Scope of Practice Update from the Desk of MSMS CEO, Tom George, MD

Dear fellow physicians,

I am writing to give you an update on the scope of practice (SOP) battles we are currently fighting in Lansing.

As you know SOP expansion is a way to undermine physician-led care. Currently there are bills in the state legislature that would allow nurse practitioners (NPs) to practice independently, and bills to change the name of physician assistants to physician associates. Additional legislation to expand the SOP of psychologists, physical therapists, optometrists, and other allied health professionals may be forthcoming.

Of course, we have fought these battles before and are familiar with the proponents’ arguments. Regardless of their field, they will say they have sufficient training (“as much or more as physicians”), will increase access to care and lower costs, and that their legislation will benefit the people of Michigan. These claims are false, and our task is to set the record straight!

What has changed since the last time these issues were debated is that we now have stronger, better evidence to refute these claims. Recent peer reviewed studies demonstrate that removing physician oversight of health care teams leads to overprescribing and over testing, increases costs, and does not improve access to care. You can find a one-page summary of our talking points with links to the relevant studies at this link.

The insurance industry is finally starting to take note of the SOP fight as more data has become available on cost increases. In the past, the health insurance lobby has often supported, or at least been ambivalent to SOP expansion, in the mistaken belief that it would reduce health care spending. Now insurers are starting to wake up and re-evaluate their positions based on this new evidence.

The new studies also suggest why some leaders in the hospital community frequently support SOP expansion. Knowing that independent practice by nonphysicians will increase the volume of tests and imaging studies, hospital systems may see this as helping their bottom lines.

The Senate Health Policy Committee had planned to hold a hearing on the NP SOP bill (SB 279) in late October. The proposed committee meeting date coincided with the fall MSMS Board of Directors meeting. In response to this news, Board members re-arranged their schedules so they could attend the hearing en masse following the Board meeting. MSMS President Salim Siddiqui, MD, and a past-president, Rose Ramirez, MD, (also a former nurse) were prepared to testify on MSMS’ behalf. However, as often happens in Lansing, the hearing was cancelled at the last minute. Not to be dissuaded, the Board took advantage of the time, lobbying senators in their offices, and even on the sidewalk.

Board members engaged in an impromptu conversation with Senator Kevin Hertel, Chairman of the Senate Health Policy Committee, in front of the Senate Office Building. 

In closing, I am happy to report that we are making headway – but now is not a time for complacency! We were able to hold a hearing off this fall, but we must continue to engage with our colleagues, and our legislators. Even if your specialty or practice does not seem immediately at risk, please step up and join with your fellow physicians in this fight!

There are three things you can do:

  1. Contact your own legislators and review the talking points with them.
  2. Participate in your county medical society legislative meetings
  3. Donate to MDPAC

If we continue to work together, we will prevail in retaining physician-led care for the citizens of Michigan.

Thank you for your interest and engagement in this issue.


Tom M. George, MD
Chief Executive Officer