Another big year for scope of practice advocacy
This year, the AMA fought vigorously to defend the practice of medicine and protect patients from inappropriate scope of practice expansions, working with at least 40 state medical associations and national medical specialty societies to help defeat more than 80 scope of practice bills in 2024.
Once again, in 2024 an array of non-physician groups—including nurse practitioners, nurse anesthetists (CRNAs), physician assistants, psychologists, optometrists, naturopaths and pharmacists—brought forth legislative proposals across the country for scope of practice expansions that threatened patient safety by seeking to authorize non-physicians to engage in the practice of medicine for which they are not trained. Together, state medical associations, national medical specialty societies, and the AMA showed up for the fight.
2024 saw a flurry of activity around advanced practice registered nurses (APRNs) such as nurse practitioners and nurse anesthetists. Generally, proposed legislation aimed to remove requirements that APRNs collaborate with or be supervised by a physician. At least 15 states defeated a total of 21 such bills involving nurse practitioners or all APRNS. For example, multiple bills were defeated in Mississippi, Pennsylvania, North Carolina and South Carolina that would have removed or substantially weakened existing supervision or collaborative practice requirements between physicians and nurse practitioners or all types of APRNs. In addition, four states defeated legislation which would have adopted the APRN Compact, a multistate professional licensing compact that aims to supersede state scope of practice laws to allow nurse practitioners to practice without physician involvement. Notably, in Oklahoma and Wisconsin, APRN scope expansion bills were vetoed by the Governor. Bills that would have removed physician collaboration or supervision for nurse anesthetists were defeated in at least 13 states.
Nine states defeated legislation that would have removed physician supervision or collaboration of physician assistants, such as Alaska, New York and Oklahoma. Three others successfully pursued substantive amendments to physician assistant scope expansion legislation that would preserve physician-led care. Finally, South Dakota State Medical Association achieved a “silent victory” this year: for the first time since 2020, a physician assistant bill was not introduced, likely because the medical society successfully defeated physician assistant scope expansion bills for the past three legislative sessions.
Naturopath scope expansion efforts were particularly aggressive this year, with naturopaths across the country seeking to pass legislation that would allow them to prescribe medications, perform minor surgery, or order and interpret diagnostic tests. Advocates for physicians and patients in several states, including Alaska and Connecticut, fought long and hard battles on this front. Ultimately, legislation involving naturopath scope of practice was defeated in at least 11 states. Naturopath scope expansion legislation was defeated in Connecticut, but the legislature passed a bill calling upon the state Department of Health to review naturopath scope of practice. The AMA, along with the Connecticut State Medical Society, participated in a series of hearings to this end, and the Department’s report is pending.
Physician advocates might recall that 2023 saw an avalanche of legislation authorizing pharmacists to perform certain primary care services, namely, diagnosing patients, often using a CLIA-waived test, and initiating medication treatment for “minor conditions.” That trend continued in 2024. At least 8 states from New York, to Mississippi, to Arizona defeated such “test and treat” legislation. In addition, Washington defeated a bill that would have empowered the Pharmacy Commission to identify drugs and devices that a pharmacist may prescribe.
Optometrists continue to seek authorization to perform surgery on the human eye using lasers or scalpels. At least 11 states plus the District of Columbia successfully fought such legislation.
Similarly, bills authorizing certain psychologists to prescribe powerful psychotropic medications were defeated in 6 states, from Hawaii to Florida.
All told, 2024 proved to be another strong year for physicians fighting to protect patients from inappropriate scope of practice expansions. AMA, working with our state medical association and national medical specialty society colleagues, helped to defeat at least 80 bills that threatened patient safety. The fight to protect patients and defend the practice of medicine is relentless, and the AMA will continue to rise to the occasion in 2025.
More articles in this issue
- Dec. 20, 2024: Medicare Payment Reform Advocacy Update
- Dec. 20, 2024: National Advocacy Update
- Dec. 20, 2024: State Advocacy Update
