A group of healthcare professionals and researchers are calling for revisions to laws in the United States restricting physicians’ scope of practice and placing limits on innovation in healthcare delivery. Their comments were compiled in a report published in the New England Journal of Medicine.
According to the authors, continual payment reforms have facilitated reorganization of healthcare delivery systems to improve care access and provide greater care value to patients. The use of telehealth and digital technology and the development and implementation of team- and community-based delivery models are some examples of how healthcare systems are reorganizing delivery of care. Despite these initiatives, physicians often face restrictions on their scope of practice that limit flexibility, increase costs, and further reduce patients’ access to care. Authors suggest that improvements should be made to better regulate physicians’ scope of practice in an effort to better serve patients’ needs.
Some states do not allow certain medical professionals to prescribe buprenorphine, even though there is an increased need for trained clinicians to administer the medication due to the growing opioid epidemic. Nurses, in some states, are also prohibited from assigning routine tasks to aides, such as administration of medications.
The authors suggest regulators should create and revise scope-of-practice regulations based on evidence for quality of care and patient safety instead of relying on objections made by other health professions. Creating state-based requirements for policy analysis, implementing “sunrise” reports documenting the need for proposed changes, estimating costs and benefits to the public of these changes, and examining potential alternatives are all examples of ways regulators can increase the use of evidence for making scope-of-practice decisions.
The authors noted that educational programs that train health professionals in silos may also perpetuate scope-of-practice restrictions. Patient-serving approaches and interprofessional collaboration are suggested as means of reducing these restrictions. Physicians are also encouraged to challenge their professional associations and insurance companies, among other relevant regulatory bodies, regarding scope of practice.
The authors wrote that “states should eliminate overly restrictive scope-of-practice regulations that they impose on the health professions,” which they believe will “allow us to unlock the full potential of the country’s health workforce.”
Frogner BK, Fraher EP, Spetz J, et al. Modernizing scope-of-practice regulations – time to prioritize patients. N Engl J Med. 2020;382(7):591-593.