Improving Value

Provider Scope of Practice

Provider scope of practice laws establish the legal framework that controls the delivery of medical services. The reach of these laws encompasses the full range of disciplines—ranging from physicians and physical therapists to podiatrists and dental hygienists—and governs which services each is allowed to provide and the settings in which they may do so.

Many believe that transforming the healthcare system to meet the demand for safe, quality, and affordable care will require a fundamental rethinking of the roles of many healthcare professionals.1

According to a RAND study, the services which nurse practitioners (NPs) and physician assistants (PAs) can provide are generally in the field of primary care and typically include: physical examinations, ordering and interpreting diagnostic tests, treating and managing a range of acute, episodic, and chronic conditions, and prescribing medications.2

A majority of the primary care physician openings have not been filled by graduates from United States medical schools. In the mid 1990’s more than 70 percent of these open primary care positions have been filled by these graduates, but in the mid 2000’s that number dropped to below 45 percent.3 

According to one estimate, more than 60 million people lack access to primary care, in part because of the shortage of primary care physicians.4 The Association of American Medical Colleges estimates the shortfall of primary care physicians could reach anywhere between 12,500 and 31,000 physicians by 2025.5 As a result there is a significant number of primary care positions that need to be filled, and there are many non-physician groups that are interested in filling this void.


1. Institute of Medicine, The Future of Nursing Focus on Scope of Practice, Report Brief, October 2010.

2. Eibner, Christine E., et al., Controlling Healthcare Spending in Massachusetts: An Analysis of Options, RAND Corporation, Santa Monica, Calif. (August 2009).

3. Ibid.

4. National Association of Community Health Centers, Access is the Answer: Community Health Centers, Primary Care and the Future of American Health Care (March 2014).

5. Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections from 2013 to 2025 (March 2015).