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Featured topic and speakers
What is the purpose of having scope of practice laws? Why do scope of practice laws vary by state? Does scope of practice help regulate the health care field?
Our guest is Claude Brunson, MD, MS, executive director of the Mississippi State Medical Association. AMA Chief Experience Officer Todd Unger hosts.
- Wondering what is scope of practice and why is it important? Visit this resource.
- Learn more about grant funding through AMA's Scope of Practice Partnership.
- AMA Health Workforce Mapper.
- Get free scope of practice resources and check out AMA efforts to #StopScopeCreep.
- The AMA is your powerful ally in patient care. Join now.
Speaker
- Claude Brunson, MD, MS, executive director, Mississippi State Medical Association
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today we're discussing trends that one state is seeing in its scope of practice expansion bills this year and how physicians there are pushing back. Our guest today is Dr. Claude Brunson, executive director of the Mississippi State Medical Association in Ridgeland, Mississippi. I'm Todd Unger, AMA's chief experience officer in Chicago.
Dr. Brunson, it's a pleasure to have you today.
Dr. Brunson: Mine as well. Thank you for having me.
Unger: Well, last year we saw a record number of scope of practice expansion bills across the country, and this year no signs of that slowing down. Dr. Brunson, how many bills have you been working on this year in Mississippi alone.
Dr. Brunson: Well, we saw that same trend here in Mississippi as well, and in fact, this legislative session, it seemed like everybody in health care wanted their slice of the physician scope of practice pie so to speak. In Mississippi, though, we had 17 scope bills introduced in this legislative session. That's up from 11 in the 2023 session.
These bills were introduced by nurse practitioners, CRNAs, nurse midwives, pharmacists, physical therapists and podiatrists. And the nurse practitioners this year, as innovative as they've always been, tried every formula they could think of, and in fact, they offered to increase their transition to practice hours from a little more than 6,000 hours up to 10,000 hours.
Unger: So in addition to just the sheer number of them, what you're saying is we're seeing it kind of in a broader set of specialties. Am I getting that right?
Dr. Brunson: You are getting it right, and in fact, we had a big fight this year with podiatrists in particular. In Mississippi, our podiatrists can treat and perform surgery on the foot only. They introduced a bill, which was House Bill 41, that sought to expand their scope of practice to perform surgery on the ankle, which seemed reasonable.
However, when we took a deeper look at the text of the bill, we noted that the surgeries they wanted to be able to perform for all the surgeries listed in a manual called the Council of Podiatric Medical Education CPME 320. In this manual, they had surgery that could go all the way up to the leg, and the manual had this as being required for graduation and certification.
So if we had signed off on this, then their national organization would then be requiring the type of surgeries that they shouldn't be able to perform here in our state. We then work with the AMA and Mississippi Orthopedic Society and the Mississippi chapter of the American College of Surgeons to defeat that bill in the Senate public health committee.
Unger: We're going to be talking more about the partnership with AMA and the Mississippi State Medical Association. Before we get into that, I'm curious what other trends are you seeing in scope of practice expansion bills this year.
Dr. Brunson: Well, we're also seeing an increasingly upward trend in the volume of bills that are filed each year. We've seen that these providers are getting more skilled in their advocacy, and they seem to be getting more and more assistance from their national societies to help them fund these campaigns. In fact, we believe that what we're seeing is a targeting of the southern states to try and get a foothold in one of these states and then launch from that state to other southern states to knock them down in a domino effect.
It seems to us that Mississippi is being targeted as the most likely state to take down. And as I mentioned earlier about the podiatry bill, a new wrinkle with this compact-like bill that would actually let a national body determine what surgeries they could do in order for them to graduate and be certified. And no one in Mississippi would have any input on the type of surgeries that they could do because it would have been set by a bill that we adopted here in our state to allow them to do that.
Unger: Dr. Brunson, last year we had the opportunity to speak with Dr. Jennifer Bryan, who I believe is president-elect of the Mississippi State Medical Association about how you've been so successful at stopping scope of practice expansion. I'd love it if you could talk about the tactics that you've been using this year to fight these type of bills.
Dr. Brunson: Yeah. Last year, our battleground was really in the Senate public health committee and whereas this year our focus has been on the House. In fact, we had a new speaker of the House elected this session whose wife is a nurse practitioner. He appointed a new chair of the House public health committee, and we saw that time and time again, they kept coming at the House this year believing that they would have a better opportunity in our House to get some of these things passed.
But as we have said time and time again to our physicians, our best advocacy method is when our physicians are talking one on one with their lawmaker that's from their district. So we took the time to build out a text message group where a few specific physicians from their district were set up to call these members whenever we needed to launch an advocacy campaign to them about some bill that we had going in. We also used these groups to do other kinds of messaging, and whenever we had something that came on in the Capital or in our home district, we would send a text message out to these groups and then they would contact their legislators with an onslaught talking about the issues, concerns that we had for a bill or things that we were advocating for.
But the other important thing that we use to apply the pressure was the public campaigns that we did, and we ran multimedia campaign featuring billboards, radio commercials, postcard mailings, AMA scope of—scope bills that have been very valuable to us over the over the past years. And then this year we also utilized more comprehensively geofencing, and we use this inside the Capitol building. And we did a geofencing campaign that targeted locations in the House public health members' home districts, and always we have a day at the Capitol where we get our docs down at the Capitol and white coats spending time talking to legislators about all the different bills. And, in fact, we had so many this year that we had—we had to have a couple of white coat rallies that we did down at the Capitol.
Unger: So it sounds like a combination of real grassroots organizing, strengthening, developing the relationships with members of your state Congress, your legislature, and then marketing to make sure the word is out using digital platforms like you're talking about there. You also mentioned working with the AMA in partnership and the scope of practice wheel, which is something that really outlines the differences in education and training among different folks out there to make that clearer to those that might not be aware. But tell us some more about how you work with the AMA to resolve these issues. How is the AMA supporting your medical society?
Dr. Brunson: The AMA has been invaluable to us over the last several years, and we've developed very close working relationships. And we at MSMA are so grateful for that very close relationship that we have with the AMA and the Scope of Practice Partnership, and through the generous funding that we've gotten by the SOPP over the course of the last few years, we've been able to run the statewide multi-media campaign that I mentioned and also a much needed public pressure campaign on our lawmakers. We also formed a very close relationship with staff attorneys Kimberly Horvath and Molly Reese, who are just phenomenal, and I always feel a little bit guilty as if they were unpaid staff members of MSMA.
But anytime we send something, they'll dive into the bill, look at the language for us, identify the important issues, and help us craft arguments against the problematic language that we may see in the bill. They've also written many letters on behalf of AMA opposing some of these onerous scope of practice legislation, and that helps bolster our position as we're talking to the leadership in the Capitol and the governor's office when we need to. But with the support—without the support of AMA, we couldn't have achieved any of the success over the years in fighting these battles that we have won to date.
Unger: Well, the work that you're doing and with the Mississippi State Medical Association obviously so important not only in the state but to the rest of the country. And of course, the AMA is always proud to support you. It seems like it's almost unrelenting, a lot of these waves of scope of practice expansion bills year after year. You're seeing them just continue in their just scope and number. How do you stay motivated to continue a fight like this?
Dr. Brunson: Well, we here at MSMA just want to make Mississippi healthier, and for us, we've never seen this as a turf war. It's not about being superior or having more education. It's all about putting patients and patient safety first, and we believe that every Mississippian and looking at a national level every American deserves access to quality health care through a physician-led team. And we don't want to see undue harm come to patients at the hands of an inexperienced health care provider. We believe firmly in that, and that is what drives us and we make no apologies for it.
Unger: Well, Dr. Brunson, thank you so much for joining us and for being such a great partner in advocating for physicians and their patients. Fighting these kind of scope of practice expansions is one of the top priorities of the AMA, and to support our work, I encourage everybody out there who's listening or watching to become an AMA member at ama-assn.org/join and also join your state society as they're really fighting these at the state level.
That wraps up today's episode, and we'll be back soon with another AMA Update. Be sure to subscribe for all our new episodes and find videos, podcasts, whatever you're looking for at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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