Inside the AMA’s Broad Struggle Against Scope Drift

An AMA-led coalition of 108 national, state and specialty medical societies has been active in dozens of states this year, working to block legislation that would provide an inappropriate expansion of medical services and procedures that medical professionals health not doctors are allowed to perform.

This coalition, the AMA Scope of Practice Partnership, helps educate lawmakers about the pitfalls of expanded scope of practice legislation, which may involve allowing optometrists to perform eye surgery or allowing nurse practitioners (NPs) to diagnose and treat patients independently.

According to the National Conference of State Legislatures, more than 70 bills have been introduced this year in state legislatures relating to expanding the scope of practice of non-physician health professionals in the areas of pharmacy, primary care , optometry, oral health and behavioral health.

“We’ve been working on this issue for 30 years, but – absolutely – it’s becoming more important every day,” said Kimberly Horvath, senior counsel at the AMA Advocacy Resource Center.

“Patients are very concerned that allowing non-physicians to provide medical-level care is a step in the wrong direction,” Horvath said on a recent episode of “AMA Moving Medicine.”

Ninety-five percent of patients said it was important for doctors to be involved in their healthcare diagnosis and treatment decisions, according to survey data cited by Horvath in the interview. .

“Patients want physicians who lead their healthcare team — they don’t just want it, they expect it,” she said.

Differences in education and training among healthcare professionals are a major reason for this preference and are often the deciding factor when a legislator votes against expanding the scope. And that’s not surprising, given that physicians have years more of training, including thousands more hours of clinical training, than non-physicians such as NPs, physician assistants ( AM) and Certified Registered Nurse Anesthetists (CRNA). For more information, see the AMA’s “Protecting Access to Physician-Led Care” briefing note (PDF).

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“We’ve worked so far this year with 25 state medical associations on this issue and some key wins,” Horvath said. “All of the work we do in this area is done hand-in-hand with state medical associations across the country. We rely on them so much for their political acumen in this space.

In a recent victory over the scope of practice, Wisconsin Governor Tony Evers vetoed a bill that would have allowed Advanced Practice Registered Nurses (APRNs) to practice independently without a supervising physician. / collaborater.

The scope of practice partnership worked to amplify the Wisconsin Medical Society’s message to the governor that the legislation, Senate Bill (SB) 394, would endanger patients and damage reputations. of Wisconsin as one of the best states in the United States for effective, high-quality health care. .

Here are other notable victories in the efforts of the AMA and state medical associations to combat range drift.

Alabama

Several bills were rejected, including:

  • SB 120
  • SB 307 / House Bill (HB) 402which would have broadened the scope of practice of pharmacists.
  • SB 101which would have widened the field of practice of podiatrists.

Colorado

HB 1095a bill that would have removed physician supervision requirements for physician assistants, was defeated.

Hawaii

Concurrent Senate Resolution 156 which would have ordered the Department of Commerce and Consumer Affairs to convene a task force to draft legislation that would grant prescription powers to qualified psychologists, was rejected

Indiana

SB 239, a truth in advertising bill, was signed by Governor Eric Holcomb. It requires healthcare professionals’ advertisements and websites to clearly state the type of license the person holds. The bill also limits the use of medical specialty designations to medical specialists, including anesthesiologists, cardiologists, dermatologists, family physicians, ophthalmologists, orthopedists, psychiatrists, surgeons and others.

Kentucky

HB 354, a bill that would have removed the physician collaboration requirement for APRNs for prescribing, was defeated. Outgoing AMA President Susan R. Bailey, MD, participated in a Legislative Review Committee meeting on the scope of the APRN.

Maryland

Several bills were rejected, including:

  • HB 276/SB 513which would have enabled clinical nurse specialists to prescribe medications and order, perform and interpret diagnostic tests.
  • SB-154 would have brought Maryland into the APRN compact, which governs nurse practitioners, nurse midwives, CRNAs and others. The pact would have nullified existing Maryland law that states nurse practitioners are required to “consult with and cooperate with, or refer a person to, an appropriate licensed physician or other health care provider as needed.”
  • HB 790/SB 311 would have allowed podiatrists to use the term “podiatrist physicians”.
  • SB 808/HB 961 would have removed the medical supervision requirement for physician assistants.

Mississippi

SB 2178Legislation that would have expanded APRN’s scope of practice was rejected.

Learn more about the Hattiesburg Clinic in Mississippi, whose value-based care journey exemplifies the power of data analytics and the vital importance of physician-led, team-based care.

South Dakota

SB-134, which would have eliminated medical supervision requirements for physician assistants, was rejected. AMA President Gerald E. Harmon, MD, testified against the bill before the Senate Health and Human Services Committee.

Tennessee

HB 184/SB 176which would have removed the physician collaboration requirement for NP prescribing authority and allowed NPs to practice without physician involvement, was rejected.

Washington

  • SB 5542which would have allowed optometrists to prescribe medication and perform surgery.
  • SB 5088which would have given prescriptive authority and other scope extensions to naturopaths.
  • SB 1863which would have established the prescriptive power of psychologists.
  • SB 5704/SB 5222which would have forced insurers to reimburse NPs at the same rate as physicians.

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Despite the efforts of the AMA, the Scope of Practice Partnership, and state and specialty societies, legislators in Kansas and New York have enacted legislation expanding the scope of practice for NPs, while Virginia has enacted legislation allowing optometrists to perform surgical procedures.

And much of the state law is still in effect.

“There are a lot of bills that we’re still interested in and working on with the states — and are already gearing up for 2023 in many states,” Horvath said.

The AMA creates resources that set the record straight for policy makers on the scope of practice, one of the only national organizations to have created hundreds of advocacy tools that medicine can use to fight against scope drift.

This includes model bills and training modules that inform legislators, regulators and other decision makers about the education and training of certain healthcare professionals in relation to the qualifications physicians must achieve to accept responsibility for a full and unrestricted license to practice medicine.

A persistent argument is that expanding scope of practice will make health care more accessible as APRNs fill gaps in areas with physician shortages.

But Horvath said research using the GEOMAP series and AMA Health Workforce Mapper has shown that doesn’t happen, and APRNs tend to practice in the same areas as doctors.

Evidence shows that allowing non-physicians to practice without physician involvement will not expand access to care in rural and underserved areas.

“Laws that expanded the scope of practice for non-physicians have not been correlated with an increase in the number of non-physicians moving into these rural areas,” Horvath said. “So these cards were instrumental in combating that notion.

“We also provide survey data, talking points, write letters and have board members who testify in the states,” she added.

Horvath recommended doctors get to know their state legislators before asking them to support or oppose a bill. She also suggested they provide them with data that supports their position and concrete examples of how the issues affect their patients and legislator constituents.

“They should know who you are,” Horvath said. “Don’t wait for a bill to be introduced or a key vote. Start now. Building those relationships, because it takes time. Even if you’ve never done it before, make today the first day to contact your legislator.

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