Scope of Practice

CRNPs are advocating to practice independently in Pennsylvania, without the requirement that they maintain a collaborative agreement with a physician. Collaborative agreements ensure that there is direct and immediate access to a physician when the patient’s care requires it.

PAMED Position
Supports physician-led, team-based care

Status:
SB 25/HB 100 (House Professional Licensure Committee) – PAMED opposes

What is PAMED Doing About it?

Continues to voice strong opposition to SB 25/HB 100
Billboards in key legislative districts
Polls in key legislative districts

What Action Should I Take?
Urge your legislators to oppose SB 25/HB 100

Take Action

Resources:

Click on the links/buttons below to learn more about the issue and how you can help keep physicians as the leader of the health care team.

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SOPP

I am a Physician
Legislators can’t be experts in everything – they learn from the experts. Legislators need to hear from you as a physician. Sharing personal experiences and examples can be incredibly impactful – much more so than anything lobbyists and organizations can do alone. You can be your legislators’ go-to, trusted resource to help ensure that physicians remain the leaders of the health care team. These talking points can help.

Talking Points
- Certified registered nurse practitioners (CRNPs) and other non-physician practitioners are valuable members of my health care team. But, the best care occurs when team members with complimentary, not interchangeable, skills work together.
- Every team needs leadership. In the health care setting, that is a physician.
- CRNPs are urging state legislators to support bills SB 25 and HB 100, which would allow them to practice independently without the requirement that they collaborate with a physician. PAMED opposes these bills that would remove the physician from the health care team.
- CRNPs say they want “full practice” authority. They already have it. In Pennsylvania, CRNPs can already:
  - Prescribe medications
  - Order lab and other diagnostic studies
  - Sign death certificates
  - Perform driver license exams
  - Order home health and hospice care
  - Refer patients for specialized care or outpatient therapies
- The current collaborative agreement requirement is in place for a reason – so that patients who require further assessment and care that exceeds the capabilities and education of a CRNP have direct and immediate access to a physician.
- CRNPs claim this is a solution to access to care issues, especially in rural and underserved areas. But, many states that allow CRNPs to practice independently don’t experience increased access to care in rural and underserved areas. Why would Pennsylvania be any different?
- Pennsylvanians want a team-based approach to their health care. In a 2015 Patient Poll commissioned by the Pennsylvania Medical Society, 79% of respondents said that physician assistants and CRNPs should continue to collaborate with physicians.
Make Your Voice Heard - Contact Your Legislators (We can help!)
- Set up a meeting or call your state legislator to discuss this issue from your personal perspective. If you’d like, PAMED’s legislative staff is happy to help. Contact John Tommasini at jtommasini@pamedsoc.org.
- You can find your state legislators at http://cqrcengage.com/pamed/Lookup.
- Call Your Representative: If your Representative is on the House Professional Licensure Committee, please call them now and schedule a meeting to discuss this issue face-to-face before they return from summer recess on Sept. 17, as the nurses have been doing with growing intensity. It is important for them to hear why physicians oppose CRNPs practicing medicine independently.
More Resources

Read Our Issue Brief
I am a Patient
As a patient, scope of practice proposals may impact you. For example, if you have multiple complex conditions, wouldn’t you feel more comfortable knowing that, even if you did see a CRNP, they could consult with a physician if needed? Legislative proposals such as Senate Bill 25 and HB 100 seek to remove the physician from the health care team altogether. #DontLoseYourDoc

These talking points can help you talk to your state legislators. As a constituent, they value your input.

Talking Points
- I value certified registered nurse practitioners (CRNPs) and other non-physician practitioners as members of my health care team. But, the best patient care occurs when all members of the health care team are working together.
- Every team needs leadership. In the health care setting, that is a physician.
- Even if I do see a CRNP, I want to know that they have direct and immediate access to a physician if my care or treatment requires it.
- CRNPs are urging state legislators to support bills Senate Bill 25 and House Bill 100, which would allow them to practice independently without the requirement that they collaborate with a physician. PAMED opposes these bills that would remove the physician from the health care team.
- Pennsylvanians such as myself want a team-based approach to their health care. In a 2015 Patient Poll commissioned by the Pennsylvania Medical Society, 79% of respondents said that physician assistants and CRNPs should continue to collaborate with physicians.
Make Your Voice Heard - Contact Your Legislators (We can help!)
- You can find your state legislators at http://cqrcengage.com/pamed/Lookup.
More Resources

Read Our Issue Brief
I am a Legislator
Read Our Issue Brief

Questions to Ask CRNPs

Key Points
- Certified registered nurse practitioners (CRNPs) and other non-physician practitioners are valuable members of the health care team. But, the best care occurs when team members with complimentary, not interchangeable, skills work together.
- Every team needs leadership. In the health care setting, that is a physician.
- CRNPs are urging state legislators to support SB 25 and HB 100, which would allow them to practice independently without the requirement that they collaborate with a physician. PAMED opposes these bills that would remove the physician from the health care team.
- CRNPs say they want “full practice” authority. They already have it. In Pennsylvania, CRNPs can already:
- Refer patients for specialized care or to outpatient therapies
- The current collaborative agreement requirement is in place for a reason – so that patients who require further assessment and care that exceeds the capabilities and education of a CRNP have direct and immediate access to a physician.
- CRNPs claim this is a solution to access to care issues, especially in rural and underserved areas. But, many states that allow CRNPs to practice independently don’t experience increased access to care in rural and underserved areas. Why would Pennsylvania be any different?
- Pennsylvanians want a team-based approach to their health care. In a 2015 Patient Poll commissioned by the Pennsylvania Medical Society, 79% of respondents said that physician assistants and CRNPs should continue to collaborate with physicians.
Connect with PAMED –
To learn more about this issue and why we oppose SB 25 and HB 100, contact Dave Thompson at dthompson@pamedsoc.org or John Tommasini at jtommasini@pamedsoc.org.

Scope Of Practice News:

Oct 21, 2019, 06:46 AM
Pennsylvania Polls Show Strong Support for Collaborative Agreements Between Nurse Practitioners and Physicians
Data from new polls suggesting current lobbying efforts by nurse practitioners in Pennsylvania to eliminate collaborative agreements are unwarranted.
Oct 11, 2019, 15:27 PM
Statement: PAMED Expresses ‘Serious Concerns’ with Elements of President Trump’s Executive Order
It suggests an expansion of the scope of practice for nurse practitioners and physician assistants.
Jun 12, 2019, 14:09 PM
Pa. Medical Society reacts to Senate passage of SB25
While we share the goal of improving access to care in rural and underserved areas, the Pennsylvania Medical Society vigorously disagrees with Senate Bill 25 as the solution.