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5 reasons not to fear the scope of practice shift

Registered nurses, physician assistants, pharmacists and others now qualify as providing primary care, and can receive federal subsidies.

Edgar Wilson, Contributing Writer

A perfect storm is building in healthcare: retiring doctors, growing provider shortages, and the population shift toward longer life (and more chronic conditions). These concerns have driven some creative responses, and chief among is a change in what it means to be a ‘doctor’ or a ‘nurse’ by broadening caregiver roles and responsibilities.

The Affordable Care Act’s emphasis on preventive care – both to save on healthcare spending, and to incentivize patients and providers to change how they approach treatment – has crowded the field of primary care providers. Registered nurses, physician assistants, pharmacists, and others now qualify not only as providing primary care, but can receive federal subsidies for doing so.

The result: a blurring and shifting of what falls under different scopes of practice.

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This has been controversial, especially among physicians’ groups, who point out that the differences between these various medical professionals are not arbitrary – and should not be subject to haphazard government rewrites of important distinctions between caregiving roles.

But physicians, nurses, and other primary care providers may have more to look forward to than they have to fear from a shift in defining scope of practice. Here are five reasons to be positive about redefinitions in caregiving roles:

Increased compensation rates. Value-based compensation models are good news for those in primary care and family practice. The federal incentives for primary care clinicians, combined with a widening field of providers for those services, courtesy of the scope of practice expansion, finally creates an opportunity to buck the trend of static compensation rates despite rising healthcare costs. It all boils down to systemic rewards for anyone who can effectively practice preventive care, proven by patient outcomes. Not only will this reward the best practices, it will give physicians, nurses, and pharmacists an equal chance to demonstrate the viability of their changing roles.

Sharing the workload means more face time. A leading complaint made by doctors today is that they don’t get to deal directly with their patients – which was often the reason they entered medicine in the first place. An influx of primary care providers, driven by a realignment of the scope of practice for non-physician professionals, could very well improve the overall amount of time providers are able to spend engaging with their patients – as long as it remains grounded in prevention and patient-centered care.

While it doesn’t negate other factors contributing to face-time interruption (like the rise of digital applications), improving access was intended to encourage patients to seek more primary care.

An antidote to consolidation. Another recurring concern among private practice physicians and their associates is that hospitals and major clinics are increasingly looking like regional monopolies. Between pressure from dominant clinics and the economic challenges of remaining independent, it is hard for many private practices to remain unincorporated.

But the structure of federal incentives for primary care specifically target these endangered practices, as well as supporting non-physicians with similar private practice ambitions. While the goal is to increase patient access without regard to geography, regional monopolies, or other factors, the effect is to encourage more providers to enter into practice, as well as fighting the trend of escalating healthcare costs. Expanding more provider roles so that they can viably open and operate family practices lends more strength to the trend.

Specialization matters. Pushing the medical industry toward a more patient-centered care model is not just about broadening scopes of practice and driving providers into primary care. Specialization is in many ways equally important, both in improving care and reducing costs. Pharmacists even have their own brand of personalized care—Medication Therapy Management, built entirely around a collaborative, face-to-face design for patient-pharmacist interaction. Models like this capitalize on bringing more providers into the primary care delivery system, then double-down with a focus on outcomes, interaction, professional collaboration, and prevention.

Patient responsibility. Prevention is impossible in a one-way relationship. Likewise, value-based payment models cannot depend exclusively on care-givers to implement the lifestyle changes and paradigm shifts required of patients to see the full benefits of a medical intervention. The intersection of these new delivery models with electronic health records, and with any luck, scaled interoperability of said digital platforms, provides a powerful new way to track patient accountability.

The patient’s will to follow a physician’s instructions has long been a weak point in improving health outcomes, and while the scope of practice shift will not eliminate that confounding variable, it does coincide with better ways to distinguish where the patient is responsible for his or her own failures to adequately follow treatment plans and medical advice.

Edgar Wilson is a marketing consultant and blogger who has worked in industries ranging from international marketing to broadcast journalism. He can be reached at