Osteopathic advocacy efforts in Arizona (pictured) and Ohio helped strike down laws that would have extended advanced practice nurses’ scope of practice beyond their education and training.
Public policy

Scope of practice update: Recent victories, an ongoing effort and 223,000 comments

The osteopathic medical profession is taking on state and federal efforts to expand nonphysician clinicians’ scope of practice.

Nonphysician clinicians are a critical part of any health care team, but physicians should not be displaced from their role as patients’ primary health care providers. Using this stance as its guide, the AOA has been advocating against expanded scope of practice for nonphysician clinicians and has contributed to advocacy wins for physicians in several states.

Victories in Ohio and Arizona

In Ohio and Arizona, the osteopathic medical profession’s legislative advocacy efforts helped strike down proposed laws this spring that would have extended advanced practice registered nurses’ (APRN) scope of practice in those states. The Ohio Osteopathic Association and Arizona Osteopathic Medical Association partnered with other stakeholders to lead campaigns funded by the Scope of Practice Partnership (SOPP).

The SOPP was cofounded by the AOA in 2006 and challenges efforts at the state level to inappropriately expand nonphysician clinicians’ scope of practice. The AOA and the Texas Osteopathic Medical Association are steering committee members of the group, which has awarded more than $1 million since its inception.

Such advocacy initiatives are rooted in ensuring patient safety and quality of care, says Nicholas Schilligo, MS, the AOA’s associate vice president of state government affairs. “Patients benefit from receiving care from interprofessional health care teams that include both physicians and nonphysician clinicians,” he says. “However, fully licensed physicians—who have complete medical education and training—should lead patient care.”

Recent AOA scope of practice advocacy

In addition to leading campaigns in Ohio and Arizona, the AOA also advocated against scope-of-practice expansion in five other states this year.

State Action taken
Alaska Opposed Alaska Senate Bill 55, which would have increased optometrists’ prescription rights. The bill failed.
Louisiana Opposed Louisiana Senate Bill 187, which would have provided a pathway for APRNs to practice independently. The bill failed.
Michigan Opposed a bill which would have licensed naturopaths in the state and allowed them to use the title “naturopathic physician.” The bill remains under consideration.
Missouri Opposed Missouri Senate Bill 1017, which would have expanded the scope of practice for athletic trainers to include clinical diagnosis. The bill failed.
Wisconsin Opposed Wisconsin Senate Bill 453, which would have allowed physical therapists to order X-rays. The bill failed.

Source: Raine Richards, JD, AOA legislative associate

VA proposes broader APRN practice rights

At the federal level, the Department of Veterans Affairs (VA) proposed a regulation earlier this spring that would allow APRNs to practice without physician oversight in VA facilities across the U.S., regardless of whether the particular state’s law normally permits independent practice of APRNs. Currently, some states allow APRNs to treat patients without physician involvement.

In a letter to the VA in July, the AOA, along with numerous osteopathic specialty colleges and state associations, urged the VA to reconsider. “While the expertise of physicians and APRNs are complementary, they are not equivalent, and our nation’s veterans deserve the best care that can be provided to them, especially given their often complex and unique health care needs,” the letter notes.

Since posting the proposed regulation for public discussion in May, the VA has received more than 223,000 comments. A final decision is expected by late fall.

The AOA is urging the VA to choose another avenue to boost access to care: Expanding its Veterans Choice Program, which allows veterans who have been waiting longer than 30 days for care or who live more than 40 miles away from a VA facility to receive care from a local non-VA physician. Shoring up the Veterans Choice Program would give VA health care professionals more time to care for patients who have more complex needs, the AOA said in its letter to the VA.