Scope of Practice
Scope of practice is defined as the activities that an individual health care practitioner is permitted to perform within a specific profession. Scope of practice protects both the health care providers and patients by providing boundaries to the provider’s individual practice which are determined based off a provider’s specific education, experiences, and demonstrated competence. Scope of practice laws vary state to state.
Proposed legislation around scope of practice has risen in recent years partly due to the growing health care work force problem. Virginia, like many other states, is experiencing shortages of both physicians and nurses. At the same time, there is increasing demand for primary care. Some have argued the solution to address our work force shortages and primary care needs is expanding the scope of practice for non-physicians. However, there are solutions such as loan forgiveness programs, increasing the number of residency slots and taking steps to improve reimbursement for primary care services, which can work to meet the needs of patients without jeopardizing their safety. MSV supports patient-centered, team-based care.
A team-based approach includes physicians and other health professionals working together, sharing decisions and information, for the benefit of the patient. Physicians, nurse practitioners, physician assistants, nurses and other professionals would work together, drawing on the specific strengths of each team member. Given the extensive training and preparation of physicians, they are best suited to lead the other members of the care team to ensure patients receive the care they deserve and need.
MSV’s Position on Scope of Practice
Physician-led, team-based care is best for patients. Physicians are best equipped to practice medicine, independently and leading a care team, because of their extensive education and training. Some mid-level providers continue to advocate to practice outside of the care team in Virginia and nationwide; MSV opposes all efforts to end physician-led team-based care.
During the 2018 General Assembly session, MSV opposed measures which would have jeopardized patient safety. Among those included opposing the independent practice for nurse practitioners (NPs).
The bill, as introduced, would have allowed:
- NPs to practice independently after 6 months of practice with either a nurse practitioner or a physician.
- NPs to practice in any specialty and with any patient population, without certification or experience.
Despite thousands of messages sent to legislators, active lobbying, and compelling testimony by MSV members, the General assembly continued to advance legislation. MSV pushed for the most stringent practice requirements to be included in the legislation, with the help of Del. Scott Garrett, MD. MSV was successful at amending the bill to include tougher requirements designed to protect patient safety.
Virginia’s law includes:
- A minimum of 5 years of clinical practice with a physician before an NP can practice without a practice agreement
- Clinical practice must be in the specialty for which the nurse practitioner was certified and licensed
- Regulation under the Joint Boards of Medicine and Nursing
- Requirements to obtain professional liability insurance
- Report back to the General Assembly in 2021 on
- The number and specialties of NPs practicing autonomously
- The geographic areas where NPs are practicing autonomously
- The number of complaint and/or disciplinary actions involving NPs practicing autonomously
- Any recommended modifications the law
In 2018, MSV also, in partnership with the Virginia Academy of Physician Assistants, opposed and defeated legislation that would have created a new Doctor of Medical Science (DMS) license.
MSV also opposed an unsuccessful optometry scope bill that would have allowed optometrists to perform surgical procedures.
The Virginia Pharmacists’ Association is bringing forward legislation to allow pharmacists to:
- Administer all vaccines
- Diagnose and treat the flu, strep, H Pylori, and UTIs
- Prescribe PrEP for HIV
- Prescribe and dispense epinephrine, and tobacco cessation medications, birth control, naloxone, prenatal vitamins, and OTC medications where a health plan requires a prescription
- Conduct TB tests
In addition, the Virginia Association for Naturopathic Physicians is supporting a bill that will:
License naturopaths under the Department of Health Professions and, in addition to the practice of homeopathic medicine, allow naturopaths to
- order and perform physical and lab tests, as well as certain diagnostic imaging studies;
- Prescribe, dispense, administer, and order prescription substances and devices including, but not limited to, therapeutic devices, barrier contraception, and durable medical equipment; and
- Perform minor surgical procedures
MSV opposes any efforts to end physician-led team based care.