Download this proposal as a PDF.

Commenting for this proposal will be open until the close of business on Monday, June 5.

Title of Proposal:

Mid-Level Scope of Practice Reform

On behalf of:       

Virginia Academy of Family Physicians

Describe the Idea or Issue:

  • Nurse Practitioner Scope of Practice
  • Physician Assistant Scope of Practice

Desired Outcome:

Development of proactive legislation to establish appropriate education, training, testing, malpractice, formulary, case complexity, continuing education, discipline, and enforcement parameters for the autonomous practice of mid-level providers.

Legislative proposal should be based around team-based care model and should hold autonomous mid-levels to equivalent obligations as physicians.

Background/Supporting Information:

  • Recurring NP Scope of Practice autonomous practice legislation
  • Recurring PA ("Doctors of Medical Science") Scope of Practice autonomous practice legislation
  • Exhaustion of political capital defending scope expansion efforts
  • Need for physician-driven legislation to control autonomy parameters


I strongly support this reform/bill.  Keep up the good work and ty for your time and commitment to helping our patients.


Rick Lee MD


There is no short cut to practice medicine. If you wish to practice medicine independently, then you MUST put in the time and effort to get the medical education and training required. There is not an easy button to push to get there. If you cannot do the required educational process , then you must accept a supervisory, team model.

Thank you for being proactive!  We need team-based care with physicians at the helm.  We also need to ensure that patients are very clear about who is providing their care (no "Doctor" title in clinical practice unless actually an MD or DO).

as a physician I think this is foolish and disappointing. Midlevels are in no way prepared to practice independently and we should not pave the way to allow this to happen. 

VAPA agrees with the Team-Based care model, and supports legislative measures that embrace and enhance that relationship.  However, we prefer to be separated from NPs in regard to autonomy pursuits.  PA education, our practice model, and our legislative goals are markedly different from that of our NP colleagues.  VAPA has never submitted legislation promoting autonomy.  The Doctor of Medical Science proposal was introduced by an out of state entity and neither vetted nor supported by VAPA, as it is contrary to current VAPA policy which opposes alternative pathways to licensure.

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