Scope of Practice

Why scope creep tops state medical associations’ priority list

Marc Zarefsky , Contributing News Writer

Ninety-five percent of U.S. voters think it is important to have a physician involved in diagnosis or treatment decisions, yet dozens of bills pending in state legislatures would expand nonphysicians’ scope of practice and remove physicians from patient care teams. 

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Kimberly Horvath, a senior attorney with the AMA Advocacy Resource Center, said the AMA is tracking about 60 potential scope-of-practice legislative efforts across the country, ranging from pharmacists’ prescribing medications based solely on in-pharmacy tests to nurses providing anesthesia care—all without physician involvement.

"Every year, we do a survey with state medical associations and national specialty societies to gauge their legislative priorities for the year," Horvath said, "and once again, scope of practice continues to top that list."

Horvath talked about why stopping inappropriate scope-of-practice expansions that can threaten patient safety is important for patients and physicians in a recent episode of “AMA Update.”

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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Each member of the health care team plays a key role in patient care, but not every health professional on the team has the same level of education.

Nurse practitioners, for example, can complete their graduate education in half the time as a physician and are not required to go through a residency or fellowship. Similar differences can be found between nurse anesthetists and anesthesiologists, between optometrists and ophthalmologists, and between psychiatrists and psychologists. 

"We know that patients value the education and training of physicians," Horvath said. "When patients go to the doctor, it's because they have a concern about their health, and they're looking for answers. Every patient is different, and physicians, because of their education and training, are trying to pick up on those differences and nuances among patients and provide them that personal level of care that they want and expect."

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A common claim made in favor of expanding nonphysicians’ scope of practice is that it will increase patients’ access to care, but that is inaccurate, Horvath said.

The AMA created more than 4,500 maps to examine where physicians practice compared with where nonphysicians practice in all 50 states, as well as the District of Columbia. The maps show that nonphysicians tend to practice in the same areas of the state as physicians—regardless of the state's scope of practice rules.

"We often hear at the state level from nonphysicians that scope expansions are necessary to increase access to care, especially in rural areas, and these maps clearly show that is not the case," Horvath said. "We know that expanding scope of practice laws does not automatically result in nonphysicians moving into rural areas of the state." 

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The AMA has succeeded in fighting numerous scope-of-practice expansion attempts by collaborating with 105 national, state and specialty medical associations through its Scope of Practice Partnership. Horvath encouraged physicians to get involved and make their voices heard on the issue. 

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"It's really important that physicians share their perspective, that they share their real-life experiences with lawmakers," she said.

AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.