What’s the news: Wisconsin Gov. Tony Evers has vetoed a bill that would have granted advanced practice registered nurses (APRNs) the legal ability to practice independently. The governor’s action was supported by the AMA and the Wisconsin Medical Society.

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Senate Bill 394 would have removed physician supervision or collaboration requirements for nurse practitioners, nurse anesthetists and clinical nurse specialists after 3,840 clinical care hours in their respective APRN role with a physician or dentist. For nurse midwives, another type of APRN, the legislation would have removed the collaboration requirement altogether. 

Physicians, prompted by the Wisconsin Medical Society’s call to action that was amplified by the AMA Scope of Practice Partnership, urged Evers to veto the bill.

“Wisconsin consistently ranks as one of the best states in the country for high quality and efficient health care,” says a message that doctors sent to the governor. “Physician-led health care teams support that quality; SB 394 would fracture those teams by allowing certain nurses to practice independently.

“Physicians know the importance of nurses and what they mean for patient care. Vetoing SB 394 will help ensure patients can continue to benefit from the education, training and experience of the entire health care team.”

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Why it’s important: In his veto message (PDF), Evers said “the bill before me today does not address some of the issues raised by parties in the medical profession that went unremedied during the legislative process.”

Evers wrote that he decided to veto SB 394 because he objected “to altering current licensure standards for APRNs, allowing practices functionally equivalent to those of physicians or potentially omitting physicians from a patient’s care altogether notwithstanding significant differences in required education, training and experience.” 

Patients are concerned about the cost and quality of health care. While there is certainly room for improvement in the health care system, allowing nonphysicians, including nurse practitioners, to diagnose and treat patients without any physician oversight is a step in the wrong direction. The best way to support high-quality care and lower costs is to keep physicians as the leader of the health care team.

Physicians have the highest level of training within health care and 20 times the clinical training compared with nondoctors. Meanwhile, 91% of patients say a doctor’s education and training are vital for optimal care, and 95% say it’s important for a physician to be involved in their diagnosis and treatment. Read more from AMA on protecting access to physician-led care (PDF).

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Why expanding APRN scope of practice is bad idea

Learn more: Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.

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