HCB News: What is the problem (or problems) that states are trying to address with these bills?
EB: It can vary by state, but in testimony, proponents cite healthcare shortages and cost factors as a reason to expand scope of practice. However, while proponents point to healthcare shortages, the American Medical Association’s workforce map shows a more accurate and factual representation of what’s happening with the healthcare workforce across the states. The maps show that non-physicians tend to practice in the same areas of the state as physicians — regardless of the state's scope of practice rules — meaning expanding scope laws doesn’t result in non-physicians moving into rural areas. The overall theme of burnout and shortages in the healthcare system is not limited to physicians, we know that shortages exist across the workforce. Driving non-physician personnel, who may already be under a tremendous amount of pressure to perform, into clinical areas that their educational framework and clinical experience did not prepare them for can lead to an adverse cascading effect within the healthcare system.

Proponents also say that giving non-physician providers scope of practice expansion will lower healthcare costs, but the facts don’t support this assertion. A leading Medicare Accountable Care Organization (ACO) showed that patients with non-physician primary care providers had $43 higher spending per member per month compared to those who had a physician — translating into $10.3 million more in annual spending. We have also seen studies show that X-ray ordering increased 441% among non-physicians, resulting in increased costs.
HCB News: Are there sections, or portions, of any of these bills that the ACR considers a step in the right direction? Or is expansion of non-physician practice in any form a mistake?
EB: Scope expansion based on legislation rather than education is a mistake. Non-physician providers play an important role within their training and are valuable members on the healthcare team. However, sweeping expansion of scope of non-physician personnel into the field of radiology raises serious concerns related to patient safety and quality. If the goal is to reach a timely, accurate diagnosis, then ensuring the patient’s imaging is funneled through to the physician with intensive, specialized radiology training and experience is the way to achieve that goal.

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