Physicians Must Lead Care Teams, Medicine Tells Feds
By Joey Berlin


The Texas Medical Association, and 99 other medical societies, are making it clear to Medicare that physicians are the nation’s most highly trained health care professionals – and the government shouldn’t weaken or eliminate their supervision of nonphysicians.

TMA signed on to a letter in response to the Centers for Medicare & Medicaid Services’ (CMS’) request for feedback on part of President Donald Trump’s executive order in October that galvanized an alarmed medical community. Also on the letter last week were the American Medical Association (AMA) and 98 other state societies and national specialty societies.

“As the most highly educated and trained health care professionals, physicians should lead the health care team,” the letter to CMS Administrator Seema Verma said. “There is a vast difference in the education and training of physicians and other health care professionals, including APRNs (advanced practice registered nurses) and PAs (physician assistants).”

The president’s executive order told the secretary of health and human services (HHS) to propose a regulation to eliminate licensure requirements “that are more stringent than applicable federal or state laws require and that limit professionals from practicing at the top of their profession.” It gives HHS one year to “ensure that items and services provided by clinicians, including physicians, physician assistants, and nurse practitioners, are appropriately reimbursed in accordance with the work performed rather than the clinician’s occupation.”

TMA quickly went to work to avoid a federal scope-of-practice expansion for nonphysician practitioners, with TMA President David C. Fleeger, MD, writing directly to President Trump and HHS Secretary Alex Azar on Oct. 28.

Then on Dec. 26, CMS requested feedback regarding the elimination of those scope-related regulations. The TMA/AMA response, sent on Jan. 16, drives home the vast differences between the education of physicians and the education of their partners on health care teams.

“The well-proven pathways of education and training for physicians include medical school and residency, and years of caring for patients under the expert guidance of medical faculty. Physicians complete 10,000-16,000 hours of clinical education and training during their four years of medical school and three-to-seven years of residency training,” the letter said. “By comparison nurse practitioners, the largest category of APRNs, must complete only 500-720 hours of clinical training after two-three years of graduate-level education. Physician assistant programs are two years in length and require 2,000 hours of clinical care. Neither nurse practitioner nor PA programs include a residency requirement.” 

The letter also noted that Medicare patients are some of the most vulnerable in the nation and said those patients “deserve care led by physicians – the most highly educated, trained, and skilled health care professionals. We cannot and should not allow anything less. Patients agree and overwhelmingly want physicians leading their health care team.” 

TMA, AMA, and the other organizations also note that more than 40 states require physician supervision of or collaboration with physician assistants, and 35 states require some doctor supervision of or collaboration with nurse practitioners.

Last Updated On

January 24, 2020

Originally Published On

January 24, 2020

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Medicare | Scope of Practice

Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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