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Stricter education

apists to have a master's degree.24 The Ameri-

State Medical Boards established a Special

can Association of Colleges of Nursing wants

Committee on Scope of Practice noting that

requirements

states to require a Doctor of Nursing Practice

"scope-of-practice changes are among the

limit entry into

degree of all new advance practice nurses by

most highly charged policy issues facing state

2015.25 A new law requires physician assistants

legislators and health care regulators."29

the medical

The American Medical Association has

to have a masters or higher degree to practice in

professions,

Ohio.26 Every state has required a master's

joined with other physician organizations

increase prices,

degree of occupational therapists since 2007.27

(including state-level medical associations) to

Starting in 2012, California will require new

establish the Scope of Practice Partnership, an

and reduce access

audiologists to have obtained a doctorate

"organized medicine coalition" to monitor leg-

to care, which can

(Au.D.), raising concerns that the legislation

islative efforts by other associations of health

result in worse

professionals.30 The president of the American

would exacerbate a shortage of audiologists.

Medical Association, Ronald M. Davis, called

The legislation followed a move by the Ameri-

health outcomes.

the Scope of Practice Partnership a "watchdog

can Speech-Language-Hearing Association, the

of legislative, regulatory, and legal endeavors

organization that accredits college audiology

that seek to expand the scope of practice of

programs, to require a doctorate for profession-

non-physician providers into the practice of

al certification. Questioning both why Califor-

medicine."31

nia legislators rushed to comply and whether

To counter efforts by organized medicine

even a master's degree is necessary to test some-

and the AMA's Scope of Practice Partnership

one's hearing, the Sacramento Bee called the

in particular, a group of 34 organizations rep-

requirement for a doctorate an "extraordinary

and costly mandate."28

resenting other licensed medical professionals

formed the Coalition for Patients' Rights.32

Ostensibly, increasing education require-

Acknowledging the difficulties in reviewing

ments would improve quality. But the relation-

scope-of-practice proposals and determining

ship between educational inputs and better

appropriate scopes of practice for various pro-

health outcomes is not that straightforward.

fessionals, several states have established legisla-

Stricter education requirements limit entry

tive committees to study scope-of-practice pro-

into the medical professions, increase prices,

posals and make recommendations. Statutes in

and reduce access to care, which can result in

Arizona and Iowa address the scope-of-practice

worse health outcomes.

review process. Arizona's statute requires con-

As with the audiology legislation in

sideration of the reason increased scope of prac-

California, it is not clear that those excluded

tice is sought, the impact on consumers' access

by these higher barriers to entry would not be

to health care, and implications for the inter-

competent practitioners. When hiring, hospi-

state migration of health care professionals.33 In

tals and other employers can and do specify

Virginia, the Board of Health Professions (with

the level of education or training required of

members from each of the 13 health regulatory

clinicians. Not every job requires the same

boards in the state) evaluates regulatory pro-

level of skills. Increasingly strict education

posals and recommends the appropriate level of

requirements deprive health care providers of

regulation.34 A Texas proposal (HB 3950) to

a range of education and training options

establish a Health Professions Scope of Practice

from which to choose. Forcing providers to

Review Commission failed in 2007.

use more highly educated--and thus more

In most cases, physicians (represented by

costly--practitioners increases prices and lim-

the state medical association) are in one cor-

its access to care.

ner and organizations representing other

clinicians are in the other.35 But non-physi-

Scope-of-Practice Turf Wars

cian clinicians also step on each other's toes.

Debates among competing groups of clin-

For example, because of a strong nursing lob-

icians over scopes of practice are increasingly

by that opposed the practice of physician

common. In July 2003, the Federation of

5