Issue Background

Scope of Practice

Physician Assistant Scope of Practice Law

NJ Bill S1184 and A1950

The Governor signed a bill in 2015 modernizing the scope of practice for physician assistants. MSNJ and specialty societies worked very closely with the physician assistant society to craft the parameters of the bill and support the final version. The main change from current law is that a physician will now be allowed to execute an agreement with the PA to determine the scope of practice, if the physician chooses to allow the PA to perform functions beyond those enumerated in current statute. Read the summary.


Pharmacy-Administered Vaccines

Governor Christie signed A3251/S2567, the bill allowing pharmacies to administer certain vaccines. The bill allows pharmacies to administer to patients 18 and older a vaccine (1) pursuant to a prescription, (2) in immunization programs authorized by a prescriber’s standing order for the vaccine or (3) in immunization programs and programs sponsored by governmental agencies that are not patient specific. A pharmacist may administer an influenza vaccine to a patient who is seven years of age or older. For a patient who is under 18 years of age, a pharmacist shall not administer a vaccine except with the permission of the patient’s parent or legal guardian.  For a patient who is under 12 years of age, a pharmacist shall not administer a vaccine unless pursuant to a prescription by an authorized prescriber.  After a hard battle, MSNJ, NJAFP and NJAAP successfully petitioned to limit the bill to flu vaccines and successfully increased the age threshold. We will continue to oppose scope of practice expansions if they do not improve patient care.

APN Scope of Practice

For the second term in a row, MSNJ successfully advocated for the defeat of legislation that would have allowed advanced practice nurses to certify cause of death.  MSNJ opposes this bill because cause of death is in fact a medical diagnosis and should be provided only by a physician. The Governor pocket vetoed the bill, as he did the term before.

MSNJ, along with specialty societies, has also lobbied successfully in the 2012-2013 and 2014-2015 legislative sessions against a general scope of practice expansion by APNs. The bill would remove the requirement for joint protocols with physicians. APN independence does not reduce cost in the long run, as APNs cost more in referrals and seek physician-level reimbursements. Nor does independence increase quality. Independence does not increase access either, as APN specialize and seek the same patients physicians do. MSNJ continues to advocate for patient access to physician-led teams. Vote “NO” on S-1152.

Scope - Psychologist Prescribing

MSNJ opposes the expansion of the scope of practice of psychologists. See our letters here (A2892 and S137)

Opposition letters:

Read The Star Ledger article, "Rule change could harm N.J. patients."

MSNJ Comments on Collaborative Agreements with Pharmacists

In late May, MSNJ filed comments with the New Jersey Board of Medical Examiners and the Board of Pharmacy on their jointly re-proposed rules governing collaborative practice agreements between physicians and pharmacists. We are pleased that the re-proposed rule contains many of the provisions that MSNJ sought in earlier comments. These include the requirement of a bona fide physician-patient relationship, and the requirement that these agreements be with individual pharmacists, not retail chains or entities. We continue to voice concerns about the level of training required of collaborating pharmacists and the limitation of the agreements to a “patient’s specific condition, disease or diseases.”

 

NJ Supreme Court Rules to Limit Scope of Practice for PAs 

In their January 19 opinion, the Supreme Court of New Jersey ruled that physician assistants cannot perform needle electromyography, as the procedure is not in their scope of practice. In an American Medical News article published on Monday, MSNJ CEO and General Counsel, Larry Downs said, "The Supreme Court upheld the appellate decision, basically narrowing the [trial] court's broad opinion. If the court had reversed, "physician assistants would have had an equal scope of practice without the similar background and training" of licensed physicians”

MSNJ thanks the AMA and the AMA Litigation Center for their support on this issue.

 

MSNJ Objects to Expansion of Chiropractors' Scope of Practice

On January 20, 2012, MSNJ filed comments in opposition to the New Jersey Board of Chiropractors proposed regulations that would expand chiropractors’ scope of practice by allowing them to perform pre-participation screens—medical examinations of students, clearing them for sports and intramural activities. While the New Jersey Legislature previously expanded the chiropractors’ scope of practice, it specifically considered and deliberately declined to include pre-participation screens in the enabling legislation. Read more.

 

New Jersey Supreme Court Rules on Scope of Practice Case

This week the Supreme Court of New Jersey published its decision in the Selective Insurance Company v. Rothman case. MSNJ and the AMA were granted leave to appear as amici curiae and filed a joint amicus brief for the court’s consideration. MSNJ and the AMA participated in the case because the trial court decision interpreted the medical practice act so broadly that there was no practical difference between a physician's scope of practice and a physician assistant’s scope of practice. The supreme court agreed with arguments advanced by MSNJ objecting to the overly broad interpretation of the medical practice act. The supreme court found that performing needle electrodiagnostic tests (EMGs) was outside the scope of practice for physician assistants.

A second issue in this case was whether the decision should be applied retroactively. On that point the court declined to act, stating the record below did not contain sufficient facts to support a prospective application. The court agreed to give Dr. Rothman an opportunity to establish such facts.

Participation in this case is part of MSNJ's legal advocacy efforts aimed at protecting the profession of medicine by ensuring that scope of practice statutes are strictly construed. We appreciate the support of the AMA's Litigation Center on this matter. Read the opinion in its entirety.

 

MSNJ Opposes Expansion of Scope of Practice for Nurses in Death Certification

In a January 3, 2012 letter to Assemblywoman Annette Quijano, MSNJ stated opposition to A-3987, a bill expanding the scope of nursing to include determining the cause of death in a patient. MSNJ maintains that determining cause of death is in fact practicing medicine and should not be extended to nurses to make the death certification process more efficient. Read the letter.