June 13, 2023
The California Medical Association (CMA), American Medical Association (AMA) and more than 90 other medical and specialty societies recently sent a joint letter to Congress expressing strong opposition to a federal bill that could compromise care quality for millions of Medicare and Medicaid patients.
The Improving Care and Access to Nurses Act (HR 2713) would expand the scope of practice of nonphysician practitioners (NPPs) — including nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, clinical nurse specialists and physician assistants — allowing them to perform tasks and services outside their education and training, while narrowing or removing supervisory requirements.
“We are deeply concerned that this broad, sweeping bill endangers the care of Medicare and Medicaid patients by expanding the types of services nonphysician practitioners can perform and removing physician involvement in patient care,” the letter said. “This legislation would allow nonphysician practitioners to perform tasks and services outside their education and training and could result in increased utilization of services, increased costs, and lower quality of care for patients.”
Despite claims to the contrary, the data is clear—scope expansions do not lead to increased access to care in rural and underserved areas. In reviewing the actual practice locations of primary care physicians compared to nonphysician practitioners, physicians and nonphysicians tend to practice in the same areas of the state. This is true even in those states where, for example, nurse practitioners can practice without physician involvement.
The letter reinforced CMA’s long-standing support for physician-led, team-based care. While all health care professionals play a critical role in providing care to patients, and nonphysician practitioners are important members of the care team, their skill sets are not interchangeable with physicians. The depth and breadth of physicians’ education is far beyond that of nonphysician practitioners.
“Our organizations remain steadfast in our commitment to patients who have said repeatedly that they want and expect physicians to lead their health care team and participate in their health care determinations,” the letter said. “Patients expect the most qualified person—physician experts with unmatched training, education, and experience—to be diagnosing and treating injured or sick individuals and making often complex clinical determinations. Unfortunately, the I CAN Act effectively removes physicians from important medical treatment decisions regarding a patient’s care.”
For more details, see the joint letter to Congress.