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The second in my series of communications from the AMA State Advocacy Conference is a discussion on "Scope of Practice Expansions Beyond Primary Care."
Scope of practice for nurse practitioners (NPs) and other non-physician health care professionals has been rapidly expanding in primary care and specialty settings. The AMA SAS panel discussion explored some of the key issues and concerns around this trend.
Rebekah Bernard, MD highlighted how NP scope expansion took off after the Robert Wood Johnson Foundation successfully advocated for direct reimbursement for NP services in the 1990s. This occurred around the same time there were concerns about a looming physician oversupply, leading to caps on medical school and residency slots.
"We've since seen an explosion in the number of NPs, with over 400,000 now in the workforce and their numbers growing at 40% compared to just 3% for physicians," reported Dr. Bernard, author of Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare and co-host of the Patients at Risk podcast.
Alexander Gross, MD points to dermatology as an example specialty area where NPs are making inroads, with 5,000 NPs compared to 11,000 dermatologists. He raised concerns about NPs' ability to accurately diagnose skin cancer, especially pigmented skin lesions.
Willie Underwood, MD discussed instances where NPs working without supervision have missed important clinical nuances that put patients at risk. "Common medical conditions being missed cost lives," he warned.
The panel also delved into issues around patient choice and truth in advertising laws. An increasing number of nurse practitioners use the title "Doctor" when introducing themselves to patients, despite having different training than physicians. They noted ongoing concerns about medical spas and other facilities offering treatments by those unsupervised or unqualified, which, in some cases, has led to serious patient harm.
Several states have passed or are considering truth in advertising laws to address some of these issues. For example, Georgia's law requires detailed disclosure to patients about a non-physician health care professional's credentials and training. It also prohibits NPs and PAs from using the term "physician."
The panel agreed the rapid scope expansion for NPs and other non-physician health care professionals into primary care and specialty areas raises important questions about patient safety that need to be carefully considered by lawmakers and regulatory bodies.
The Medical Society of Delaware has been very active in addressing scope of practice and truth in advertising in their lobbying and legislative activities. Presently, our Government Affairs Committee is hard at work on educational transparency (Title Misappropriation) legislation with the hope of getting passage this legislative session.
Look for my next communication next month highlighting another topic from this Summit.
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