AMA continues fight against scope of practice creep
American Medical Association (AMA) Board of Trustees member Scott Ferguson, MD, a diagnostic radiologist in West Memphis, Arkansas, explains how the organization is fighting against scope creep laws that would give practice rights to non-physicians with minimal training.
“It’s unbelievable. The AMA had 180 scope of practice victories around the country where we opposed inappropriate expansion into the field of practicing medicine without the proper background and training,” Ferguson explained.
Scope creep is a primary policy fight for AMA advocacy efforts to ensure physicians with years of training are making treatment decisions for patients, as opposed to clinicians with lower level licenses and less training. Ferguson said the AMA fights bills at the state and local level that have legalized and regulated such policies.
The AMA faces resistance in places where lawmakers feel the good of expanding practice rights to non-physicians outweighs the concerns of doctors. The group suffered a recent loss in Oklahoma, where the legislature overrode Governor J. Kevin Stitt’s veto of two scope of practice bills that gave greater authority to nurse practitioners, certified registered nurse anesthetists and midwives, along with physician assistants, to practice medicine. This was done to mitigate physician shortages in the state.
“When it happens in one state the next one and the next one use that as an example,” Ferguson said.
He said another example that AMA is f ighting is with the federal VA health system, which is considering allowing optometrists to perform laser eye surgery.
The American Academy of Ophthalmology (AAO) said optometrists are not allowed to perform eye surgeries in VA medical facilities. but added this longstanding policy is under threat.
"The academy—along with prominent veterans’ and military groups—is concerned that the VA may loosen the scope of practice for optometry as it develops a national standard of practice for VA-employed optometrists. If this happens, it could allow VA-employed optometrists to perform eye surgery in VA facilities. This new standard could also supersede laws in several states that currently prohibit optometrists from performing surgery," the AAO said in a statement to Health Exec.
In 2022, the VA modified its Community Care “Standardized Episode of Care (SEOC): Eye Care Comprehensive” guideline to remove language supporting a longstanding VA policy that “only ophthalmologists can perform invasive procedures, including injections, lasers, and eye surgery.” THE AAO said this decision was made without input from veterans, physicians, or the public.
"This dangerous policy opens the door for the VA to refer patients living in the few states that allow optometric surgery to private sector optometrists for laser surgeries under the VA’s Community Care referral guidelines," the AAO said.
The AMA noted that state legislatures saw a record number of scope of practice expansion bills in 2023, only for the record to be beaten in 2024. The association said these bills were supported by non-physician providers in efforts to weaken physician-led, team-based care.
The AMA said some areas that non-physicians are looking to gain ground include:
- Pharmacists pursuing bills that would allow them to test for and prescribe medications for several conditions, as well as bills that would allow them to treat substance-use disorder, or HIV outside a physician-led team.
- Optometrists are seeking bills that would allow them to perform surgery.
- Psychologists and naturopaths are pursuing bills that would let them prescribe medications.
- Nurse practitioners, other advanced practice registered nurses, and physician assistants are backing bills that would allow them to practice without any physician involvement, the AMA said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]