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granting a specific health profession expanded clinical authority.
The very nature of scope of practice battles means that legislators
find vocal advocates from their own legislative district on both sides
of the issue. They soon learn they cannot escape the controversy.

in place. The core argument is that without independent practice,
patient access is severely reduced, especially for seniors, low-income
patients and rural communities. For legislators these arguments can
be compelling.

The Professional Licensure Committee chairs do have a few
" tools " at their disposal as they deal with the scope of practice issues
and the respective advocates. Comparable action or inaction in other states, particularly neighboring states, is easy to quantify. Public
hearings provide advocates on both sides with an opportunity to
state their case in a public forum. Sometimes studies are requested
from trusted governmental groups like the Legislative Budget and
Finance Committee. On the downside, advocacy groups working
on scope of practice legislation are very likely to engage their membership by holding rallies at the capitol, meaning the capitol rotunda
becomes a sea of white coat-wearing health care professionals.

While each scope of practice battle features its own nuances and
political implications, physician opposition centers on the negative
effect on utilization of services, health care costs and the quality of
patient care. Another persuasive argument has been documenting
the massive difference in education and training compared to those
required of a physician.

After all the shouting, studying and testifying is done the
Professional Licensure Committee chair often relies on a summit
meeting between the key stakeholders. That is usually constructed
as a mandate for the parties involved to come to an agreement ( " ...
or I will do that for you and neither of you will like it " ). Another element may be the mandated moratorium banning future legislation
for a specified number of years and imposed on all parties by the
chairman. Again, the intent is to avoid that contentious vote pitting
one profession against another.

As the COVID-19 pandemic crisis unfolded the Pennsylvania
General Assembly was again a battleground. Legislation creating the
Advanced Practice Registered Nurse-Certified Nurse Practitioner
license and focused on eliminating collaborative agreements was introduced and then amended in House committee to allow a 6-year
pilot project on independent practice in 2020. Certified Registered
Nurse Practitioners with specified training and experience would
participate, but only in health professional shortage areas of the
Commonwealth. In addition, a legislative study would determine
the effectiveness of the pilot project before final enabling legislation
was possible. The expectation that the new language in the bill,
which passed the House 201-1, would also be passed by the Senate
proved to be unfounded. So in the next 2-year legislative session the
battle will continue.

Physicians and their advocacy organizations are at a distinct
disadvantage in that they face a wide array of scope of practice
confrontations, impacting physician specialties across the profession, from anesthesiology to psychiatry. At both the national and
state levels of organized medicine, aggressive advocacy on scope of
practice issues has been a priority issue for many years. In addition
to taking on insurers and battling the trial lawyers on tort reform,
defending against practice expansion by other health care providers
is a strong membership selling point.
On scope of practice issues physicians are playing defense.
Holding an unrestricted license to practice medicine, they oppose
the expanded scope sought by other health care professionals who
either seek licensure or believe they are qualified to invade the sacred
turf of unsupervised diagnosis and treatment, particularly prescribing privileges.
Recently primary care-related scope issues have become particularly prominent. Mandated oversight or collaborative agreements
with physicians are viewed by CRNP and PA reform advocates as
redundant given the standards of education and certification already

Physician advocates also present data gathered from around
the country confirming that the independence-seeking health care
professionals are not likely to actually move to and work in the rural
and underserved communities that they vow to serve. Historically
they have continued to practice in the same locales as physicians.

After decades of scope of practice battles, the ongoing
COVID-19 pandemic offers an opportunity for a fresh look from
both sides of the equation. Physician advocates will assert that
the " physician led team approach " provided high quality care in
extremely difficult clinical circumstances. Health care professionals
seeking an expanded scope of practice will contend that in dealing
with the COVID-19 crisis it was proven that more clinical freedom
and responsibility needed to address the crisis didn't jeopardize the
quality of patient care.
Somehow, it may just be that both sides are right.
Larry L. Light
lighthouselobby@gmail.com

SPRING 2021 | CHESTER COUNT Y Medicine 27

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Chester County Medicine Spring 2021

Table of Contents for the Digital Edition of Chester County Medicine Spring 2021