Advocacy in action: Fighting scope creep

There is certainly room for improvement in the U.S. health system, but allowing nonphysicians such as nurse practitioners (NPs) or physician assistants 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 (PDF).

Compared with nurse practitioners, physicians have 20 times more clinical training. And while all physicians get vital hands-on instruction, 60% of NP programs are mostly or completely online. 

Expanding nonphysicians’ scope of practice also increases costs. For example: 

• X-ray ordering rose 441% among nonphysicians. 
• Nonphysicians needed twice the number of biopsies to screen for skin cancer. 
• Patients were 15% likelier to get an antibiotic from a nonphysician. 
• 6.3% of NPs prescribed opioids to more than half of their patients, compared with 1.3% of physicians. 

And patients prefer physician-led care (PDF), with: 

• 95% saying it’s important for a physician to be involved in their diagnosis and treatment. 
• 91% agreeing that a physician’s education and training are vital for optimal care. 
• 75% saying they would wait longer and pay more to be treated by a physician. 

Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. That’s why the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety, and it’s why fighting scope creep is a top priority of how the AMA is fighting for physicians. 

In addition, the AMA’s Truth in Advertising campaign helps ensure patients can answer the simple question, “Who is a doctor?”, the AMA believes that all health care professionals—physicians and nonphysicians—should be required to accurately and clearly disclose their training and qualifications to patients. 

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In strong collaboration with our state medical association and national medical specialty society partners, the AMA has: 

• Achieved more than 100+ state-level victories in 2023 in strong collaboration with our Federation of Medicine partners. 
• Helped defeat legislation across the country that would have allowed:
  • Physician assistants to practice independently without physician oversight.
  • Pharmacists to diagnose and treat patients, as well as prescribe medications.
  • Optometrists to perform surgery.
  • Naturopaths to prescribe legend drugs.
  • Scope of practice expansion for nurse practitioners and other APRNs.
• Worked with multiple state medical associations to introduce new or strengthen existing Truth in Advertising laws.

The AMA is: 

• Working with medical associations to oppose inappropriate scope expansions in 30+ states so far in 2024.
• Leading the AMA Scope of Practice Partnership, which has provided more than $4.0 million in grants since its inception to support state medical association and specialty society efforts. Ten grants have been awarded in 2024.
• Continuing to actively oppose the VA Federal Supremacy Project to ensure that veterans are provided with the care they deserve—care from a physician-led team.
• Continuing to actively oppose federal bills that seek to expand the scope of practice for pharmacists, psychologists, chiropractors, nurse practitioners, physician assistants, and nurse anesthetists in Medicare and other federal health care programs.

Learn more about how the AMA successfully fights scope-of-practice expansions that threaten patient safety. 

• Recently adopted AMA policy on scope of practice. 
• Health Workforce Mapper: Customize and visualize the geographic distribution of physicians and nonphysician clinicians at a state or county level. 
• AMA members can access hundreds of scope-of-practice advocacy tools, including issue briefs, model legislation, state law charts and detailed data modules.

Visit AMA Advocacy in Action to learn more about the advocacy priorities the AMA is actively working on.

The AMA works to generate support for policies critical to the nation’s health care system—and we can’t do it without your help. Learn more about ways to get involved with AMA advocacy.