Why the AMA President Thinks Scope of Practice Expansions Are a ‘Terrible Idea’

Why the AMA President Thinks Scope of Practice Expansions Are a ‘Terrible Idea’
Why the AMA President Thinks Scope of Practice Expansions Are a ‘Terrible Idea’


The nation faces a projected shortage of between 37,800 and 124,000 physicians by 2034. There are three reasons for this massive dearth of physicians, American Medical Association President Dr. Jesse Ehrenfeld said Tuesday during an interview at HLTH in Las Vegas.

The first is that the U.S. population is aging. Older people tend to have multiple comorbid conditions, so more care needs to be delivered. The physician population is aging as well — more than two in every five physicians will reach retirement age in the next 10 years, Dr. Ehrenfeld pointed out. The final reason is the clinician burnout crisis. For the first time ever, a majority of physicians in the U.S. report that they would not encourage their offspring to go into medicine, Dr. Ehrenfeld noted.

To solve this workforce problem, some industry stakeholders argue that the scope of practice should be expanded for skilled healthcare professionals like nurse practitioners and pharmacists. Dr. Ehrenfeld said this is a “terrible idea.”

“I rely on my advanced practice professional colleagues every day when I’m seeing patients, but there’s no substitute for the nuance, the judgment and the experience of physicians. We think it sells patients short to say that a nurse is a replacement for a physician,” he remarked. “I did 10 years in the military, and I will tell you that when the president of the United States is injured or ill, the call is for a physician, not a nurse. And there’s a reason for that.”

Dr. Ehrenfeld recalled a recent conversation he had with a Native tribal leader in Wisconsin. The leader was supporting the argument that nurse practitioners should be allowed to practice independently, saying that rural communities simply don’t have physicians to be able to care for the community.

“I told them, ‘I understand that, and I hear that, but we shouldn’t sell your tribes short by giving you something less than you deserve.’ We shouldn’t provide substandard care as a substitute for the best care. We ought to be providing physician-led care to every patient in America,” Dr. Ehrenfeld declared.

He argued that the U.S. healthcare system must center around interprofessional care delivery teams. Each member of these care teams — from a dietician to a cardiologist to a nurse —has different strengths. The industry should focus on leveraging healthcare professionals’ various strengths instead of trying to fit workers into roles they haven’t sought traditional training for, Dr. Ehrenfeld said.

This is why he said the concept of siloed independent practice “makes no sense” to him.

“There are different perspectives. There are different things that people are really good at doing. We ought to be leveraging those differences, not trying to use them to pull people apart, which unfortunately, continues to happen in a growing number of jurisdictions,” Dr. Ehrenfeld said.

Photo credit: Chinnapong, Getty Images



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