Legislative Awareness

We are a nonpartisan educational nonprofit dedicated to preserving physician-led care through education, transparency, and research.

We provide informational resources to legislators to help them understand the ramifications of their decisions about physician-led policies when considering new legislation.

Issue at a Glance

Across the U.S., patients face increasing variation in who delivers their care — often without their knowledge. Legislative and regulatory changes have expanded the scope of nonphysician providers, sometimes beyond their training or oversight. While every healthcare team member plays a vital role, evidence consistently shows that physician-led care ensures higher safety, accuracy, and accountability.

The Driving Force of For-Profit Priorities

Private equity firms often push for lower staffing costs and higher revenue margins, which can include: replacing or reducing physician oversight with lower-paid NPP’s and pressuring practitioners to see more patients in less time, increasing the risk of errors.

See How Physicians are Being Replaced:

When healthcare is owned by for-profit entities, such as private equity or shareholders, rather than physician-led, patient care can be compromised. Ownership by non-physicians introduces financial incentives that conflict with clinical judgment — squeezing more production out of physicians by forcing them to see more patients, or decreasing ancillary support staff, or restricting critical medical supply needs.

Strong CPOM laws and their enforcement are essential to ensure that clinical decisions remain in the hands of physicians, who can safeguard patient safety and maintain the integrity of medical care. Legislators play a critical role in reinforcing these protections to prevent profit-driven erosion of physician-led healthcare.

Study: New Link Found Between Private-Equity-Owned ERs and Increased Patient Deaths >

The Misrepresented Research Conclusions

Here’s the truth:

  • Every high quality study comparing NPP care to physician care has involved some degree of physician supervision
  • These studies were simple, low-risk primary care visits and often for a specific medical condition that had a physician protocol. Complex cases and undifferentiated (acute complaints that were not yet diagnosed) were excluded from studies. 

“What is conspicuously missing, despite decades of unsupervised practice in many states, is a single high-quality randomized controlled trial demonstrating that nurse practitioners or physician assistants can safely and effectively practice without physician involvement.” – Rebekah Bernard

The fact that such research still does not exist should raise serious concern. If independent practice were truly safe and effective, there would be solid, reproducible data by now.

The Importance of Physician-Led Care

U.S. Physicians undergo some of the most rigorous education and training in the world to take care of you and your family, and take on tremendous debt to do so. There is no substitute for this training.

Medical students gain about 3,000-4,000 hours of clinical experience over the final two years. Once graduated, physicians gain about 3,500 – 4,000 hours per each year of residency. Depending on their specialty, they must gain at least 12,000 hours (over 3 years) before they are eligible to become board-certified and practice independently.

Learn More About Physician Training:

In contrast, the AANP’s official position regarding team-based care is to place Nurse Practitioners — not physicians — at the head of the care team. In fact, AANP believes that NP’s should not be required to be part of any team to practice. 

“The American Association of Nurse Practitioners® (AANP) supports and encourages the implementation of integrated, interprofessional team-based approaches to coordinated health care delivery that are centered on patient needs and provide for nurse practitioner (NP) leadership of the team.”

“AANP opposes laws and regulations that make it illegal for a clinician to practice to the top of their education and clinical preparation, as well as those that require an NP — through licensure or regulation — to be part of a team as a condition to practice.” 

https://www.aanp.org/…/position-statements/team-based-care   

The Importance of Truth in Advertising

Many times patients are seen by “providers” or “practitioners” wearing white coats who are not physicians, but those white coats do not show the title or credentials of the professionals who see them.

Several states have enacted legislation aimed at enhancing transparency in healthcare advertising, including IN, CA, GA, TN. These laws are designed to ensure that patients can easily identify the qualifications of their healthcare providers, thereby reducing confusion and promoting informed decision-making.

Check out transparency bills from IN, CA, GA, TN >

When advertising is inherently likely to deceive, it enjoys no First Amendment protection, and the government may restrict or ban it entirely. Even if the speech is only potentially misleading, regulations must ensure it is not deceptive. A California court has upheld that it may legitimately restrict the use of “Dr.” or “doctor” in advertising and healthcare settings to protect patients and uphold transparency.

Costs of Care, Access, and Rural Health

A multi-year analysis from the Hattiesburg Clinic in Mississippi, an ACO with financial incentives to decrease overall costs of care while maintaining quality, showed that replacing physicians with PAs and NPs led to higher costs, about $28 million more annually, which was driven by higher test ordering, specialist referrals, and emergency department visits. While higher frequency of order tests, referrals, and increased ER visits drive up costs and decrease profits in an ACO model, these same activities generate more revenue and profit in fee-for-service health systems. Experts publishing this study disclosed that, based on “a wealth of internal data, the results are consistent and clear: By allowing APPs to function with independent panels under physician supervision, we failed to meet our goals in the primary care setting of providing patients with an equivalent value-based experience.” 

Learn More >

An issue brief from the American Medical Association (AMA) shows that states granting full practice authority to NPPs still see providers clustering in the same urban regions as physicians, meaning no meaningful increase in rural care access. 

Learn More >

A causal analysis of three years of Veterans Health Administration (VHA) emergency department data found that NPs practicing without physician supervision cost 7% more per case, increased lengths of stay by 11%, and saw 20% higher rates of 30-day preventable hospitalizations compared to physicians. 

Learn More >

The implication is clear: investing in physician-led care teams—not substituting physicians—offers better outcomes, lower costs, and truly broader reach.

Physician Workforce

The major cause of the physician shortage is the long-standing cap on Medicare-funded residency positions. Established in the Balanced Budget Act of 1997, this cap limits the number of hospital-supported full-time residency slots. Despite modest increases of roughly 1,200 positions in 2021 and 2023, growth under this cap has been minimal. Hospitals cannot expand residency programs fast enough to meet the nation’s healthcare needs.

Without significant policy changes to expand physician training and support physician-led care, patient access to highly trained medical professionals will continue to decline.

References 

Oversupply of NPPs Projected

Between 2015 and 2024, MSN-level NP programs grew 15%, post-MSN programs grew 50%, and Doctor of Nursing Practice (DNP) programs doubled in size.The Health Resources & Services Administration (HRSA) projects that the growth of NPs and PAs will outpace demand, resulting in an oversupply of non-physician practitioners. By 2035, the supply of NPs is expected to more than double projected demand.

Learn More >

Bedside Nursing Shortage

While metropolitan areas may see a slight surplus of RNs by 2035 (1%), nonmetro areas are projected to experience ongoing shortfalls—13% in 2025, 9% by 2030, and 2% by 2035. These shortages highlight the ongoing challenges in ensuring adequate bedside nursing care across the country.

Learn More >

A longitudinal study of over 600,000 hospital patients in England, published in JAMA Network Open, found that each day of low registered nurse (RN) staffing increased the risk of death within 30 days of admission and raised mortality risk. Even when staffing shortages were filled using temporary nurses, the risk of death remained elevated. A 10% rise in temporary RN staffing increased mortality risk by 2.3%, regardless of whether the nurses came from internal “bank” pools or external agencies. The authors note that temporary staff—often unfamiliar with hospital systems—can disrupt care continuity and compromise safety.

Learn More >

Medicare Reimbursements

Since Medicare began reimbursing non-physician practitioner (NPP) services at 85% of physician rates, healthcare organizations have increased profit margins by replacing physicians with NPPs, lowering employment costs while increasing referral and order generation.

Standards of Care and Professional Liability

If an NPP harms a patient, the standard to which they are held may be lower — making it harder for patients to obtain fair compensation and for oversight mechanisms to align with physician‑level expectations.

Legislators must recognize that independent‑practice NPP models shift not only duties but liability structures — and may expose patients to higher risk when the provider’s training and accountability do not match that of a physician.

Case Examples: 

  • In Simonson v. Keppard (2007), a court held that the standard of care for a nurse practitioner “must not be measured by the standard of care for a physician or surgeon.” (Physicians for Patient Protection)
  • In Lattimore v. Dickey (2015), the court reaffirmed that “a nurse’s conduct must not be measured by the standard of care required of a physician or surgeon, but by that of other nurses in the same or similar locality and under similar circumstances.” (Physicians for Patient Protection)
  • In a reported case involving an infant treated by an NP, the board found that the NP failed to assess and document critical vital signs — but again judged against what an NP in similar circumstances would have done, not what a physician would have done. (NSO)

Policies that expand scope of practice must ensure that standards of training, accountability, credentialing, and liability keep pace with expanded responsibilities.

Without this alignment, patients receive care from providers who may not meet physician‑level training or oversight, and the safety net of physician‑led care is weakened.

Legislative Resources

Stay Informed. Make Evidence-Based Policy Decisions.

Legislators at both state and federal levels play a vital role in shaping laws that determine who delivers care, how it’s regulated, and whether patients receive care that meets the highest medical standards.

Below are educational resources to help you better understand the current landscape of healthcare delivery, workforce trends, and patient safety implications of proposed scope-of-practice and corporate ownership changes.

  • Quick look: Data sheet (from Hill Day) 
  • Deep dive: Check out books Patient at Risk and Imposter Doctors 
  • Explore more: Patients at Risk Podcast

For U.S. Legislators:

Examples of Federal legislation efforts consistent with physician-led care:

  • H.R. 3890 – Preserving Patient Access to Physician Care Act

    Supports fair Medicare reimbursement to ensure physicians can continue to provide direct care to patients.

    View Bill >

  • S.1390 – Strengthening Medicare for Patients and Providers Act

    Promotes payment stability and helps prevent physician shortages in underserved areas.

    View Bill >

  • Medicare Pay Cuts Threaten Physician Practices

    Repeated cuts to Medicare reimbursement jeopardize access to physician care, especially in rural and primary care settings.

    Learn More >

  • “Take Back Our Hospitals” — Repealing ACA Section 6001

    Physicians call for restoring the right to own and operate hospitals, improving patient access and quality of care.

    Read More >

For State Legislators:

Examples of State legislation efforts consistent with physician-led care:

Truth and Transparency in Healthcare

Patients have the right to know who is providing their care. Increasingly, patients are told they are seeing a “provider” — without clarity on whether it’s a physician or a non-physician practitioner (NPP). States are addressing this through “Truth in Advertising” laws:

Corporate Practice of Medicine (CPOM) and Private Equity

Private equity ownership in healthcare has been linked to rising mortality rates, cost-cutting that reduces quality, and the replacement of physicians with non-physician practitioners. Strong CPOM laws help preserve physician judgment, prevent corporate interference, and keep patient welfare as the top priority.

Request an Expert Briefing

We can connect you with physicians who are available to provide testimony, private briefings, expert opinions on legislative proposals.

Request an Expert Briefing