Scope of Practice


White Paper on Scope of Practice: Everything you need to know


Statement from the Association of American Physicians and Surgeons


Education Gaps NP vs. Physician


Know Your Provider


“The Three Percent”


Educational Chart



Supporting Team Based Care


*NPs are able to practice unrestricted in 23 states with the minimum of 500-700 hours of training.  This is equivalent to 3% of clinical time required of physicians before they can independently practice.


*Nurse practitioners practice in many different fields, and no differentiation is made in respect to granting the license for independent practice by the Board of Licensure, ongoing CME requirements, certification and recertification, peer review.  In other words, they can specialize, without any additional formal training after receiving their initial degree.


*Newly eligible nurse practitioners are out in practice with significantly less clinical exposure than a physician, even less than a graduating medical student who still has to complete a residency in their chosen field; an additional 3-7 years. As such, independent practice without limitations doesn’t make sense.


*Rather than reducing costs, providers with less experience and training increase the likelihood of error and decrease efficiency when the unexpected or unfamiliar are encountered. Several studies show that lesser trained providers order more tests and refer more to specialists to compensate for their lack of experience. See our section on cost saving myths here.


*If an NP doesn’t recognize a complex problem, without a collaborative agreement, who are they going to call? The risk evolves that the physician may not always be available when the assistance is needed and the physician is assuming complex liability. Without some sort of integration of care or collaborative agreement, unnecessary risk occurs when a physician has to go into a situation “cold” and raises liability issues for all involved.


*American Medical Association studies show that granting Full Practice Authority to midlevel providers does not provide any kind of incentive to locate to rural and underserved areas of the state so it fails to address the access to care issue.


*The physician community does not deny that nurse practitioners have a valuable role to play in delivering excellent care to patients. Nurse practitioners need to be able to practice to the full level of their licenses, however, we must move forward in a manner that encourages the development of effective clinical care teams as a way to deliver the highest quality, most coordinated and safest care for our patients. Independent practice by nurse practitioners deviates from this national trend, disintegrating care and creating yet another silo. Allowing nurse practitioners the ability to independently diagnose, prescribe, treat or provide other unsupervised services with no physician collaboration further fragments the health care team.


Physician-led Team-based Care


Keep The Team



Malpractice issues


*Under a recent study, “Nurse Practitioner 2012 Liability Update: A Three-part Approach” (“CNA/NSO study)” revealed that nurse practitioners who worked in adult medical/primary care and family practice specialties were most likely to experience a claim.


The most frequent allegations made against nurse practitioners involved:


Failure to and/or delay in making a correct diagnosis (Diagnosis related claims accounted for


43% of all nurse practitioner closed claims between 2007 and 2011)


Failure to provide treatment and care


Medication prescription errors


Overall, between 2009 and 2012, there was an increase in average paid indemnity for nurse practitioner claims from $186,282 (2009) to $221,852 (2012).


Nurse Practitioner Liability Claims Costs Rising 2.3% a Year: CNA HealthPro


Nurse Practitioner Closed Claims Study



Cost savings myth


Overprescription of antibiotics


Increased Mortality rates for anesthesia with non-physician providers


A Comparison of Diagnostic Imaging Ordering Patterns Between Advanced Practice Clinicians and Primary Care Physicians Following Office-Based Evaluation and Management Visits


Skeletal x-rays are on the rise, especially among nonradiologists


Midlevel Providers doing increased number of unnecessary skin biopsies


NY Times article on lack of evidence on cost savings