What’s the news: The AMA and the Mississippi State Medical Association were successful in their efforts to prevent scope of practice expansions that would have harmed Mississippi patients.
Mississippi House Bill 849 died in committee, while House Bill 1437, a committee substitute, was tabled and didn’t progress to a vote before the state’s legislative session ended on April 6.
The bills would “dangerously erode the existing collaborative practice requirements between physicians and advanced practice registered nurses, requirements that protect patients under current Mississippi law,” said an eight-page February letter (PDF) from James L. Madara, MD, the AMA’s CEO and executive vice president. Dr. Madara wrote to Sam Creekmore IV, chair of the Mississippi House Public Health and Human Services Committee. Dr. Madara urged lawmakers to vote no on HB 849 and HB 1437.
The bills would have removed well-defined collaborative practice and supervision requirements in Mississippi law and replaced them with a weak, time-limited collaborative consultative requirement, Dr. Madara added. The bills also would have created a framework for advanced practice registered nurses to practice medicine, while holding them and physicians to different standards when they provided the same service to the same patient in the same setting.
“Patients are already confused about who is providing their care and often mistake advanced practice registered nurses for physicians in a clinical setting. In addition, patients may not have a choice in who provides their care, particularly in a hospital, urgent, or emergency care setting,” the AMA’s letter says. “This is both confusing and fundamentally inequitable to patients—all of whom deserve access to the highest quality of care and should expect that anyone providing their care will be held to the same high standards.”
Dr. Madara sent a similar letter (PDF) to Hob Bryan, chair of the Mississippi Senate Public Health and Welfare Committee.
Meanwhile, the Mississippi State Medical Association mounted a multipronged advocacy effort to oppose HB 849, which included directly lobbying legislators at the Capitol, providing expert testimony, sending formal position letters to key committees of jurisdiction and mobilizing physician members to contact their representatives to urge opposition. The association also worked closely with allied medical societies to present a unified voice in defense of safe, physician-led care.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
Why it’s important: Patients want—and expect—physicians to lead their health care team. In fact, “95% of U.S. voters say it is important for a physician to be involved in their diagnosis and treatment decisions,” and “63% of voters specifically oppose allowing nurse anesthetists to perform anesthesia without physician oversight, a dangerous change” that HB 849 would have allowed, according to the AMA letter.
Claude D. Brunson, MD, MSCHS, executive director of the Mississippi State Medical Association, said that “stopping HB 849 was critical to maintaining safe, high-quality medical care for patients across Mississippi.”
Dr. Brunson, an AMA member, added that “the bill would have significantly expanded nonphysician scope of practice without appropriate education, training or supervision standards. Such changes pose real risks to patient safety, particularly in rural or underserved areas where vulnerable populations may not recognize the difference in training between physicians and nonphysician providers.
“For physicians,” he noted, “the bill threatened to fragment care, dilute accountability, and undermine collaborative team-based models that prioritize patient outcomes. Preventing this legislation helped preserve the integrity of medical standards and ensured patients continue to receive care from professionals with the highest level of medical education and clinical training.”
In the AMA’s letter, Dr. Madara outlined these other concerns about the ultimately unsuccessful legislative effort to undermine physician-led care.
Education plays a critical role in patient safety and there is a stark difference in education and training between physicians and advanced practice registered nurses. Physicians complete 12,000 to 16,000 hours of standardized clinical training; meanwhile, nurse practitioners complete only 500–750 hours of clinical training and certified registered nurse anesthetists complete just 2,600 hours of formalized clinical training.
Gaps in nurse-practitioner education and training put patients at risk. One study cited in the AMA’s letter found that 75% of nurse respondents reported being “not confident” or only “somewhat confident” in their ability to interpret basic skeletal radiographs, while 78% felt that way about interpreting a basic chest radiograph.
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See how the AMA defends against scope of practice expansions that threaten patient safety.
Costs rise when nurse practitioners are unsupervised. Mississippi’s Hattiesburg Clinic found letting nonphysicians have their own primary care panel of patients led to higher costs, more referrals, higher emergency department use and lower patient satisfaction compared to care that physicians provided.
The cost was nearly $43 higher per patient per month when they had a nonphysician as their primary care provider. That could have translated to an additional $10.3 million in spending annually for Hattiesburg Clinic, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Scope expansion doesn’t increase access to care. Oregon, where nurse practitioners can practice without physician involvement, saw the number of nurse practitioners increase between 2018 and 2022. However, they chose to practice in the same highly populated areas of the state that physicians did – not rural areas. Meanwhile, a study by the Centers for Medicare & Medicaid Services discovered that just 9% of nursing alumni from the Graduate Nurse Demonstration Project went on to work in rural areas.
Learn more: Last year, the AMA worked with state medical associations to defeat more than 80 bills that would have inappropriately expanded nonphysicians’ scope of practice. In addition to opposing bills that would let nurse anesthetists, nurse midwives, nurse practitioners or others to practice without any physician supervision or collaboration, the AMA opposes legislation inappropriately expanding naturopaths, optometrists, pharmacists and psychologists’ scope of practice.
A recent AMA webinar on how states are taking up key health care issues covers scope of practice, among other priorities.
