April 5, 2024: Advocacy Update spotlight on opposed scope of practice expansion

The AMA, alongside state medical associations and national medical specialty societies, continues to oppose inappropriate scope of practice expansion efforts by non-physicians. Recent efforts—with more details following—include the AMA testifying against naturopath scope expansions in Alaska and Connecticut, Georgia defeating a CRNA bill, Oklahoma governor vetoing an APRN bill, and the AMA sending a letter opposing a New Hampshire physician assistant bill.

This year, multiple bills introduced across the country would expand the scope of practice of naturopaths by authorizing naturopaths to prescribe medications. The AMA is staunchly opposed to these propositions.

With no residency requirement, naturopaths lack the robust clinical training of a physician. Notably, there is no guarantee that a naturopath will encounter a broad range of illnesses or conditions in the patients they treat during their clinical education. A naturopath’s pharmacological education is combined with and taught alongside naturopathic therapeutics and philosophies such as botanical medicine and homeopathy—it is not comparable to a physician’s education. Altogether, the AMA believes naturopaths lack the education and training necessary to safely diagnose and prescribe medications to patients. And yet, bills proposed across the country would allow naturopaths to do just that, with very few guardrails.

Scott Ferguson, MD, member of the AMA Board of Trustees, has taken these bills to task. He has testified against naturopath prescribing bills in state legislative hearings from Connecticut to Alaska. Before state legislatures, Dr. Ferguson—as a physician expert and former legislator himself—effectively compares the educational preparation of a naturopath to that of a physician and champions the importance of the medical education and residency training in providing medical care to patients. Representing the AMA, he advocates strongly against these proposed scope of practice expansions.

The legislatures in Alaska and Connecticut have yet to make final decisions on these naturopath scope of practice expansion bills.   

The Medical Association of Georgia (MAG) successfully defeated several scope bills during the 2024 legislative session which recently adjourned on March 28. At the top of this list are two bills (SB 419 and SB 46) that would have removed language requiring anesthesia services provided by nurse anesthetists to be under the direction and responsibility of a physician. Defeating these bills preserves physician supervision of nurse anesthetists, which is imperative to protect the safety of patients receiving anesthesia. The Scope of Practice Partnership (SOPP) supported MAG’s efforts with a SOPP grant.

Oklahoma Governor Stitt vetoed an APRN scope expansion bill (SB 458) which would have allowed nurse practitioners, clinical nurse specialists and certified nurse midwives to practice and prescribe medications without any physician involvement. Following tireless efforts from the Oklahoma State Medical Association (OSMA) to secure the veto, Governor Stitt put the safety of patients first and preserved physician supervision of APRNs. While this is fantastic news, the governor’s veto can be overturned by a supermajority vote (75%) of both houses, so OSMA continues to work hard to sustain the veto. 

The AMA recently sent a letter (PDF) to Representative Sherman Packard, Speaker of the New Hampshire House of Representatives, and Matt Wilhelm, House Democratic Leader of the New Hampshire House of Representatives, expressing strong opposition to a physician assistant scope expansion bill. As originally drafted, the bill (HB 1222) would have removed all language requiring physician assistants to collaborate with physicians, thereby allowing physician assistants to practice medicine without any physician involvement.

“This is a dangerous bill that sets New Hampshire apart from almost every other state in the nation and walks back collaborative practice language that this legislature just recently passed,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in his letter (PDF) to the lawmakers. Dr. Madara went on to express the importance of physician-led care, particularly given the increased complexity of health care, stating “[a]s the provision of health care in this country becomes more complex, a fully coordinated, quality-focused and patient-centered health care team will be the optimal means by which Americans will receive their health care. In the physician-led team approach, each member of the team plays a critical role in delivering efficient, accurate, and cost-effective care to patients.”

The bill passed the House with an amendment that retains written collaborative practice agreements between a physician assistant and physician for physician assistants with less than 8,000 hours of clinical practice who do not work in a group practice or health system with a physician who practices in the same specialty in which the physician assistant is practicing. The bill is now in the Senate Health and Human Services Committee.

• April 5, 2024: Medicare Payment Reform Advocacy Update
• April 5, 2024: National Advocacy Update
• April 5, 2024: State Advocacy Update