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 speciality 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 comment

  1. 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.

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