ACEP ID:

March 29, 2022

Sample Op-Ed: Scope of Practice

The following is a template op-ed for you to tailor and submit to your local paper of record. Most publications provide guidance on how to submit op-eds on their website. When possible, use an anecdote or story to add a powerful emotional element. Please be mindful of word count parameters specific to the publication to which you are pitching the op-ed. 

[Example introduction and initial impact of proposed legislation: Imagine you or, worse, your child is hurt. You go to the emergency department, and you’re given a choice: See a healthcare provider with more than a decade of education and thousands of hours of training or another with a fraction of that experience. Who do you choose?

What if you don’t have that choice? And your only option is that healthcare provider with the lesser education and training?

Legislation currently in the [name of governmental chamber] could do just that by [placeholder: expanding the scope of practice for nurse practitioners and physician assistants in the emergency department]. It would not only shortchange patient care by cutting their access to the most highly trained expert available, it also could potentially put them at risk.]

[Placeholder: Include here background on the legislation, including the bill number, lawmakers backing it and any relevant lobbying or interest groups.]

[Example for background on state’s status quo: Currently, emergency departments in [state] must have a physician leading the team. [Name of organization] fully supports keeping in place that model of care. Why? Because there is no substitute for a licensed, trained, and board-certified emergency physician, and when it matters most, patients want the most qualified health care professionals in the room. Nearly 80% of adults trust a physician in an emergency, whereas only [placeholder: 6% would be comfortable turning to a nurse practitioner OR placeholder: 5% would be comfortable turning to a physician assistant PR placeholder: 8% would be comfortable turning to a registered nurse], according to an ACEP/Morning Consult poll.

Despite this, hospitals [placeholder: in nearby states, in other states] are increasingly having non-physicians, including [placeholder: nurse practitioners and physician assistants], perform complex medical procedures. Granting too much independence to non-physicians is dangerous and short-sighted as it puts patients in the care of health care professionals with a fraction of the training of emergency physicians. And when non-physicians are not trained for difficult procedures, complex diagnosis or even providing medical advice, patients face the consequences.

We’ve seen evidence that giving too much independence to non-physicians can lead to overprescribing and overutilization of diagnostic imaging. For instance, nurse practitioners prescribed more opioids than physicians, according to one analysis. In states that allow independent prescribing, nurse practitioners were 20 times more likely to overprescribe opioids than those in prescription-restricted states. Non-physicians also ordered more imaging over a 12-year period, according to another study. Scans increased more than 400% by non-physicians, primarily nurse practitioners and physician assistants.

It's clear: Policy makers can best protect patients by [placeholder: voting against this measure] and safeguarding emergency physicians’ role as the leader of the emergency department’s care team. Emergency physicians are, by far, the most highly trained and qualified health care professionals in the emergency department and, at patients’ most critical moments, we must ensure that they continue to oversee these life-changing medical decisions. 

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