AMA to fight legislation expanding scope of practice

The American Medical Association pledged to fight legislation that expands mid-level providers’ autonomy.

Under a new policy proposal adopted Tuesday by the AMA House of Delegates, the trade group will support research on the cost and quality of nurse practitioners, physician assistants and other advanced practice practitioners caring for patients without a doctor’s supervision. The association will help craft state legislation to oppose laws that expand the scope of practice for non-physicians and to reverse such laws that already exist.

The AMA convened delegates from groups including state and territorial medical associations and national specialty societies in Chicago this week to vote on a slate of policy proposals.

Expanding scope of practice has been a longstanding point of contention between physicians and advanced practice practitioners. Nurses have pointed to a number of studies that found no significant difference in care quality between APPs and physicians.

State legislators drafted more than 70 bills this year that would adjust scope-of-practice laws. Most of those bills sought to codify the relaxing of such laws during the COVID-19 pandemic, when physicians were occupied by the most acute cases. Currently, nearly half of states give nurse practitioners broad practice authority.

Mid-level providers prescribed antibiotics more frequently, ordered more imaging and provided more expensive care, according to research cited by the AMA.

While doctors at the meeting Tuesday agreed on the research proposal, they diverged on how the AMA should support state medical societies and whether the AMA should push to reverse existing legislation.

The AMA’s reference committee had suggested deleting the section calling for state legislation on reversing scope of practice laws. The trade group already has model legislation on related topics, like team-based care, which emphasizes coordinating care across providers and settings, the committee said.

Dr. Lynn Parry of Colorado agreed with that assessment, raising concerns about the potential perception that “all we care about is our own income,” particularly when it comes to pushing to reverse legislation that already exists.

“We really need to show that our focus is on improving care of our patients,” she said.

A toolkit that supports state medical groups would be more helpful than developing model legislation that’s applied across states, said Dr. Don Lee of Wisconsin.

However, most speakers disagreed, arguing that without model legislation and a coordinated push that standardizes the group’s position across states, new bills expanding scope of practice will continue to be introduced.

Florida is fortunate to have a robust legislative and advocacy program, but others may need the AMA’s help, said Dr. Jason Goldman of Florida.

“We don’t want to create a two-tiered system,” he said. “While there are important uses for nurse practitioners and mid-levels … the healthcare team does need to be led by physicians.”