Scope of practice advocacy

There is no equivalency between a physician and a non-physician health professional. Despite their education, skills and experience, however, family physicians face encroachment on their scope of practice by clinicians who lack comparable proficiency.

The American Academy of Family Physicians (AAFP) advocates for policy safeguarding family physicians' scope of practice: the sum of all activities a licensed health professional can legally perform. In recent years, an increasing number of state laws have been passed that expand what non-physicians are allowed to do. This scope creep encroaches on family physicians’ scope of practice.

When practicing under physician supervision as part of integrated health care teams, non-physician professionals are instrumental in caring for patients. But patient safety is at risk when scope creep lets non-physicians deliver services beyond their education and training.

The AAFP believes that the best way to support high-quality care and lower costs is to ensure that physicians lead health care teams. The Academy advocates against policy that would allow non-physicians such as physician assistants (PAs), nurse practitioners (NPs) and pharmacists to diagnose and treat patients without physician oversight.

Family physicians complete more than 20,000 hours in medical training, compared with as little as 2,800 hours for nurse practitioners. As leaders of integrated care teams, family doctors have the expertise and experience to:

The Academy believes in the patient-centered medical home as the ideal approach to physician-led care. Under this principle, patients have access to the expertise of all health professionals and are ensured the best care from the most appropriate health care professional at the proper time.

Research demonstrates that expanding the scope of practice for NPs and PAs has resulted in overuse of diagnostic imaging and other services.

In states that allow independent prescribing, NPs and PAs were 20 times more likely to overprescribe opioids than those in restricted states.

One study found that NPs and PAs delivering primary care independently resulted in higher costs, higher utilization of services and lower quality of care compared with panels of patients treated by a primary care physician.

An array of research clearly shows that NPs and PAs often do not understand and diagnose complex medical issues. They also:

The effects of this uncoordinated care mean higher health care costs, lower patient safety and poorer health care outcomes.

Every year, multiple states pass or consider legislation or regulations to let non-physician health care professionals expand their scope of practice. Particularly as health systems continue to consolidate, such expansions are often presented as a way to address physician shortages or control costs. Research says scope creep accomplishes neither.

The Academy advocates for policies and guidelines that push back against this encroachment, protect the scope of primary care and allow family physicians to work closely with other specialties and health professionals as they lead health care teams.

The AAFP’s scope-of-practice advocacy includes efforts to:

Though all members of the health care team are important, they are not interchangeable.

The AAFP’s scope-of-practice advocacy calls for standardized training criteria and licensure regulations that value demonstrated experience and competence in patient care.

The Academy’s scope-of-practice advocacy cites strong evidence to back its patient-centered medical home principle and the importance of team-based care led by physicians.

Patients agree with this approach. Data indicates that patients prefer their care to come from physicians, who have unmatched training, education and experience.

Because all states have individual laws and regulations governing scope of practice, most scope creep comes from state legislation, which the AAFP’s chapters monitor and challenge. The Academy also advocates for family physicians’ scope of practice when legislation in the U.S. House of Representatives or the U.S. Senate could result in scope creep.

One such piece of legislation the AAFP successfully combatted is the Improving Care and Access to Nurses (I CAN) Act. The Academy plans to advocate against the bill if it is reintroduced.

The AAFP also successfully advocated against the Equitable Community Access to Pharmacist Services Act, which would have expanded pharmacists’ scope of practice at the expense of patient health.