Scope of practice refers to those activities that a person licensed to practice as a health professional is permitted to perform, which is increasingly determined by statutes enacted by state legislatures and by rules adopted by the appropriate licensing entity.
Laws, definitions and regulations on scope of practice within health care professions vary from state to state.
It’s the AMA’s long-held belief that every health care professional has an important role to play in caring for patients, but the high-stakes field of medicine demands the education, experience and acumen of a fully trained physician. This is why the AMA stands in strong support of physician-led health care teams.
As part of a physician-led care team, nonphysician health care professionals can and do provide safe and essential health care to patients.
The health and safety of patients are threatened, however, when nonphysician health care professionals, such as nurse practitioners or physician assistants, are permitted to perform services that are beyond the boundaries of what they have been educated and clinically trained to do.
Scope of practice challenges remain at every level
Every year, and in nearly every state and at times on the federal level, nonphysician health care professionals lobby legislatures and regulatory boards to expand their scope(s) of practice.
AMA has extensive policy on scope of practice including opposing legislation that allows the independent practice of nonphysicians and strongly supporting physician-led team care. AMA works closely with state and specialty medical societies to address such efforts.
In the April 11, 2022, edition of the AMA Moving Medicine update, Michaela Sternstein, JD, vice president of the AMA Advocacy Resource Center, addresses scope of practice and the AMA’s ongoing current efforts to address this important issue on behalf of physicians.
Physicians are trained to lead
The AMA is committed to supporting physician-led care and fighting scope of practice expansions that threaten patient safety. Each member of the physician-led health care team plays an integral role in the delivery of health care that cannot exist without interprofessional collaboration.
Yet nonphysicians skillsets are not interchangeable with that of fully trained physicians, who have higher levels of education and clinical training (PDF). Health care teams working together—with physicians in the lead—is critical to having the best and safest outcomes for patients.
According to an AMA national survey (PDF), 95% of U.S. voters say it is important to them for a physician to be involved in diagnosis and treatment decisions. It remains important to explain to legislators and regulators the limitations in the education and training for nonphysician health care professionals that can result in substandard or potentially harmful care of patients.
Scope expansion doesn’t equal increased access to care
Proponents of scope expansions often claim such measures are necessary to expand access to care in rural areas. However, data tools, such as the AMA’s Health Workforce Mapper, have been instrumental in refuting this notion by mapping the practice location of physicians and nonphysicians across the country. This AMA issue brief (PDF, members only) reviewed the actual practice locations of primary care physicians compared to nurse practitioners and found that physicians and nurse practitioners tend to practice in the same areas of the state—even in those states where nurse practitioners can practice without physician supervision or collaboration.
AMA’s state and federal advocacy efforts have safeguarded the practice of medicine and safety of patients by opposing nonphysician professional attempts to inappropriately expand their scope of practice each year.
Other key scope of practice resources include:
- AMA scope of practice key tools and resources
- AMA Truth in Advertising Campaign
- AMA Journal of Ethics
- JAMA Network™
Reviewed by: Michaela Sternstein, JD, vice president, AMA Advocacy Resource Center, and Kimberly Horvath, JD, senior attorney, AMA Advocacy Resource Center
Reviewed on: May 2022