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Scope of Practice Efforts

Scope of Practice Efforts

2023 Issue Brief: Scope of Practice

WSMA policy states that absent commensurate education and training requirements to ensure patient safety and a demonstrable and compelling societal need, the WSMA opposes efforts of non-physician practitioners to expand the scope of their practice to include additional services currently performed by physicians.

Our ask of the Legislature in 2023

During the 2023 legislative session, the WSMA will ask the Washington State Legislature to oppose scope of practice proposals that ignore the unique training of physicians, fail to include necessary education and training requirements, and jeopardize patient safety.

Scope bills we expect to see during the 2023 session

Naturopaths: Senate Bill 5411 would grant naturopaths prescriptive authority for all Schedule III-V drugs, including opioids, without detailing specific education and training requirements. A naturopath's educational emphasis on the self-healing process does not include the comprehensive medical and pharmacological background needed to properly and accurately prescribe potentially dangerous prescription drugs like fentanyl, morphine, benzodiazepines, and ketamine or to understand how they may interact with other drugs a patient may be taking and other conditions they may have.

ARNPs: Senate Bill 5373/House Bill 1495 would mandate state insurance carriers reimburse physician assistants and advanced registered nurse practitioners at the same rate as physicians for the "same services." Due to their longer and more in-depth education and training, physicians tend to work with higher acuity patients-those who present with multiple complex conditions and require the highest level of clinical knowledge and experience to treat appropriately and effectively. Insurance reimbursement policies should have the flexibility to make distinctions in education and training.

Optometrists: Senate Bill 5389 would allow optometrists to perform certain surgical procedures, including those that require the use of scalpels, injections, and lasers on the eyes and tissues surrounding the eyes, without appropriate education and training or regulatory guardrails. Optometrists are not medical doctors, and their education is observation-based. Only an ophthalmologist has training in the safest and most advanced treatments of the eye-surgical, pharmacological, and other interventions-as well as training in surgical procedures and techniques to ensure patient safety.

Psychologists: House Bill 1041 would allow, under certain conditions, psychologists to be granted prescriptive authority for psychotropic medications used in the diagnosis and treatment of individuals with certain mental and behavioral disorders. Psychotropics include some of the most dangerous drugs and require a high level of expertise and medical training, especially because psychotropic drugs can have complex interactions with other drugs and most behavioral health patients are receiving treatment for other health conditions.

Background on the education and training requirements by practitioner type

Education and training requirements by practicioner type table

More information

Contact WSMA Director of Government Affairs Sean Graham at or 360.259.4184.

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