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Experts Call for Uniform Scope-of-Practice Rules


Trump administration hints that it may agree and is considering a broader scope of practice for nurse practitioners and physicians.


Scope of practice laws, long the province of the states and the subject of fierce lobbying, should be standardized across the country, argue healthcare workforce experts in an opinion piece published in this week’s New England Journal of Medicine. This could be more than wishful thinking because the authors may have an ally in the Trump administration.

“Greater uniformity would support health professionals’ ability to practice to the full extent of their education and training and enhance opportunities for efficient and effective health service delivery that better meets patients’ needs,” wrote Bianca Frogner, PhD, the director of Center for Health Workforce Studies at the University of Washington, and her seven colleagues.

Uniformity is especially important when it comes to telehealth services, they note, because telehealth services are often provided across state lines, so each state having their own rules is an impediment.

The Trump administration has hinted at a willingness to consider a broader scope of practice for nurse practitioners and physicians. On October 3, 2019, President Trump signed an executive order that says that within a year the HHS secretary shall propose reforms that will, among other things, called for an eliminate “supervision requirements” and “and all other licensure requirements” that are more stringent that federal and state laws require and that “limit professionals from practicing at the top of their profession.”

Related: Number of Nurse Practitioners Has Doubled

A related section of the executive order says the HHS secretary should propose a regulation that would reimburse physicians, physician assistants, and nurse practitioners based on the work they do “rather than the clinician’s occupation.”

The American Medical Association and the American Academy of Family Physicians have sounded the alarm about the executive order and are fighting it.

Frogner and her colleagues suggested that regulators should make decisions on scope-of-practice rules based on evidence of safety and quality “rather than the objections raised by other health professions.” They noted that even in states with broader rules, health care systems and organizations are slow to expand staff privileges.

The other authors of the Perspective piece, titled “Modernizing Scope-of-Practice Regulations-Time to Prioritize Patients” are Erin Fraher, Joanne Spetz, Patricia Pittman, Jean Moore, Angela Beck, David Armstrong, and Peter Buerhaus.

Why is this important?
Just last week, a study published in Health Affairs showed that the number of nurse practitioners doubled between 2010 and 2017. Many see nurse practitioners-and physician assistants-as the answer to the shortage of primary care physicians. But as Frogner and her colleagues point out, pitched battles in state legislatures often result in maintaining the status quo. Uniform, national standards might accelerate the trend toward more nurse practitioners (and physician assistants).

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