As the number of physician assistants and other advanced practice providers grows and they treat an increasing number of patients nationwide, the line between how advanced practice providers and physicians can practice has blurred.
Some policymakers have introduced legislation aiming to loosen restrictions on how non-physician providers, such as certified registered nurse anesthetists, are allowed to practice without the supervision of a physician. The motion to expand the scope of practice of certain providers has been vigorously debated.
This legislation is supported by the American Association of Nurse Anesthesiology and the Rural Health Action Alliance.
"CRNAs are the primary providers of anesthesia care in rural settings and have been instrumental in delivering care during the pandemic to patients where they live and when they need it," Angela Mund, DNP, CRNA, president of AANA, said in a news release from the organization. "Often, CRNAs serve as the sole anesthesia provider in rural hospitals, affording these facilities the capability to provide many necessary procedures."
Other organizations, including the American Medical Association, oppose similar legislation regarding CRNAs. In a letter to legislative leaders, AMA CEO James Madara, MD, said the organization opposes CRNA liberty expansion because CRNAs do not have the same amount of training and education as physicians, and that increasing scope of practice can lead to higher patient costs.
Ninety-five percent of U.S. voters said physicians should be involved in treatment decisions. This preference may have contributed to a lawsuit submitted by three California nurse practitioners who want the right to use the title "doctor."
The DNPs claim a California statute allowing only state-licensed allopathic and osteopathic physicians to use the term "doctor" is unconstitutional and claim they have earned the right to the title after receiving their doctorate degrees.
A bill in Missouri, meanwhile, faced backlash for pushing to expand the medical capabilities of nurse practitioners.
"The amount of training that the nurse practitioners have to be practicing is far less, in some respects less than 10% of what a physician has, day to day," John Burroughs, MD, board chair of the Missouri Academy of Family Physicians, told NBC affiliate KYTV.
Deborah Blinzler, RN, told the news outlet the requirements to obtain a nurse practitioner title does provide equitable experience and training when compared to physicians.
"To be a nurse practitioner, you have to have a nursing background," Ms. Blinzler told KYTV. "A lot of us have had 20-30 years of experience before going back to school. That gives us the experience. We have our base, BSN. Then we go on for our MSN or the doctorate. So we have three or two to three years on top of that. Then physicians go on for a residency, which is more training, but we've had 10 to 15 years of training."
Supporters say expanding the independent practice capabilities of advanced practice providers will expand access to care. The issue remains widely debated, however.