Turf wars heat up after pandemic blurred provider treatment lines

Nurse practitioners, physicians assistants and pharmacists are pressing for more autonomy to diagnose patients, recommend treatments and write prescriptions, and doctors’ aren’t pleased.

Why it matters: So-called scope of practice fights have been going on for decades. But certain emergency powers granted during the pandemic allowed advanced practice providers who were not doctors to provide more services than ever before and reignited the battle in many states.

Driving the news: Relaxed laws allowing “unrestricted independent practice” by nurse practitioners exist in 25 states, as well as the District of Columbia and two U.S. territories.

  • New York became the latest to join that list when Gov. Kathy Hochul signed legislation into law over the weekend to allow “NPs” to practice without supervision from a medical doctor.
  • Massachusetts Gov. Charlie Baker signed similar legislation earlier this year expanding the independent practice of physician assistants.
  • In Maryland, the state legislature overturned a veto over the weekend by Gov. Larry Hogan so nurse practitioners, midwives and physician’s assistants could perform abortions.
  • The Biden administration’s test-t0-treat initiative would allow pharmacists to administer antiviral drugs on the spot to patients who’ve tested positive for COVID, spurring that industry to push for regulatory changes to cement its enhanced role in patient care, Axios’ Caitlin Owens wrote last month.

Between the lines: The pandemic allowed certain advanced providers, like nurse practitioners, to demonstrate they were able to fill critical gaps in the strained health care system by being allowed to exercise the entire “scope” of their license, proponents argue.

  • “We’re not seeking to work beyond our education and training,” American Association of Nurse Practitioners president April Kapu told Axios. “We’re only asking to work to the extent and education of the training we have.”
  • She pointed to data that found improved access in rural areas and improved outcomes among patients when nurse practitioners were able to practice without limits often placed by state laws.

But, but, but: Doctors call this “scope-of-practice creep,” and they say the non-physician providers are jeopardizing patient safety without expanding access or saving money the way proponents claim.

  • The American Medical Association has been fighting this battle for years and helped defeat scope of practice expansion bills in Florida, Kansas, Kentucky, Louisiana, Maine, Mississippi, Tennessee and Texas last year.
  • “The American Medical Association strongly supports physician-led team-based care where all members of the team use their unique knowledge and valuable contributions to enhance patient outcomes,” the organization said in an emailed statement.
  • “Nurse practitioners are valuable members of this team, but they are not a replacement for physicians,” they said, pointing to an AMA-sponsored poll of 1,000 U.S. voters between Jan. 27–Feb. 1. In the poll, 95% of respondents said it was important for a physician to be involved in their diagnosis and treatment.

What to watch: State-by-state legislative fights will continue with both sides making arguments for improved patient outcomes and access