Paige Twenter – Becker’s Clinical Leadership
In recent years, debates over scopes of practice and titles have intensified among associations representing physicians, advanced practice providers and other healthcare professionals.
For three decades, the American Medical Association has advocated against what it calls “scope creep,” or efforts to broaden the scopes of practice for advanced practice providers, pharmacists, psychologists and other nonphysicians. In recent years, national associations for these healthcare roles have fired back.
The debates over scope of practice and professional titles are highly complex, featuring various arguments on both sides. Here is a brief synopsis of the main arguments, which is not meant to be comprehensive.
Three things to know:
1. The case for broader scopes of practice
Advocates for expanding scopes often cite the nation’s growing physician shortage — especially in rural areas — rising patient volumes and an aging population with high-acuity needs.
To address these challenges, national associations for pharmacists and APPs say they can increase healthcare access in shortage areas while delivering the same high-quality care as physicians.
“I don’t want to replace physicians. I believe we should all be able to practice to the full extent of our education and training for the benefit of patients,” Janet Setnor, MSN, CRNA, president of the American Association of Nurse Anesthesiology, told Becker’s.
Some organizations also say expanded scopes reduce healthcare costs. In a national study, states with full NP scopes of practice regulations had 17% lower outpatient costs than states with reduced scopes of practice, according to findings published in the Journal of Nursing Regulation.
Patients seem favorable toward APPs having broader scopes. In April 2022, a poll of 2,210 American adults found that 82% of recent healthcare patients are in support of nurse practitioners providing the full extent of care. Patients have similar trust in and positive associations with physician associates, according to research.
2. The case against broader scopes of practice
The AMA says expanding scope of practice can harm patients and increase the cost of care, pointing to an AMA-produced survey that found 95% of voters say it is important for a physician to be involved in diagnosis and treatment decisions.
Another argument lies in the differences in education and training. Physicians often log more hours of clinical education and training than APPs, according to the AMA.
AMA President Bruce Scott, MD, told Becker’s in June that expanded scopes are not the answer to physician shortages and healthcare access issues. Nurse practitioners and physician assistants “tend to practice in the same areas of the country, and they’re drawn to specialty care even though they typically have no additional training when they switch from one specialty to another specialty,” he said.
“There is certainly room for improvement in the U.S. health system, but allowing nonphysicians such as nurse practitioners or physician assistants to diagnose and treat patients without any physician oversight is a step in the wrong direction,” the association’s website says.
3. What’s in a name?
A similar controversy involves what healthcare workers call themselves. Can a practicing APP who has a doctorate legally call themselves a doctor? Multiple state legislatures are looking at this exact question.
Some regulations and laws currently bar certain healthcare workers from presenting themselves as a doctor. For example, a California nurse practitioner who had a doctorate was fined about $20,000 for marketing herself as “Dr. Sarah,” implying she was a medical doctor. In January, a Massachusetts physician was fined $25,000 for improper supervision of the NP.
Changing titles have also led to scuffles.
When the American Academy of Physician Associates voted to replace the term “physician assistant” with “physician associate” in 2021, the organization said it was to reflect their experience and roles. The American Osteopathic Association and AMA rebuked the decision, saying the change would confuse patients.
In 2023, AAPA CEO Lisa Gables told Becker’s the rebranding effort will take at least a decade to enter state laws and hospital policies. The organization does not recommend PAs refer to themselves as physician associates with patients.
