Across the nation, the fight’s on to protect physician-led care (2024)

After helping state medical associations and national specialty societies defeat more than 100 bills to inappropriately expand nonphysicians’ scope of practice in 2023, the AMA is again relentlessly joining its allies in organized medicine to continue the fight for physician-led, team-based care in this year’s legislative session.

This intensive and effective advocacy effort has ranged across the country, as the AMA has helped battle scope creep in Alaska, Connecticut, Georgia, Oklahoma, New Hampshire and elsewhere.

Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians.

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.

This year, multiple bills have been introduced across the country to expand the scope of practice of naturopaths by authorizing them to prescribe medications. The AMA is staunchly opposed to these proposals.

With no residency training requirement, naturopaths lack the robust clinical training of a physician. Notably, there is no guarantee that a naturopath will encounter a broad range of illnesses or conditions in the patients they treat during their clinical education. A naturopath’s pharmacological education is combined with, and taught alongside, naturopathic therapeutics and philosophies such as botanical medicine and homeopathy. That education, simply put, is not comparable to that of a physician.

When all is said and done, the AMA believes that naturopaths lack the education and training necessary to safely diagnose and prescribe medications to patients. And yet bills proposed across the country would allow naturopaths to do just that, and with very few guardrails.

AMA Trustee Scott Ferguson, MD, has taken these bills to task. He has testified against naturopath prescribing bills in state legislative hearings in Connecticut and Alaska. Before state legislatures, Dr. Ferguson—as a physician expert and former legislator himself—has effectively compared the educational preparation of a naturopath to that of a physician and championed the importance of the medical education and residency training in providing medical care to patients. Representing the AMA, he has advocated strongly against these proposed scope of practice expansions.

The legislatures in Alaska and Connecticut have yet to make final decisions on these naturopath scope of practice expansion bills. Naturopath scope expansion bills have failed in Washington and Florida this session.

Learn more with Dr. Ferguson about what doctors wish patients knew about scope of practice.

The Medical Association of Georgia successfully defeated several scope of practice bills during the 2024 legislative session that adjourned last month. At the top of this list are two measures—Senate Bills 419 and 460—that would have removed language requiring anesthesia services provided by certified registered nurse anesthetists (CRNAs) to be done under the direction and responsibility of a physician.

Defeating these bills preserves physician supervision of nurse anesthetists, which is imperative to protect the safety of patients receiving anesthesia. A grant from the AMA Scope of Practice Partnership helped support the state medical society’s advocacy efforts.

Meanwhile, an Oklahoma measure—Senate Bill 458—to allow nurse practitioners, clinical nurse specialists and certified nurse midwives to practice and prescribe medications without any physician involvement made it to the governor’s desk.

Following tireless efforts from the Oklahoma State Medical Association, Gov. J. Kevin Stitt put the safety of patients first and preserved physician supervision of advanced practice registered nurses (APRNs) by vetoing the bill. While the news is very welcome, the governor’s veto can be overturned by a supermajority vote (75%) of both houses, so the state medical association is working hard to sustain the veto.

The AMA has weighed in to strongly oppose a measure to expand physician assistants’ scope of practice in New Hampshire as proposed in House Bill 1222. As originally drafted, the bill would have removed all language requiring physician assistants (PAs) to collaborate with physicians, thereby allowing them to practice medicine without any physician involvement.

“This is a dangerous bill that sets New Hampshire apart from almost every other state in the nation and walks back collaborative practice language that this legislature just recently passed,” AMA Executive Vice President and CEO James L. Madara, MD, wrote to leaders (PDF) of both parties in the New Hampshire House of Representatives.

“As the provision of health care in this country becomes more complex, a fully coordinated, quality-focused and patient-centered health care team will be the optimal means by which Americans will receive their health care,” Dr. Madara added. “In the physician-led team approach, each member of the team plays a critical role in delivering efficient, accurate and cost-effective care to patients.”

The bill passed the House with an amendment that retains written collaborative practice agreements between a physician assistant and a physician for PAs who have less than 8,000 hours of clinical practice and who do not work in a group practice or health system with a physician in the same specialty. The bill is pending in the Senate Health and Human Services Committee.