NP, PA Scope of Practice Debates Intensify

As the physician shortage intensifies, so does the debate over the appropriate scope of practice of nonphysician providers. Where do you draw the line?

As the physician shortage intensifies and more patients are expected to gain insurance due to the Affordable Care Act, the debate over the appropriate scope of practice of nonphysician providers is escalating.

In California, for instance, some lawmakers "are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices,” according to the Los Angeles Times.

But also according to The Times, some doctors fear that giving nonphysician providers more authority and independence could jeopardize patient safety. Others say it could drive up healthcare costs because non-physician providers may order more tests and prescribe more antibiotics. "Patient safety should always trump access concerns," said Paul Phinney, MD, president of the California Medical Association.

Below, readers discuss where they would draw the line when it comes to scope of practice of nonphysician providers. Looking for more discussion on this topic? There’s a new debate going on regarding physician supervision of PAs and NPs and whether it should vary depending on training and experience level. 

Facing a dilemma in practice? E-mail it to We’ll share it without revealing your name, and we will ask other physician readers to weigh in.