SCOPE OF PRACTICE

In the ER, the emergency physician leads every care team. We believe physican-led teams are the gold standard for patient care. And we steadfastly believe any practitioner who seeks to practice independently should be held to similar training standards as physicians.

independent practice

For nurse practitioners and physician assistants

In Virginia, we must ensure stringently regulated clinical training for Nurse Practitioners, Physician Assistants, and other advanced practice providers. Advanced practice providers such as NPs and PAs often introduce “scope of practice” bills in the Virginia General Assembly that seek greater autonomy.

A physician is required to complete four years of med school and, at a minimum, three years of residency training, even in primary care. Many physicians take additional years to build a specialty, such as in neurosurgery, orthopedics, and, of course, emergency medicine.

NPs, PAs and other advanced healthcare professionals are important members of an ER care team and should, in some cases, be able to practice independent of physician oversight. However, their requests for minimal post-graduate education and clinical training is unacceptable and will lead to a drop in quality of care. The standard of training should be nothing less than the highest possible level.

VACEP has fought this battle regularly, and in 2023 was able to keep clinical training for NPs to five years before gaining independent practice.

There are some scope of practice issues we support. Paramedics work both in the field (as part of an ambulance crew, for example) or in the emergency department as ER techs when they are taking extra shifts. In the field, they can administer medications and provide basic medical care, but for a time in Virginia, they could not. In 2023, we supported their cause to grant them the ability to provide the same level of care when working as ER techs, under the direction of a physician, as they do while on an ambulance.