A nationwide fight is underway to protect physician-led medical care

AMA Newswire

A nationwide fight is underway to protect physician-led medical care

April 25, 2024

After helping state medical associations and national specialty societies to vote down more than 100 bills in 2023 that would have inappropriately expanded the scope of practice of non-physicians, the AMA is again working relentlessly with its allies in organized medicine to continue the fight for physician-led, team-based care in this year’s legislative session.

This focused and effective advocacy effort has spread across the country, and the AMA has helped fight expansion in Alaska, Connecticut, Georgia, Oklahoma, New Hampshire and more.

Combating scope creep is a key component of the AMA Recovery Plan for America’s physicians.

Patients have the right to be treated by physicians who are the most highly educated, trained and skilled medical professionals, and the AMA vigorously defends medical practice against scope of practice expansions that threaten patient safety.

Several bills have been introduced across the country this year that would expand the scope of practice for naturopathic doctors by allowing them to prescribe medications. The AMA is staunchly opposed to these proposals.

Because no residency training is required, naturopaths do not have the extensive clinical training of physicians. In particular, there is no guarantee that the patients they treat during their clinical training will encounter a wide range of illnesses and conditions. A naturopath’s pharmacology education is combined with and taught in parallel with naturopathic treatments and philosophies such as phytotherapy and homeopathy. Simply put, their education does not compare to that of a physician.

After all, the AMA believes that naturopathic doctors don’t have the education and training necessary to safely diagnose and prescribe medications to patients, yet bills being proposed around the country would allow naturopathic doctors to do just that with few guardrails.

AMA Board Member Scott Ferguson, MD, has been a vocal critic of these bills. He has testified in state legislative hearings in Connecticut and Alaska in opposition to naturopathic prescribing bills. In state legislatures, Dr. Ferguson, a medical professional and former legislator himself, has effectively compared the educational preparation of naturopathic doctors to that of medical doctors and defended the importance of medical education and training in providing health care to patients. On behalf of the AMA, he has strongly opposed these proposed scope of practice expansions.

The Alaska and Connecticut legislatures have not yet made final decisions on bills to expand the scope of practice for these naturopaths. Bills to expand the scope of practice for naturopaths were rejected in Washington and Florida this session.

Learn more from Dr. Ferguson about what doctors want patients to know about their scope of practice.

The Georgia Medical Association successfully defeated several scope of practice bills during the 2024 legislative session that concluded last month. Topping the list were Senate Bills 419 and 460, two bills that would have removed language requiring anesthesia services provided by certified registered nurse anesthetists (CRNAs) to be under the direction and responsibility of a physician.

Voting these bills would preserve physician oversight of nurse anesthetists, which is essential to keeping patients safe when they receive anesthesia. Grant funding from the AMA Scope of Practice Partnership helped state medical associations support their advocacy efforts.

Meanwhile, in Oklahoma, a bill (Senate Bill 458) has reached the governor’s desk that would allow nurses, clinical nurse specialists and certified midwives to provide medical care and prescribe medication without a doctor’s intervention.

Thanks to the tireless efforts of the Oklahoma State Medical Association, Governor J. Kevin Stitt has put patient safety first and maintained physician oversight of advanced practice nurses (APRNs) by vetoing the bill. While this news is very welcome, the State Medical Association is fighting hard to maintain the veto, as the Governor’s veto can only be overridden by a majority (75%) vote in both houses of Congress.

The AMA has taken a strong stance in opposition to measures that would expand the scope of practice for physician assistants, as proposed in New Hampshire in House Bill 1222. As originally drafted, the bill would have removed all language requiring physician assistants (PAs) to collaborate with physicians, allowing them to practice medicine without a physician’s involvement.

“This is a dangerous bill that would repeal the collaborative practice language that this Legislature only recently passed, setting New Hampshire apart from nearly every other state in the nation,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a letter (PDF) to leaders of both parties in the New Hampshire House of Representatives.

“As health care delivery becomes more complex in this country, a fully coordinated, quality-driven, patient-centered care team will be the best way for Americans to receive health care,” Dr. Madara added. “In a physician-led team approach, each member of the team plays a critical role in providing efficient, precise and cost-effective care to patients.”

The bill passed the House with an amendment that would preserve collaborative practice agreements between physician assistants and physicians who have fewer than 8,000 clinical hours and who do not work in a group practice or health system with a physician in the same specialty. The bill is before the Senate Health and Human Services Committee.