AMA successfully fights scope of practice expansions that threaten patient safety

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 by nonphysicians that threaten patient safety. 

For over 30 years, the AMA’s state and federal advocacy efforts have safeguarded the practice of medicine by supporting physician-led care and opposing attempts by nonphysicians to inappropriately expand their scope of practice. 

The AMA, working in strong collaboration with state medical and national specialty society members, has secured hundreds of victories in stopping inappropriate scope expansions of nonphysicians and supporting physician-led care. Below are a few recent examples from the 2023 legislative session.

Georgia defeats scope expansion efforts; passes truth in advertising legislation

Georgia saw scope of practice wins this year. The Medical Association of Georgia, which received grant funding from the Scope of Practice Partnership to bolster their advocacy efforts on scope of practice, successfully defeated two bills (SB 102 and HB 445) that would have authorized certified registered nurse anesthetists to practice without physician supervision. 

In addition, Georgia’s legislature passed SB 197, the Health Care Practitioners Truth and Transparency Act, which strengthens Georgia’s truth in advertising law and increases health care transparency in the state.

Eleven scope of practice bills defeated in Mississippi

In a major victory for Mississippi patients, the Mississippi State Medical Association defeated all eleven of the scope of practice bills introduced in the state legislature during the 2023 legislative session. 

South Dakota physician assistant bill defeated for third year

Through the efforts of the South Dakota State Medical Association, which were supported by the AMA, SB 175, a bill that would authorize physician assistants full practice authority, was defeated on the Senate floor. This is the third year in a row this type of bill has been introduced, and this year marks the greatest margin by which it has been defeated.

Indiana defeats scope expansion bills for four types of nonphysicians  

With support from the Scope of Practice Partnership, Indiana State Medical Association successfully fought against bills proposing to expand the scope of practice of four different nonphysicians. Victories include defeat of: SB 49, which would have allowed certified registered nurse anesthetists to practice without physician supervision; SB 213/HB 1330, which would have removed collaboration requirements for advanced practice registered nurses; SB 190, which would have amended collaborative practice agreements between a physician assistant and a physician; and HB 1182, which would have authorized pharmacists to diagnose illness and prescribe medications.

The AMA has been active in the 118th Congress opposing multiple bills concerning scope of practice. These bills range across a variety of topic areas and include pieces of legislation such as:

• S. 131/H.R. 618, the “Improving Access to Workers’ Compensation for Injured Federal Workers Act.” This legislation would allow nurse practitioners and physician assistants to diagnose, prescribe, treat and certify an injury and extent of disability for the purposes of compensating federal workers under the Federal Employees’ Compensation Act (FECA).
• S. 799/H.R. 1610, the “Chiropractic Medicare Coverage Modernization Act of 2023,” which would amend the Social Security Act’s definition of physician to expend Medicare coverage for services furnished by chiropractors beyond the manual manipulation of the spine.
• H.R. 1770, the “Equitable Community Access to Pharmacist Services Act,” which would inappropriately allow pharmacists to perform services that would otherwise be covered if they had been furnished by a physician, test and treat patients for certain illnesses including those that address a public health need or relate to a public health emergency, and expand Medicare payment for pharmacists in limited but significant ways.

The pieces of legislation mentioned above are just a few examples of the bills being opposed by the AMA.

On the administrative side, the AMA also provides comment letters in opposition to scope of practice expansions as needed. Additionally, the AMA has vigilantly opposed the VA Federal Supremacy Project, which is currently implementing National Standards of Practice for 48 health care occupations. This Project preempts state scope of practice laws and creates a single set of practice standards for all VA-employed physicians, and separate standards for 47 other nonphysician health care professionals.

Recently, the AMA participated in a roundtable discussion with the U.S. House of Representatives Veterans Affairs Committee Subcommittee on Health. The AMA expressed concerns with the potential scope expansions that will result from this Project and asked that it be rescinded.

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The AMA recognizes the importance of the house of medicine working together, which is why it formed the Scope of Practice Partnership (SOPP) in 2006. Today, the SOPP is comprised of 105 national, state and specialty medical associations. The SOPP has awarded more than $3.5 million in grants to its members to fund advocacy tools and campaigns aimed at supporting physician-led team-based care and stopping inappropriate scope expansions by nonphysicians.

The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to utilize when fighting against laws and regulations that expand scope of practice. AMA advocacy resources include:

• Model bills and legislative templates on key issues related to scope of practice and transparency in health care
• 50-state law analyses showing the legal landscape around scope of practice as related to multiple nonphysician practitioners
• Comprehensive modules explaining the differences in education and training received by physicians and various nonphysicians
• Issue briefs to inform lawmakers on important scope of practice matters
• Surveys to demonstrate the patient perspective on scope expansions
• Over 6,000 workforce maps and the interactive Health Workforce Mapper, which demonstrate that expanding scope of practice does not equal expanding access to care
• “Education Matters” wheels comparing the education and training of physicians and nonphysicians for legislators across the country
• Other turn-key advocacy materials

The AMA launched the Truth in Advertising campaign, which aims to ensure patients clearly know the license and training of those providing their health care, and empowering them to make informed decisions about their care.

The AMA regularly corresponds with legislators and regulators in an effort to stop inappropriate scope of practice expansions. So far in 2023, the AMA has formally weighed in to oppose more than 20 state bills that would put patients at risk by expanding the scope of practice of nonphysicians. On the federal level, the AMA has also sent multiple letters in the 117th and 118th Congress and has provided comments to the Administration opposing scope of practice expansions. The AMA will continue to be vigilant in its advocacy in support of physician-led care.