Advocacy Victories

6 recent scope of practice wins for DOs

DOs continue to fight inappropriate scope of practice expansion efforts by non-physician clinicians.


Teaming up with state osteopathic associations and specialty affiliates, the AOA has commented on 18 unnecessary scope of practice issues at the state level so far this year. The AOA opposes legislation that allows the independent practice of medicine by anyone who hasn’t completed state requirements for physician licensure, according to a recent policy update approved by the AOA’s 2018 House of Delegates.

Here are the latest scope of practice updates regarding naturopathy, assistant physicians, midwives and registered nurses.


State Issue
Alaska House Bill 326 would have redefined the practice of “naturopathy” as a system of medical practice and greatly expanded naturopaths’ scope of practice to include independently prescribing certain controlled substances, performing operative procedures and performing and ordering examinations and clinical laboratory tests for diagnostic purposes. AOA and the Alaska Osteopathic Medical Association jointly opposed the bill and it died upon adjournment.
Hawaii HB 1949 / Senate Bill 2299 would have expanded the scope of practice for naturopaths to allow them to prescribe testosterone. The AOA and the Hawaii Association of Osteopathic Physicians and Surgeons jointly opposed and the bills died upon adjournment.

Assistant physicians (APs), midwives, advanced practice registered nurses

State Issue
Hawaii HB 1813 would have created a new category of licensure for APs, allowing medical school graduates who have not completed a residency program to provide primary care services and prescribe drugs to patients under limited physician supervision. The AOA, HAOPS, the American Osteopathic Board of Family Physicians and the American College of Osteopathic Internists jointly opposed and the bill died upon adjournment.
Hawaii HB 2184 would have licensed and established an inappropriate scope of practice for direct-entry midwifes who may not have completed any formal education. The AOA and the HAOPS jointly opposed and the bill died upon adjournment.
New Hampshire HB 1506 would have created AP licensure and allowed APs who have practiced for five years without any disciplinary actions on record to obtain full physician licensure by passing a yet-to-be-developed exam, without completing any postgraduate medical education or passing a comprehensive licensing examination series. The AOA, ACOFP and ACOI opposed the bill and it was amended to remove the objectionable language.
Oklahoma SB 570 would have granted independent practice rights to advanced practice registered nurses. The AOA sent a letter supporting Oklahoma Osteopathic Association’s position of opposition and the bill died upon adjournment.


  1. DO

    The AOA should define “independent practice”. The AAPA (on behalf of PAs) has recently adopted new policy called “Optimal Team Practice” which sounds great but is really a policy to do away with Supervisory Agreements. In my mind, THAT is independent practice that the AAPA is advocating for. And should be opposed directly by organized physician groups.

    1. Douglas L. Eubanks, D.O.

      I work as medical director for a small group of clinics the serve the under served in a metropolitan area on the west coast. I am the only physician supervising a number of PAs, NPs and ND and I can reinforce the FACT that these are not physicians. While they may be highly motivated and concerned for their patients, their training is definitely not up to the standard of an MD or DO physician. They are “providers” that extend medical resources to the under served and fill the gap for government mandated programs that are woefully under reimbursed. The economy of this approach is questionable as these under trained providers order more tests and imaging, must refer to specialists more often and there is often some delay in diagnosis. On the plus side, they do provide an entry to the medical system for the under served whose problems are as often associated with psychological stress, bad personal care and health practices. Many times these problems can be handled with education, listening and simple medications. As long as these providers are supported by practice limitations and physician support, they can expand the availability of medical care within the available economic resources of the community much as the military uses medics and corpsmen or the Alaskan native health system uses their village medical technicians.

  2. DO

    I agree with Dr Eubanks – and legislatively NPs and PAs lobby groups are using this same rationale (increased midlevel presence in underserved populations for care) for relaxing supervisory rules or scope of practice limitations – not increase or maintain them.

    EVERY state/ state board in the US is being targeted by NPs (AANP) and PAs (AAPA) to do away with supervisory agreements – and in effect, have midlevel practitioners practice independently.

    I think physicians should define independent practice as no supervisory relationship – AANP and AAPA define independent practice as something else.

    These supervision agreements are meant to strengthen care – and they do.

    Relaxing these regulations (having supervisory agreements) or doing away with them altogether – which is what is happening in droves – is not resulting in proportional increased practice of NPs and PAs in underserved populations.

    AANP and AAPA suggest these supervisory agreements are burdensome. We as physicians can and should argue otherwise.

    Work with your state board to keep supervisory agreements in place.

  3. Michael Massey, DO

    Is there any AOA investigation into Hawaii’s discrimatory practice against DO’s in license application requirements compad to allopathic requirements? HI requires DO’s to submit a competency form with verification by two physicians . This is not a requirement for MD applicants. This is from a state that is trying to expand practice scope of less trained professionals ie naturopath. These requirements for DO’s are also not requirements for fmg’s.

    1. Raine Richards, JD, AOA Director of Public Policy

      Dear Dr. Massey,

      We spoke with the Hawaii Medical Board at the FSMB meeting last week, and its leaders were unaware of any inequality in the state’s DO and MD licensing processes. Upon further investigation, the Certificate of Competency form for DOs appears to be similar to the Hospital Form that MDs are required to have hospitals where they held or applied for privileges or worked as an intern/resident complete. Both forms solicit information about the applicant’s competency and ability to safely practice medicine from individuals who know the applicant in a professional capacity. I hope that this helps allay your concerns.

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