Physicians, PAs, NPs Debate Appropriate Scope of Practice

March 26, 2013

In what circumstances, if any, should nonphysician providers practice without physician supervision?

Last week, we asked readers to weigh in regarding the appropriate scope of practice of nonphysician providers. The question unleashed a firestorm of comments, making it clear Physicians Practice readers are fiercely divided over the issue.

Many readers questioned how much physician supervision of physician assistants and nurse practitioners is necessary.  One reader stated, “NPs and PAs should remain under physician supervision as they are mid-level providers and not physicians. They have not obtained the same level of education nor training to the degree that a physician has; if mid-levels want independent practices then they need to go to medical school and become doctors.”

But another reader replied: “As a PA student, I agree with some of your points ... Should a newly graduated PA be allowed to treat patients with absolutely no supervision? Of course not! However, it is for the same reason that medical interns are heavily supervised by older physicians. As we gain experience through years of practice, we become increasingly self-sufficient and provide excellent care.”

As the physician shortage intensifies and as more patients are newly insured due to the Affordable Care Act, debates like this one are raging across the country. The Wall Street Journal recently reported that more than 1,795 scope-of-practice bills have been introduced over the past two years.

We’d like to know what you think. In what circumstances, if any, should nonphysician providers practice without physician supervision? For instance, should level of training and years of experience the PA or NP has acquired play a role? Also, who should determine if physician supervision is necessary? Should there be a national standard? Should individual practices be able to make these calls? 

Share your thoughts in the comments box below.