‘Turf war’ erupts between nurses, AMA on role of non-physician practitioners

Several groups representing nurses have accused the American Medical Association of igniting a “turf war” and “hampering access to care” by adopting a resolution to oppose efforts to allow non-physician practitioners to practice independently without the supervision of a licensed physician.

The resolution stirring the controversy was approved at the most recent interim meeting of the AMA delegates. As adopted, it directs the AMA to create a national strategy to:

  • “Oppose the continual, nationwide efforts to grant independent practice” to non-physician practitioners, such as the Advanced Practice Registered Nurses (APRN) Compact, with public relations campaigns and drafting model legislation.
  • “Effectively educate the public, legislators, regulators, and healthcare administrators."
  • Oppose legislation at the state and federal level “aimed at inappropriate scope of practice expansion of non-physician healthcare,” with a report expected during the next AMA annual meeting.

Driving the resolution was the aforementioned APRN Compact, which would allow APRNs to obtain a single, multistate license to practice in states which have passed the authorizing legislation to join. So far, only three (Idaho, North Dakota and Wyoming) have done so, short of the 10 states needed in order for the compact to be implemented.

Use of APRNs has been promoted by CMS and HHS. A recent report on the Graduate Nurses Education (GNE) demonstration project, which had been authorized by the Affordable Care Act, found it increased enrollment in APRN programs, which the agency said could help alleviate the expected shortage of physicians in the coming decades. The shortage is expected to be particularly hard on primary care settings, where more medical professionals are going to be needed as health systems steer patients away from higher-cost sites of care. The Association of American Medical Colleges (AAMC) has projected a shortfall of up to 43,000 primary care physicians by 2030, with 87 percent of medical schools saying they're worried about the lack of qualified primary care preceptors.

Expanding the role of APRNs has been opposed by the AMA before. When the Department of Veterans Affairs allowed APRNs to practice independently in a 2016 regulation, AMA board chair Stephen Permut said it would “significantly undermine the delivery of care within the VA.”

The real reason for the opposition, argued the American Nurses Association (ANA), is about protecting the “turf” of AMA members.

“For AMA to imply that APRNs are incapable of providing excellent care or that their care puts the patient at risk is blatantly dishonest,” ANA president Pamela F. Cipriano, PhD, RN, said in a statement. “The future of health care calls on all health care professionals to work together as a team to meet the growing demand for health care services.”

The American Association of Nurse Practitioners (AANP) was more pointed in its criticism of the policy. Its president, Joyce Knestrick, PhD, APRN, accused the AMA of putting “the profit of its physician membership ahead of patients and their access to high-quality health care,” and saying there’s no study which shows care is safer or outcomes are better in states where licensure for independent practice is more restrictive.

“Stop the rhetoric and resolutions that undermine patient choice, access and true coordinated care,” Knestick said in a statement. “The AMA’s ongoing fear mongering and physician protectionist resolutions are hurting patients and negatively impacting the health of our nation. It’s time the AMA lay their dated tactics aside.”

Other professional organizations have similarly pushed back on the expansion of non-physician practitioners into the care typically provided by its members. The American College of Radiology supported the change made by the VA—except when it came to giving APRNs the authority to perform, supervise and interpret imaging exams.

The AMA declined to offer a response to the nursing groups’ criticisms.

“We will let the policy speak for itself,” an AMA official told HealthExec.