In a move that raises the stakes in doctors' ongoing scope-creep battle against nonphysician providers, the American Medical Association's (AMA) legislative body voted recently to change its policy on the supervision of advanced practice registered nurses (APRNs). AMA's House of Delegates called for state medical boards to regulate APRNs in addition to nursing boards.
The AMA has long claimed that nonphysician providers, such as nurse practitioners (NPs) and physician assistants (PAs), need greater oversight because expanded scope of practice for advanced practice practitioners threatens patient safety and undermines the physician-led team model.
APRNs have been touted as a solution to expand access to care and reduce disparities, especially in rural and underserved communities, and they have been promoted by organizations such as the National Academy of Medicine. But the AMA disputes that scope expansions are necessary to increase access to care.
The organization that represents the nation's physicians told Medscape Medical News in a prepared statement that it opposes scope expansions because removing doctors from the care team results in higher costs to the patient and lower quality care.
Several nursing organizations swiftly criticized the policy recommendation, including the American Nurses Association (ANA), the American Association of Nurse Practitioners (AANP), and the National Council of State Boards of Nursing.
The policy shift would create more administrative burdens for APRNs and generate "a downstream effect that only hurts patients," particularly those in underserved communities without timely access to care, ANA president Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, told Medscape.
"The licensing and regulation of APRNs have never required the oversight of state medical boards," she said, adding that it should remain the obligation of nursing regulatory bodies.
Jon Fanning, MS, CAE, CNED, chief executive officer of the AANP, called the AMA proposal "flawed."
"The restrictive involvement of the board of medicine directly contributes to healthcare access challenges, resulting in continued low health care rankings, geographic disparities in care, and unnecessary regulatory cost in these states," he said in a press release.
Still, the AMA has vowed to #StopScopeCreep. Securing stricter practice guidelines was a central theme of the association's recent annual meeting and a goal of its plan to strengthen the physician workforce. The organization invests heavily in advocacy and education efforts to defeat state bills seeking to extend APRN authority. To that end, the AMA Scope of Practice Partnership, a coalition of over 100 medical associations, has awarded members $3.5 million in grants to combat scope-expansion legislation.
The AMA and the American College of Radiology recently partnered to create advocacy materials, including handouts encouraging patients to ask questions such as: "Will a physician be reviewing my chart, lab results, x-rays, and other tests?"
The policy recommendation comes as concerns mount over the potential for significant physician shortages, fueled partly by older physicians' retirements and doctors reducing hours or exiting the workforce due to pandemic fatigue and burnout.
While practice regulations vary by state, a new federal bill could change that by broadening the authority of APRNs under Medicare and Medicaid guidelines. Introduced in the US House of Representatives in April and supported by the ANA, the Improving Care and Access to Nurses (ICAN) Act would allow APRNs to perform more procedures, including cardiac and pulmonary rehabilitation and certification of terminal illness for hospice, according to an ANA press release.
In the meantime, several state legislatures are considering bills that would expand APRN scope of practice. Utah is the latest to join a growing list of states — about half now — offering full practice authority to NPs.
Other states offer a reduced scope of practice for APRNs, typically requiring a collaborative agreement with a supervising physician. The remaining states enforce tighter regulations and physician oversight.
A recent Medscape survey found that most physicians report having a good rapport with NPs, but many have mixed feelings about giving them expanded practice roles, with one third saying it would harm patient care. Feelings were only slightly more favorable toward PAs. However, about 75% of patients were either neutral or supportive of independent practice for NPs and PAs.
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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Cite this: AMA Supports APRN Oversight by Both Medical and Nursing Boards - Medscape - Jul 06, 2023.