How scope creep is pushing beyond primary care

Dermatology, emergency medicine and anesthesia are just three specialty areas in which undermining physician-led care is endangering patient safety.

By Tanya Albert Henry, Contributing AMA News Writer

Attempts to inappropriately expand scope of practice for nonphysician providers are taking root well beyond the clinic walls of internists and family physicians. Specialists, too, are seeing nurse practitioners (NPs) and physician assistants (PAs) seek more independence in practicing in emergency departments, dermatology clinics, anesthesiology departments and beyond.

In fact, recent AMA survey data shows that scope of practice tops the list of 2024 legislative priorities for state and specialty medical associations surveyed, with 86% ranking it at the top of their legislative priority list.

Expanding nonphysician providers’ scope of practice can make patients less safe. That is especially so when health professionals present themselves in a way that makes it difficult for patients to understand their role or training, experts said during a panel discussion at the 2024 AMA State Advocacy Summit.

Cost-cutting measures have driven a large amount of the growth in nurse practitioners and physician assistants in emergency medicine, despite research showing that these nonphysicians often deliver costlier care when practicing outside the physician-led care team. 

“The initial use case for NPs and PAs was for the lower acuity patients that we were seeing. Patients that would come in and be triaged as low acuity, the NPs and PAs would be seeing those patients in partnership with a physician,” said Alison Haddock, MD, president-elect of the American College of Emergency Physicians.

“But that's grown and grown over the past 10 or 20 years to the point where there are emergency departments that are staffed solely by nurse practitioners or physician assistants. That is a big problem that we're seeing in emergency medicine.”

And the expansion is expected to continue to grow in many specialties.

"This replacement of physicians is a result of health care policy advocated by nonphysician practitioner leadership, and I think we're only going to see a continued trend unless something changes," said family physician Rebekah Bernard, MD, whose latest book is Imposter Doctors: Patients at Risk.

Patient safety risks

Last year, the AMA played a role in helping defeat more than 100 bills in state legislatures that threatened patient safety by inappropriately expanding nonphysician providers’ scope of practice.

There are already noteworthy cases of how scope expansion and poor or no oversight of nurse practitioners and physician assistants is causing patient harm.

Continue reading in the full article.

Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals.

The AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.

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