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Scope of Practice

Legislatures around the country continue to address the scope of practice for physicians and allied health care professionals. Proposed changes to a healthcare professions’ scope of practice often elicit strongly worded comments from professional interest groups. Typically, these debates are perceived as turf battles between two or more professions, with the common refrain of “this is part of my practice so it can’t be part of yours.” Often lost among the competing arguments and assertions are the most important issues of whether this proposed change will better protect the public and enhance consumers’ access to competent healthcare services.

What procedures health care professionals can perform is dependent on their scope of practice, which is defined by either their state medical board, dental board, or nursing board, etc., often with the guidance or instruction (via statute) of the state’s legislature. Non-physician practitioners increasingly render services autonomously, particularly in rural and underserved areas, to make up for provider shortages. State legislators and other state health policymakers consider a broad range of issues related to scope of practice, including supervision requirements, prescriptive authority and other requirements for practice.

The AASM has developed two charts which provide the scope of practice for physicians, dentists and advanced nurse practitioners across the country. The State Medical & Dental Scope of Practice contains information on the scope of practice for physicians and dentists in each state, the citation of where the information is located, and asks if the statute allows a DDS to diagnose and treat a patient with obstructive sleep apnea.

The second chart includes information on Advanced Nurse Practitioner Supervision Policy Supervision. Requirements for nurse practitioners (NP) fall into two basic categories: Full practice and collaborative practice. Full practice allows nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing.  Collaborative practice is a written statement that defines the joint practice of a physician and an NP in a collaborative and complementary working relationship. It frequently includes the responsibilities of both the collaborating physician and the NP and often defines the prescribing authority of a NP.