The Affordable Care Act didn’t create the scope of practice issues, but it certainly accelerated them by changing the nature of employment for most physicians. The arguments over scope are practice are the product of financial pressure in healthcare systems, ever-expanding knowledge requirements, sub-specialization of medicine, staff shortages, and even COVID protocols the past couple of years.

With New York and Kansas granting practice authority for NP’s this month, that’s 25 states.

Clinical Advisor – NPs Granted Full Practice Authority in New York

Growth rates for physicians in practice, at least according to the Bureau of Labor Statistics, are less than 1% a year. That’s a near static rate, with active physicians per 10,000 people in the United States stuck at 29 for a decade now. On the nurse practitioner side, there are now 140,000 NP’s employed, and the growth rate for the professional exceeds 5%.

Nurse.com – Nurse Practitioners Are Primed to Help Bridge Physician Shortage

Those figures have prompted some projections about what healthcare in the US will transform into, as well as concerns about those transformations. One of the best summaries we’ve seen is in the Michigan State Medical Society’s The Future of Medicine 2022:

MSMS – Michigan Medicine – The Future of Medicine 2022

And a variety of responses to the prognostications, from individuals, and from organizations.

MSMS – In Response: What Health Care Will Look Like in 2032

AMA – Why physician-led care teams are key to battling doctor shortage

JD Supra – Use of Non-Physician Healthcare Practitioners Expanding in California

Side issues in the scope of practice battles also include location and provision of care, with companies like Amazon, Walmart, and a bevy of telehealth startups still vying to move the physical presence of initial primary care.

Amazon – Amazon Care now available nationwide as demand continues to grow

Politico – Amazon’s telehealth gold rush

PBS – Doctors oppose bill that would let pharmacists continue to vaccinate children after pandemic

The problem with competing with completely digital Telehealth firms is that it creates the same dynamic that tore up retail in the 1990’s and 2000’s – physical practices compete with digital companies that don’t have the same infrastructure cost. Except in this case, due to licensing, the physical locations can compete if they can structure reimbursement.

Jamestown Sun – Reimbursement rates may be a barrier to providing telehealth