Scope Of Practice Matters
This is why NHMS fights so hard for scope of practice.
https://www.nhms.org/ophthalmology-scopeHealthcare policy decisions made today will define patient care in New Hampshire for decades. Physician voices are essential to ensuring that healthcare policy reflects clinical expertise, protects patients, and strengthens care for communities across the Granite State.
Every healthcare professional plays an important role on the care team. The policy question is not whether non-physician clinicians provide valuable care — it is whether expanding independent authority preserves patient safety, transparency, accountability, and quality standards for New Hampshire patients.
Scope expansion is fundamentally a patient safety and healthcare delivery issue.
The central policy question is not whether non-physician clinicians are valuable members of the healthcare team — they are — but whether expanded independent authority maintains the same standard of patient safety and clinical accountability.
Training pathways are not equivalent.
Legislators should understand the major differences in education and supervised clinical training of each clinical profession. The differences matter most when patients have multiple chronic conditions, symptoms are unclear, when rare complications arise. The question is not intelligence or dedication. It is depth, breadth, and duration of clinical training.
Access problems are multifactoral
Supporters of expansion often argue it will improve access to care, particularly in rural areas. Legislators should assess all drivers of workforce shortages - reimbursement, burnout, infrastructure, and recruitment challenges. These factors are not specific to one profession and will be determining factors in whether access to care actually increases in rural areas.
Team-based care is already working
Many healthcare systems successfully use collaborative care models. Legislators should consider whether the goal is better team utilization versus eliminating physician involvement entirely.
Independent prescribing and diagnosis carry downstream risks
Scope expansions involving prescribing authority or independent diagnosis can affect continuity of care, diagnostic accuracy, antibiotic stewardship, opioid prescribing, and coordination among treating clinicians. Fragmented care can increase costs and adverse outcomes, especially for medically complex patients.
Patients often do not understand credential differences
Research suggests many patients cannot clearly distinguish among healthcare credentials or understand differences in training. Legislators should consider title transparency requirements, identification standards, and whether informed disclosure protections should accompany expansion. Patients deserve to know who is treating them and the qualifications of that clinician.
Healthcare quality and accountability structures matter
Expanding authority without parallel accountability structures can create gaps in patient protection. Legislators should consider malpractice standards.
Scope of Practice information you need to talk to legislators
Myth: Scope expansion increased access to care.
Truth: Scope of practice expansion seldom leads to increased access in rural areas. Nurse practitioners, physician associates and other providers tend to practice in the same areas of the state - even in those states where providers can practice without physician supervision or collaboration. For the most part, state laws that have expanded the scope of practice have not significantly increased access to care in rural areas.
Truth: Proven reforms include telehealth expansion, increasing residency positions, loan forgiveness programs for physicians in rural and underserved areas, and programs that encourage students from underserved areas to pursue medical school.
Myth: Employing non physician practitioners helps reduce the cost of health care.
Truth: Studies have shown, non-physician practitioners may end up increasing costs to the health care system due to inappropriate prescribing, unnecessary referrals to specialists, and unnecessary orders for diagnostic imaging studies such as x-rays. Care provided by non-physicians working on their own patient panels led to higher costs, more referrals, higher emergency department use, and lower patient satisfaction than care provided by physicians.(1) Ambulatory visits involving NPs and PAs more frequently resulted in an antibiotic prescription compared with physician visits.(2)
Myth: Primary care providers are interchangeable.
Fact: 95% of patients say it's important for a physician to be involved in their diagnosis and treatment.
All patients deserve safe and quality healthcare. Expanding scope of practice may sound like a viable solution, but in reality, it does not work to achieve this goal. Pharmacists for example, are admirably trained medication experts and crucial members of a collaborative healthcare team. However, patients are put in harm’s way when they are exposed to pharmacists practicing outside the scope of their pharmaceutical training. The risk of misdiagnosis, missed underlying medical conditions, and poor health outcomes is high. It does patients a disservice to ask that they settle for less.
Myth: When providing consent to be treated by non-physician practitioners, patients understand the level of education, training and independence of their provider.
Fact: Many patients do not fully understand the differences in education, clinical training, supervision, and scope of practice between physicians and non-physician providers. Research over the past decade suggests that patient understanding varies widely. NHMS advocates for clear, transparent information about who is providing patient care, including each clinician’s education, training, licensure, and role on the care team.
1. Batson, BN, Crosby, SN, Fitzpatrick, JM. Targeting Value-Based Care with Physician-Led Care Teams. Journal of the Mississippi State Medical Association. 2022; Vol. LXIII (1): 19-21.
2. (Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 2009; 302:758–66. )