Preserving Physician-Led Care in New York
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Colleagues:
The quality of patient care in New York depends on the expertise, training, and leadership of physicians. Over the past two decades, New York has seen ongoing debates about expanding the scope of practice for non-physician providers, nurse practitioners and physician assistants to practice independently. While these providers play a vital role on care teams, it is critical to understand the differences in training and experience between physicians and non-physician providers, as these differences directly impact patient outcomes.
As physicians we undergo 4 years of medical school plus 3–7 years of residency and fellowship, totaling 12,000–16,000 hours of supervised patient care training while physician assistants have 2–3 years of graduate training with roughly 1,600–2,000 hours of clinical experience, typically with no formal post-graduate residency, and nurse practitioners have 2–4 years of graduate-level training, usually accumulating ~500 hours of clinical experience and with no formal post-graduate residency.
The depth and breadth of training for physicians far exceed that of non-physician providers. This does not diminish the important role NPs and PAs play; they are essential members of healthcare teams. However, allowing independent practice for non-physician providers can unintentionally compromise care quality and increase costs and does not necessarily improve access to care.
Non-physician providers are not more likely than physicians to practice in underserved areas, limiting the argument that they increase access to care. In addition, studies indicate that NPs and PAs may order more tests, make more specialist referrals, and have higher rates of hospital readmissions and emergency department returns compared to physician-led care. These patterns can increase healthcare costs rather than reduce them.
Expanding the role of non-physician providers without sufficient oversight risks fragmenting care and undermining the outcomes patients expect. The solution is not to restrict non-physician providers but to ensure physician-led team-based care remains the standard.
As New York continues to face physician shortages, particularly in high-acuity specialties, maintaining a physician-led care framework is critical. In a physician-led model, each professional practices at the top of their training, combining expertise to deliver the highest quality care. This approach balances efficiency, cost-effectiveness, and patient safety.
MSSNY remains committed to protecting this model. Preserving physician-led teams ensures that patients receive care guided by the most highly trained clinicians while supporting the essential contributions of NPs, PAs, and other healthcare professionals. We advocate for policies that prevent premature or unsafe expansion of independent NPP practice and reinforce collaboration within the healthcare team. To that end, with support from an AMA Scope of Practice Partnership grant, MSSNY ran a digital ad campaign across the state. By reinforcing physician leadership in care teams, New York can safeguard both quality and access.
Please join me in opposing scope of practice expansion that would allow physician assistants to work in primary care independent of physician supervision after 8,000 hours of clinical practice. Contact your legislator here and let them know SCOPE expansion of PAs is not beneficial for the residents of New York State.
All the best,
Mark J. Adams, MD, MBA, FACR
MSSNY President
