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June 17, 2022

AMA wants to fight SOP expansion for non-physicians. Is that the right call?

Daily Briefing

    The American Medical Association's (AMA) House of Delegates (HOD) adopted a new policy proposal pledging to fight legislation that expands the scope of practice (SOP) for mid-level providers, Jessica Kim Cohen reports for Modern Healthcare. But Advisory Board's Eliza Dailey argues that Advance Practice Providers (APPs) can and should work autonomously—and explains how to make sure it's done right.

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    AMA pledges to fight legislation that expands SOP for non-physicians

    Earlier this month at the 2022 AMA Annual Meeting, delegates from a variety of medical associations and national specialty societies voted to adopt a policy proposal that will support research on the cost and quality of NPs, PAs, and other mid-level providers caring for patients without supervision from a physician.

    In addition, AMA pledged to help craft state laws that oppose expanding non-physicians' SOP, while working to reverse any such laws that currently exist.

    While doctors at AMA's meeting largely supported the research proposal, many questioned how AMA should support state medical societies and whether the association should advocate for the reversal of existing SOP legislation.

    AMA's reference committee recommended deleting the section of the proposal calling for state legislation to reverse SOP expansion laws. However, most speakers disagreed, arguing that there should be a coordinated push to standardize the group's position opposing SOP expansion across states.

    "We don't want to create a two-tiered system," said Jason Goldman of Florida. "While there are important uses for nurse practitioners and mid-levels … the healthcare team does need to be led by physicians."

    Notably, AMA already has modeled legislation on related topics, including team-based care, which emphasizes the importance of coordinated care across multiple providers and settings. (Cohen, Modern Healthcare, 6/14)


    Advisory Board's take

    APP autonomy is well underway. Here's how to do it right.

    By Eliza Dailey

    Just like we saw telehealth take hold, we also saw APPs practice autonomously to respond to the pandemic and fill workforce gaps. Many states are now taking action to make these Covid-related flexibilities permanent. And the job outlook for APPs is strong. We're projected to see a 45% increase in employment for APRNs and 31% for PAs across the next ten years. Not to mention, APPs are now a standard care team member in many settings.

    Long story short: The genie is already out of the bottle. The trend towards APP autonomy is well underway and doesn't show signs of slowing down.

    While the AMA raises concerns about care quality, with the right model in place, APPs are a valuable care team member. APPs can and should work autonomously. But to do this, organizations must stand up models that allow their APPs to succeed. In my team’s research before and during the pandemic, we found four things that unlock APP autonomy: (You can read more in this research briefing.)

    1. Standardized roles that advance strategic goals,
    2. Centralized onboarding and clinical training,
    3. Performance-based compensation, and
    4. Involvement in group governance

    After countless conversations, I know this model can work, but we need to invest in our APPs. In many ways, shifting the way we treat them to be more like our physicians. Don't get me wrong: There will always be a need and unique role for physicians. But APPs can help us solve longstanding issues like access, burnout, and patient experience.

    As the article mentions, almost half of states already give NPs broad practice authority. Rather than backtracking, we should take proactive steps to make our care models work better for physicians, APPs, and—importantly—patients. To help, I've compiled our best research on APPs below:


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