Scope of practice: Need for continuing dialogue

In my travels around the country, an issue continually surfaces: scope of practice. Physicians repeatedly voice concern that nonphysician practitioners are attempting to provide medical care without appropriate training, experience or skills.

The concern centers around quality of care, appropriate supervision and appropriate education. Many nonphysician disciplines have pursued state licensing to provide care that historically has been reserved for MD and DO graduates, based upon education and training.

In 2002, psychologists successfully petitioned for and were granted prescribing authority for psychotropic drugs in New Mexico. The same issue surfaced in Louisiana. Optometrists have pursued authority to perform surgical procedures on the eye in many jurisdictions. These assaults on the practice of medicine prompted a coordinated response from the American Medical Association.

In early 2003, five state medical executives and five specialty society executives were assembled to address concerns regarding training and education, state regulations, legislative licensure efforts by nonphysicians and general scope of practice issues.

In 2005, this group formally constituted the Scope of Practice Partnership which now includes 50 state medical societies, 25 national specialty societies and the American Osteopathic Assn. The cost is borne by the specialty societies, the AOA, a number of state societies and the AMA. The AMA provides day-to-day support using the efforts of a group of dedicated lawyers and staff through the AMA Advocacy Resource Center.

Based upon AMA House of Delegates directives in June 2006, the SOPP was charged with providing distinguishing qualifications among health care providers. In response to that charge, the AMA has developed a series of modules that outline the training, licensure and state regulation of 10 nonphysician provider groups.

Four have been completed, and the rest will be completed by the end of 2008. These modules provide information necessary to counter common claims by these providers in their efforts to extend their scope of practice.

The AMA has initiated an extensive database collection and research effort to map geographically the nonphysician practice patterns as well as the practice patterns of physicians within state borders. With these maps, the AMA has illustrated clearly that nonphysicians practice primarily in the same urban corridors as physicians, thereby debunking the argument by nonphysicians that they will practice in rural areas that are not covered by physicians.

The SOPP has additional work groups and projects staffed by AMA attorneys and administrative staff to research clinical doctorate education templates and to develop models to rapidly facilitate coalitions against unwarranted scope of practice expansions.

The SOPP also is involved in public relations campaigns to address truth in advertising by nonphysician providers, many of which mislead the public on education, training and qualifications. Grants have also been awarded to assist in legislative scope of practice issues.

Even with all these activities, including tracking more than 250 bills in state legislatures on scope of practice issues in 2008, physicians must be sensitive to the impending physician work force demands that will outstrip the current capabilities of the profession to address many patient needs in the future.

There are just not enough doctors to provide all the care. Consequently, efforts to have a dialogue with selected professional nonphysician organizations have been and will be continually expended to address the concept of team care to meet the growing demand for health care services.

Our challenge is to engage and utilize appropriately those skill sets that will ensure continued excellence in health care for the American people.

That, too, is the mission and professional responsibility of the AMA.