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Nonphysician Providers Push for Expanded Scope of Practice


As nonphysician providers push for more responsibilities, physician organizations push back.

As the physician shortage intensifies, the campaign to expand the scope of practice of nonphysician providers is picking up. 

In March, nursing groups in 11 states were pushing legislation to remove physician supervisory requirements for nurses with a master’s degree or higher, according to the Washington Post. Just last week, the California Senate passed a bill enabling nurse practitioners to treat Medicaid and Medicare patients even if the doctors they work for do not, according to The Sacramento Bee.

In May, Ann Davis, senior director of state advocacy and outreach at the American Academy of Physician Assistants (AAPA) told Physicians Practice that during the last 12 months, 40 states and Washington D.C., had made “positive changes” to their physician assistant (PA) laws. Davis did stress that the AAPA believes PAs should practice under the supervision of a physician.

Even optometrists are getting in on the action. The California Senate recently passed a bill allowing optometrists to check for high blood pressure, cholesterol, and administer specific immunizations, according to The Sacramento Bee.

But many physicians say expanding scope of practice of nonphysician providers - most specifically lifting physician supervisory requirements - is not the solution to ensuring patient access to care amid the physician shortage. As one Physicians Practice reader recently commented on Practice Notes: “NPs and PAs should remain under physician supervision as they are [nonphysician] providers and not physicians. They have not obtained the same level of education nor training to the degree that a physician has.”

Physician groups share similar concerns. The California Medical Association, for instance, opposed both of the bills recently passed in the state, according to The Sacramento Bee.

In September 2012, the AAFP released a report entitled “Primary Care for the 21st Century,” which advocated for the Patient-Centered Medical Home team-based approach to primary care as part of the solution to the physician shortage. The AAFP stressed that those care teams should be led by doctors, not nonphysician providers -more specifically, not nurse practitioners.

The report garnered support from the American Academy of Pediatrics, the American Medical Association, and the American Osteopathic Organization, but it unleashed a torrent of criticism from the American Association of Nurse Practitioners (AANP).

"The American Academy of Nurse Practitioners strongly supports patient-centered and team-based care models. However, AANP believes that AAFP's efforts to link these evolving models of care with the licensure of nurse practitioner (NP) practice are misdirected and out of step with today's environment,” AANP President Angela Golden said in a statement. “… The ongoing attempts by the AAFP to limit the ability of NPs to practice to the full extent of their education and training only serves to increase the already overwhelming hardships placed on millions of Americans who are struggling to gain access to high quality healthcare.”

Regardless of how you feel about the AANPs stance, and about expanding the scope of practice of nonphysician providers in general, it is true that there is primary-care access crisis in this country that will only worsen as the physician shortage continues and as millions of new patients gain access to insurance due to the Affordable Care Act in 2014.

What do you believe is the best way to address the physician shortage? Share your thoughts below.


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