Scope of Practice

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The Pennsylvania Medical Society (PAMED) continues to vigorously support physician-led, team-based care. Scope of practice expansion, for non-physician providers, can lead to safety concerns, increased costs and an increase in unnecessary testing.

Non-physician providers include Certified Registered Nurse Practitioners (CRNPs), Physician Assistants (PAs), Registered Nurses (RNs) and Surgical Technicians.

Key Items:

• Pennsylvania law requires CRNPs to have a collaborative agreement with a physician which, in essence, establishes the parameters under which a CRNP will function in working with that physician.
• Studies have shown that non-physician led care ends up increasing health costs:
  • X-ray ordering increased 441% among non-physicians
  • Patients with non-physician primary care providers had $43 higher spending per member, per month compared to those who had a physician.
• Optimal patient care is most effectively delivered through health care teams. The “team” approach, consisting of CRNPs, PAs, RNs, Surgical Techs, and a cadre of other non-physicians that play a vital role in patient care.
• Recent studies by the American Medical Association found that 91% of patients view physicians’ education and training as vital for optimal care.
• There is a misconception that allowing independent practice of non-physician roles will expand access to care in rural and underserved communities.
  • The American Medical Association mapped the locations of primary care physicians and nurse practitioners nationwide in 2013, 2018, and 2020 and each time the results showed they tend to practice in the same areas of the state as physicians, regardless of scope of practice laws.
  • There are a number of ways to enhance access to physicians outside of expanded scope of practice.
• The role of CRNPs varies depending on the practice setting. In some private medical practices, CRNPs see their own panel of patients…they diagnose and develop treatment plans accordingly. In hospitals, their roles can range from direct patient care to triaging patients or providing post-surgical follow-up.