The California Medical Association (CMA), along with 10 other medical societies representing more than 180,000 physicians, sent a letter to the Department of Veterans Affairs (VA) expressing concerns with a proposed rule that would allow advanced practice registered nurses (APRN) to practice independently in the VA health system.  

The agency announced at the end of May that it wants to expand the scope of practice for APRNs to allow them to order and read diagnostic tests, administer anesthesia, prescribe medications, and manage acute and chronic diseases—without physician oversight. The proposal is intended to address long wait times for veterans seeking health care.

CMA is extremely concerned that the VA rule would lower the standards of care and put the health of veterans at risk.

“Our veterans have earned and deserve the highest quality and best care, but this rule would lower the standard of care for veterans around the country," CMA and other state medical associations wrote in the letter.

"There is absolutely no question about the value of team-based care, not only to our veterans but also to all of our patients. The physician and every other member of the health care team each brings unique value to patient care, based on his or her education, skills and training. Team-based health care must, however, be physician-led; that is the hallmark of quality care. This central tenet applies both to primary care and specialty care. By eliminating this key requirement, the proposed rule places the health of those who have served our nation at risk.”

The VA says it is acting to meet a growing demand for care from veterans and a shortage of physicians on its staff. Under the proposed rule, APRNs working for the Department of Veterans Affairs would be able to practice independently even in states like California where it is outside of their legally defined scope of practice.

CMA believes that ignoring state laws on scope of practice lowers the quality of health care for veterans. “The proposal supersedes state law, centralizes health care decision-making, and eliminates local control of licensing and regulation of physicians and health care providers,” CMA wrote in the letter. “This actually results in a lower-standard of care for our veterans than for other patients.”

The letter was cosigned by the Multi-State Medical Society Coalition, including the Arizona Medical Association, Florida Medical Association, Louisiana State Medical Society, Medical Society of New Jersey, Medical Society of the State of New York, North Carolina Medical Society, Oklahoma State Medical Association, South Carolina Medical Association and Texas Medical Association.

The American Medical Association also passed a resolution at its recent annual meeting in opposition to the VA proposed rule.

Comments on the VA rulemaking are due July 25.