The American Medical Association’s Concerns Over Nurse Practitioner Scope Creep: Implications for Medical Malpractice

In recent years, the healthcare landscape has witnessed a significant shift with nurse practitioners (NPs) assuming roles traditionally held by medical doctors (MDs). This expansion of responsibilities, often referred to as “scope creep,” has garnered attention from various medical organizations, notably the American Medical Association (AMA). The AMA has expressed concerns that this trend may impact patient safety and increase liability risks for healthcare providers.

Understanding Scope Creep

Scope creep refers to the gradual expansion of a professional’s duties beyond their original scope of practice. In the context of nurse practitioners, this means taking on more complex medical tasks, such as diagnosing conditions, prescribing medications, and performing procedures, which were once the exclusive domain of physicians.

The AMA has been vocal in its opposition to what it perceives as an overextension of NP responsibilities. The association argues that while NPs are valuable members of the healthcare team, their training does not equip them to handle the complexities associated with certain medical decisions and interventions. The AMA emphasizes that patient care should be led by physicians, who undergo extensive education and training to manage intricate medical cases.

The Rise of Independent Practice for NPs

A significant factor contributing to the scope creep debate is the increasing number of states granting NPs full practice authority (FPA). As of 2025, 27 states, along with the District of Columbia and several U.S. territories, allow NPs to practice independently without physician supervision. This legislative shift has enabled NPs to operate their own practices, prescribe medications, and manage patient care autonomously.

Proponents of FPA argue that it addresses physician shortages and improves access to healthcare, especially in underserved areas. However, the AMA contends that such autonomy may compromise patient safety. The association points to instances where the absence of physician oversight has led to adverse patient outcomes, particularly in complex medical situations.

Malpractice Risks Associated with Scope Creep

The expansion of NP responsibilities raises pertinent questions about liability and accountability. As NPs take on more complex tasks, they may face increased exposure to medical malpractice claims. Common allegations against NPs include:

• Diagnostic Errors: Failure to accurately diagnose conditions can lead to delayed or inappropriate treatments.
  
• Medication Mistakes: Errors in prescribing or administering medications, such as incorrect dosages or drug interactions, can have serious consequences.
  
• Informed Consent Issues: Inadequate communication with patients about treatment risks and benefits may result in legal claims.

While NPs are generally less likely to be named in malpractice suits compared to physicians, the frequency of claims against them is rising. Between 2012 and 2017, the percentage of malpractice lawsuits involving NPs increased from 7% to 16.4%, particularly among those practicing independently.

Moreover, physicians who collaborate with or supervise NPs may also face liability risks. In some cases, supervising physicians have been held accountable for the actions of NPs under their oversight, even if they were not directly involved in the patient care decision-making process.

The AMA’s Advocacy Efforts

The AMA has actively worked to address what it perceives as the risks associated with scope creep. Through its Scope of Practice Partnership, the AMA has provided over $4 million in grants to support state medical associations in opposing legislation that would grant NPs and other non-physician practitioners independent practice authority.

Additionally, the AMA has launched the “Truth in Advertising” campaign to ensure that healthcare providers accurately represent their qualifications to patients. The initiative aims to prevent confusion and ensure that patients are aware of the level of training and expertise of their healthcare providers.

Balancing Access and Safety

The debate over scope creep underscores the need to balance expanding access to healthcare with maintaining high standards of patient safety. While NPs play a crucial role in the healthcare system, particularly in primary care and underserved areas, their increasing autonomy necessitates careful consideration of the associated risks.

Healthcare providers, including NPs and supervising physicians, must stay informed about state regulations and ensure that they operate within their legal and professional boundaries. Implementing robust training programs, clear communication channels, and comprehensive malpractice insurance coverage can help mitigate potential liabilities.

Conclusion

The expansion of nurse practitioner responsibilities, or scope creep, presents both opportunities and challenges for the healthcare system. While it may enhance access to care, particularly in underserved regions, it also introduces potential risks related to patient safety and medical malpractice. The American Medical Association’s concerns highlight the importance of maintaining high standards of care and ensuring that all healthcare providers operate within their areas of expertise. As the healthcare landscape continues to evolve, ongoing dialogue and collaboration among medical professionals.

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