Excerpts from Relevant ACP Policy on Licensure and Scope of Practice

Clinical Care Teams

  • ACP reaffirms the importance of patients having access to a personal physician who is trained in the care of the “whole person” and has leadership responsibilities for a team of health professionals, consistent with the Joint Principles of the Patient-Centered Medical Home.
  • Although physicians have extensive education, skills, and training that make them uniquely qualified to exercise advanced clinical responsibilities within teams, well-functioning teams will assign responsibilities to advanced practice registered nurses, other registered nurses, physician assistants, clinical pharmacists, and other health care professionals for specific dimensions of care commensurate with their training and skills to most effectively serve the needs of the patient.
  • Physicians, advanced practice registered nurses, other registered nurses, physician assistants, clinical pharmacists, and other health care professionals have different training, skills, knowledge bases, competencies, and experience in patient care.
  • Although some training and competencies overlap, physicians have more years of training, and the range of care appropriately provided by each discipline is not equal.
  • Advanced practice registered nurses and physician assistants cannot substitute for or replace the skills and expertise of physicians within their discipline, but when they practice to the top of their licenses, they can provide complementary and unique approaches, as well as additional skills in the service of patients and families.
  • Patients have the right to be informed of the discipline, educational background, and competencies of the members of the clinical care team. To minimize patient confusion and ensure informed choice, the clinical care team should be able and prepared to provide patients and families with information about the training of all health professionals within the team and the meaning of all professional designations (such as MD, DO, NP, DNP, PA, PhD, PharmD, and LCSW-C), including information on the differences in the years of training and clinical experiences associated with their professional designations. Such information should always be available for each clinician providing care.”
  • Because patients view the term “doctor” as being synonymous with “physician” when used in a health care setting, it is incumbent on all health care professionals with a doctoral degree other than MD or DO to clarify that they are not physicians when using the term “doctor” in the patient care setting.
  • The purpose of licensure must be to ensure public health and safety.
    • Licensure should be evidence-based. It should protect the public from receiving care from clinicians that is beyond their training, skills, clinical experience, and demonstrated competence; licensure should not restrict qualified clinicians from providing care that is commensurate with, but does not extend beyond, their training, skills, clinical experience, and demonstrated competence.
    • Licensure should ensure that each member of the health care team practices within ethical standards as a condition of obtaining and maintaining their license. 
    •  Licensure should ensure a level of consistency (minimum standards) in the credentialing of clinicians who provide health care services.”
  • Licensing bodies should recognize that the skills, training, clinical experience, and demonstrated competencies of physicians, nurses, physician assistants, and other health professionals are not equal and not interchangeable.

Nurse Practitioners in Primary Care:

  • Physicians and nurse practitioners complete training with different levels of knowledge, skills, and abilities that while not equivalent, are complementary. As trained health care professionals, physicians and nurse practitioners share a commitment to providing high quality care. However, physicians are often the most appropriate health care professional for many patients.
    • Whenever possible, the needs and preferences of every patient should be met by the health care professional with the most appropriate skills and training to provide the necessary care.
    • Patients with complex problems, multiple diagnoses or difficult management challenges will typically be best served by physicians working with a team of health care professionals that may include nurse practitioners and other non-physician clinicians.
    • Patients have the right to be informed of the credentials of the person providing their care to allow them to understand the background, orientation and qualifications of the health care professionals providing their care and to better enable them to distinguish among different health care professionals.
    • The College recognizes the important role that nurse practitioners play in meeting the current and growing demand for primary care, especially in underserved areas.
    • The College advocates for research to develop effective systems of consultation between physicians and nurse practitioners as clinically indicated.
  • Collaboration is defined as ongoing interdisciplinary communication regarding the care of individuals and populations of patients in order to promote quality and cost-effective care. Recognizing the importance of coordinated care to improving health outcomes, we offer the following principles on collaboration between physicians and nurse practitioners:
    • Effective interdisciplinary collaboration is critical to ensuring that all patients receive the highest possible quality of care.
    • Members of a health care team should understand their complementary roles in the delivery of care as defined through their respective professional practice acts.
    • Collaboration among physicians and nurse practitioners can occur during both face-to-face encounters and electronically through the use of technology, including telephone, e-mail, telehealth, and electronic health records.
    • Effective collaboration among nurse practitioners and physicians requires appropriate sharing of information and mutual acknowledgement and respect for each professional’s knowledge, skills, and contributions to the provision of care.
    • Payment systems should provide sufficient reimbursement for the coordination of care and collaboration between nurse practitioners and physicians.
  • Licensing and certification examinations for nurse practitioners should be developed by the nursing discipline and based on standardized training involved in graduating from advanced practice nursing programs as well as scope of practice statutes and regulations. Certification examinations should be carefully constructed so as to avoid any appearance of equivalency of training/certification with physicians.

Retail Health Clinics:

Retail health clinics should have a well-defined and limited scope of clinical services that are consistent with state scope-of-practice laws and with the more limited physical space and infrastructure that such a setting permits. These well-defined and limited services should be clearly disclosed to the patient prior to or at the visit.

Managed Care Setting:

ACP supports scope of practice legislation or designation by managed care organizations that are consistent with ACP policy that focuses on physicians’ training and expertise rather than legislative mandates or managed care policies that specifically name medical specialties as primary care physicians. (HoD 95; reaffirmed BoR 08; reaffirmed BoR 19)

Pharmacy Scope of Practice:

ACP supports physician-led physician-pharmacist collaborative practice agreements that reflect ACP’s principles supporting dynamic clinical care teams and ensure that team members act in the patient’s best interests. Potential benefits of collaborative practice agreements include improved treatment and management of chronic diseases such as diabetes and medication adherence. You can view the complete policy here. ACP opposes independent pharmacist prescriptive privileges and initiation of drug therapy outside of a collective practice agreement, physician standing order or supervision, or similar arrangement.

ACP supports the use of state-licensed pharmacists as sources of immunization information, hosts of immunization sites, and immunizers for adult patients, as appropriate and allowed by state law proving they coordinate, communicate, and collaborate with the patient’s primary care team to ensure patient safety and continuity of care.