It’s all about a strong defense when it comes to proposed legislation that aims to inappropriately expand nonphysicians’ scopes of practice.
Last year, the AMA worked with state medical associations to defeat more than 80 attempts to let nurses, pharmacists, naturopaths, optometrists, psychologists, nurse midwives and other non-MDs and non-DOs inappropriately expand the care that they are allowed to provide patients without physician supervision. Scope creep bills were seen in more than 40 states.
“The biggest change we’re seeing this year is the volume,” said Kimberly Horvath, a senior attorney with the AMA Advocacy Resource Center.
In addition to new legislation, there are bills that failed to pass in previous years that come back again and again, year after year. And in states that have expanded a particular nonphysician’s scope of practice in previous years, it’s common for that nonphysician group to come back again asking for even broader scope expansions, Horvath said during an AMA webinar examining how states are taking up key health care issues such as scope of practice.
During the webinar recorded in March, a panel of AMA experts discussed their work with national, state and specialty medical societies to address key legislative priorities, including scope of practice, prior authorization and physician well-being.
Horvath said the AMA and state medical societies are “seeing some good trends so far this year” when it comes to defeating the numerous bills. But she said she doesn’t “like to count anything as a win until that last gavel has been struck and the [legislative] session is officially over.” Many state legislatures end in June, though others adjourn earlier in the year and others continue all year long.
The success on scope of practice so far in 2025 “is a testament to the work of the people that we get to work with and have the privilege to work with every day at the state medical associations,” Horvath said. “Their lobbyists or government affairs staff are amazing. But it’s also the physicians—the physicians who take the time out of their busy schedule to talk to lawmakers.”
AMA President-elect Bobby Mukkamala, MD, who moderated the webinar, said he has seen how physicians sharing their stories is important when it comes to scope of practice. Often, it can be the first time that lawmakers are hearing the other side of the story.
Dr. Mukkamala has testified before Michigan’s legislature on the topic several times, telling them: “If I’m going to put a kid to sleep to deal with their airway issue, I want an anesthesiologist available and not just a nurse anesthetist.” Over the years that the issue came before the legislature, “two times the lawmakers 100% agreed and they insisted that the anesthesiologists be part of that anesthesia team. The third time it came up, we lost,” he said.
Nevertheless, he said, physicians must keep telling lawmakers their stories.
“It’s critical that we present that to them because that’s where the rubber meets the road. And the more we can take it down from a theoretical academic conversation to this is what’s happening to your constituents, to our patients, to our neighbors, I think that’s when they start to listen,” he said.
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.
Safety is advocacy cornerstone
Patient safety is on the line when health care professionals who do not have the hours of classroom learning and hands-on training that physicians do attempt to make diagnoses, prescribe medications and perform procedures that they don’t have the expertise to do.
Bills seek, or have sought, to let:
- Nurse practitioners and physician assistants practice without any physician involvement.
- Optometrists perform surgery.
- Psychologists and naturopaths prescribe medication.
- Pharmacists test for and then prescribe medications for several conditions, known as “test to treat.”
- Pharmacists treat substance-use disorder, or even HIV, outside of a physician-led team.
The AMA, among other things, reviews legislation, writes letters and drafts testimony, provides best practices and in-kind resources to support colleagues at the state level. The AMA also leads the Scope of Practice Partnership, a group of more than 110 state medical associations and national specialty societies that works together to defeat scope of practice expansion bills that pose dangers to patients.
“Patient safety is at the cornerstone of everything we do in trying to defeat these scope of expansion bills,” Horvath said.
Informed patients
While physicians are often the leading voice in opposing inappropriate scope perspective, the patient perspective is critically important as well, and the AMA brings that to its advocacy, Horvath said.
AMA surveys have shown that patients want—and expect—physicians to lead their health care team. Surveys also show that they want physicians involved in the medical diagnosis and treatment decisions for their health care.
“We make sure lawmakers know this as well,” Horvath said.
Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
