FP Report -- May 1999
Chapters seek help addressing midlevel providers' scope-of-practice legislation
Midlevel health professionals are expanding their practices through state legislation, and an AAFP commission asked constituent chapters in March what help they need to address the proposed laws.
For example ...
Here are examples of chapter responses to the AAFP survey on midlevel providers' scope-of-practice legislation.
Kansas. Information comparing the training of midlevel providers to the training of family physicians could be helpful.
New York. A summary of scope of practice statutes for nurses, NPs and PAs, nurse midwives, et al. would be helpful.
Colorado. Are there examples where working collaboratively with nurse practitioners (on legislation) has worked?
Nebraska. The nurse practitioners in our state very aggressively sought independent practice. One lobbyist said it was a lost battle. We were able to stop their bill with testimony of female family physicians, and we stressed collaborative arrangements.
Pennsylvania. Trying to completely hold back this tide will be impossible. The Academy should work on strategies to educate the membership how to stay successful and viable as small businesses in the face of growing privileges for nonphysicians.
Texas. Any state that says they don't have a scope of practice problem is incredibly lucky or incredibly politically naive.
"The chapters want more information, and we're already starting to supply that," said Mary Jo Welker, M.D., of Columbus, Ohio, chair of the AAFP Commis-sion on Legislation and Governmental Affairs.
The number of scope-of-practice bills for midlevel providers has increased dramatically in the last five years, said Welker.
"Family physicians have always said you should receive privileges based on training and experience," said Welker. "Lots of providers are saying, 'We can diagnose. We can treat. We can prescribe.' We need to look at their training and experience. For example, pharmacists want to prescribe, but they haven't done the patient's history or physical and have no clinical relationship with the patient. Nurse practitioners want to prescribe independently, but what's their background in pharmacology? Will the services of midlevel providers be cost-effective? Will we pay a price in patient outcomes?"
In the survey, 25 chapters said they actively opposed most state legislative proposals to expand midlevel providers' scope of practice. Only four chapters said they didn't oppose most of those bills.
The AAFP plans to seek data on allied health professionals' training, experience, and projected growth and distribution and will share that information with chapters.
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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