Here’s the top state issue keeping doctors up at night in 2024

Nearly 90% of survey respondents list scope of practice expansions as No. 1 priority. Learn how the AMA helped defeat over 100 such bills last year.

By: Kevin B. O'Reilly , Senior News Editor

While the presidential election will no doubt absorb a great deal of attention this year, at the state legislative level there is policy to be made that will collectively affect the health of the nation—for better or worse.

For the people working at state medical associations and national medical specialty societies, new AMA survey data makes clear what lies at the top of their list of legislative priorities for 2024: scope of practice.

In all, 86% of the medical association professionals surveyed put scope of practice atop their legislative priority list—outpacing a long list of other important issues. While 81% of national medical specialty society respondents listed scope of practice first on their agenda, the share rose to 88% among respondents from state medical associations.

The AMA survey results should come as little surprise considering that last year state legislatures across the nation considered an unprecedented number of bills seeking to preempt physician-led, team-based care and inappropriately expand the scope of practice of nonphysicians.

Over 100 state-level bills defeated

The AMA played a role in defeating bills that impacted a broad range of nonphysician providers, including nurse practitioners, nurse anesthetists, physician assistants, psychologists, optometrists, naturopaths and pharmacists.

All of the proposed scope of practice bills had two things in common. These bills:

• Threatened patient safety by proposing to allow nonphysicians to engage in patient-care activities that constitute the practice of medicine and for which they are not trained to provide.
• Were pitched aggressively to legislators by impassioned stakeholders looking to erode physician-led care.

The AMA met these challenges head-on last year, working with state medical associations and national specialty societies to secure more than 100 wins for physicians and patients in legislative tussles over scope of practice expansions pursued by a wide variety of nonphysician providers. ?

The issue also is in focus at the 2024 AMA State Advocacy Summit that runs through Saturday, drawing hundreds of physician leaders and medical society staff. Among today’s sessions is one that features physician experts examining scope of practice expansions beyond primary care.

Nurse practitioners

Alongside the Missouri State Medical Association, the AMA successfully engaged with the Missouri state legislature to oppose multiple bills that aimed to remove collaborative practice requirements for nurse practitioners, authorize nurse practitioners to prescribe medications, and allow nurse anesthetists to provide anesthesia care without any physician involvement. All the Missouri advanced practice registered nurse bills died.

And Missouri is not a unique case. All told, the AMA helped to defeat at least 24 bills that would have expanded the scope of practice of nurse practitioners to include making a diagnosis, treating patients or prescribing medications independently, and helped to defeat at least a dozen bills that would have weakened or eliminated physician supervision requirements for nurse anesthetists. ?

All major scope of practice expansion bills affecting nurse practitioners were soundly defeated in 2023, and no nurse-anesthetist scope of practice expansions passed.

Learn more with the AMA about the difference between physicians and nurse practitioners .

Pharmacists

Meanwhile, nonphysicians outside the nursing field proposed bold scope of practice expansions. Pharmacy groups, for example, came out in full force with bills proposed across the country that would have allowed pharmacists to diagnose and treat patients over the pharmacy counter.

The AMA fought alongside the Mississippi State Medical Association to defeat a bill that would have allowed pharmacists to independently diagnose patients and prescribe medications for a wide range of potentially serious health conditions, even though pharmacists lack medical training and receive no education in making a diagnosis or performing a physical examination.

The AMA played a role in defeating pharmacy bills like this one in about a dozen states. Fighting against other propositions, the AMA also helped to defeat bills in at least six states that would have allowed optometrists to perform eye surgeries or administer injections, despite the fact that optometrists have minimal to no training in such practices.?

Explore the eight things we learned about scope creep in 2023 .

Physician assistants

When it comes to physician assistants , the AMA helped to defeat more than a dozen bills that aimed to weaken physician involvement in physician assistant practice or allow use of the title “physician associate.”

Some physician assistant scope expansion bills did make it through state legislatures this year; however, no physician assistant title change bills were successful. One bill, enacted in Montana, allows for full independent practice by physician assistants, but only after completing 8,000 hours of postgraduate clinical experience.

Other physician assistant bills enacted last year loosen the relationship between physician assistants and physicians, but they tend also to include protective provisions, like requirements that a physician assistant must achieve 6,000 or more practice hours after graduation before the physician assistant may enjoy weakened physician supervision or collaboration requirements. The AMA played a role in securing favorable or neutralizing amendments to a handful of these bills.?

Psychologists

In the face of a surprising wave of psychologist prescribing bills, the AMA helped to protect patients in six states. A bill in New York that is similar to many of the psychologist prescribing bills that were introduced would have authorized psychologists—whose education includes no medical training or hard sciences requirements—to prescribe powerful psychotropic medications and controlled substances to all patients regardless of age or health status, without physician involvement, merely upon completion of an ill-defined course in prescribing.

The AMA and the Medical Society of the State of New York advocated strongly against this bill, and AMA’s workforce maps, which demonstrate how physicians and non-physicians tend to practice in the same areas of a state, debunked the notion that expanded prescriptive authority for psychologists would improve access to care and helped to defeat this and similar bills.?

Finally, and of note, the AMA contributed to the defeat of naturopath licensing bills in at least seven states.?

Find out in detail?why education matters to medical scope of practice , with information on:

• Nurse practitioners compared with physicians.
• Physician assistants compared with physicians.
• Nurse anesthetists compared with anesthesiologists.
• Psychologists compared with psychiatrists.
• Naturopaths compared with physicians.

?? To take a deeper dive into these key points read the full article here. ??

Scope of practice demands urgent action

Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. The AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.

Become a member and help the AMA tackle the key causes and provide relief for physicians. Join now.

AMA Recovery Plan for America's Physicians

Learn more about the work the AMA is doing to address scope of practice .