians, and we provide those to state medical associations across the country. We provide detailed information on the difference in education and training because, as you mentioned, this is critically important for lawmakers to understand, and I think sometimes they're surprised to learn about the vast difference in the education and training of physicians and non-physicians.

We also provide data, and I would say this kind of falls into two buckets. Two really important buckets. One, data on access to care and using things like the AMA's geomap series, which we recently updated. We have a map for each and every state—actually, multiple maps for each and every state—showing the practice locations of physicians and non-physicians, and what we can tell from these maps and what we can clearly illustrate is that non-physicians, including, for example, nurse practitioners, tend to practice in the same areas of the state as physicians. And this is true regardless of state scope of practice laws and kind of true across the board.

Unger: That kind of data confronts, I guess, maybe a misperception around access. Is that what that is saying?

Horvath: Absolutely. Absolutely. We often hear at the state level from non-physicians that scope expansions are necessary to increase access to care, especially in rural areas, and these maps clearly show that is not the case. Like I said, the maps show that nurse practitioners, for example, tend to practice in the same areas of the state as physicians. They don't tend to move into the rural areas and there's a lot of reasons for that.

But we know that expanding scope of practice laws does not, then, automatically result in non-physicians moving into rural areas of the state. And there are other things that state medical says—I'm sorry—that state legislatures can do to increase access, like expanding funding for graduate medical education and residency programs, like expanding access for telehealth. So there's other avenues to get there, but this is not one of them.

Unger: So just a part I want to just highlight about what you said, a lot of what you're bringing to the table is the data. Because there are misperceptions and state legislators might not be aware of the reality that we're facing. And some of that that we talked about at the State Advocacy Summit is coming from local health systems, like Hattiesburg Clinic, for instance, that's actually doing a lot of analysis and bringing data to the table. But something, additionally, that AMA is doing is something called the Scope of Practice Partnership. Talk to us a little bit about how that matches up the work that the AMA does with what's happening with our state societies.

Horvath: Yeah. So the Scope of Practice Partnership, or the SOPP, is really integral to the work that we do at the state level. It's comprised of every single state medical association, 39 state osteopathic associations, 18 national specialty societies and, of course, the American Medical Association and the American Osteopathic Association. And we're really proud to lead the SOPP here at the AMA.

And one of the primary purposes and reasons, really, for the SOPP is to advocate for and support physician-led care and oppose inappropriate scope expansions at the state level, and one of the ways that we do this is by providing grants to state medical associations to help them at the state level and further strengthen their advocacy in this space. And we do this by providing those grants and we are very proud that the AMA has dramatically increased its funding for the SOPP so that we can do more of this at the state level.

Unger: Now, Kimberly when we talked to physicians out there, I will tell you with absolute certainty bringing data to the table at that scope of practice is at the top of their list about concerns right now that they're facing. So if a physician out there wants to get involved in efforts to address inappropriate scope expansions, what should they do?

Horvath: Yeah. There are so many things that they can do. They become a member of the AMA, of course. They should also become a member of their state medical association and their national specialty societies. And we know from our experience with the SOPP and experience on scope of practice and so many issues that we work on at the state level that we are always stronger when we're working together.

Also, encourage physicians to get to know their legislators at the state level. Don't be shy. Reach out. Let them know who you are. And when your state medical association encourages you to reach out to legislators on a specific bill, take that extra step. We also encourage physicians to become engaged and knowledgeable about these issues. There's a ton of information on the AMA website and also, probably, information through your state medical associations and the national specialty societies.

It's really important that physicians share their perspective, that they share their real-life experiences with lawmakers. And then I will say at the national level, they can register for the National Advocacy Summit that's coming up in a couple of weeks in February. There's information on the AMA website and I believe will also be in the description of this episode.

Unger: Well, with so much activity going on both the state and the federal level, it's no wonder that the AMA has made addressing scope of practice expansions a key part of the Recovery Plan for America's Physicians and I encourage everybody out there, if you're not familiar with what the recovery plan looks like, to check that out on the AMA site at Learn more about our activities and how you can get involved in this critical issue.

And that wraps up today's episode. Thank you, Kim, for the work that you and the Advocacy Resource Center are doing on behalf of both physicians and patients, and to all our partners across state societies and specialty societies across this country for their partnerships. We'll be back soon with another AMA Update. You can find all our videos and podcasts at Thanks for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.