“Divisive.” “Demeaning.” “Ugly.” Nurse practitioners (NPs) and physician assistants (PAs) expressed frustration when a controversial social media post from the American Medical Association (AMA) called to “#StopScopeCreep … because patient safety isn’t a game.” The now-deleted post, which originally appeared on Twitter and Facebook on October 30, 2020, called for limits on the autonomy of NPs and PAs to ensure all patient care is physician-led.

The AMA expressed in a statement to the Clinical Advisor that the intent behind #StopScopeCreep post was to reinforce the organization’s commitment to team-based healthcare guided by a physician, which the AMA believes is the best method for optimizing patient outcomes.

“This campaign highlights the AMA’s efforts to encourage physician-led healthcare teams that use the unique knowledge and valuable contributions of all clinicians to enhance patient outcomes,” the AMA stated. “NPs and PAs are valuable members of this team, and patients win when each member of their healthcare team plays the role they are educated and trained to play.”

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The AMA stated that independent practice of NPs and PAs “would further compartmentalize and fragment healthcare delivery; while team-based care fosters greater integration and coordination.”

The American Academy of Physician Assistants (AAPA) published a letter to the AMA’s leadership team expressing the organization’s frustration with the post. The AAPA argued that #StopScopeCreep does the opposite of strengthen healthcare teams; it forges a divide between advanced practice providers (APPs) and physicians.

“On behalf of the more than 140,000 PAs across this country who work alongside physicians in every medical setting and specialty, we ask that the AMA cease advancing the false and offensive narrative in your #StopScopeCreep campaign, which suggests PA care is not safe and jeopardizes patient safety,” the AAPA wrote.

Both the AAPA and the American Association of Nurse Practitioners (AANP) stated that the post could mislead patients, who after seeing the post may believe that they would receive substandard care from an APP.

“NPs are delivering the care they were educated, clinically trained, and nationally certified to provide — and that state law licenses and authorizes. This hashtag and so-called ‘movement’ are focused on one thing: misleading patients and policymakers to protect physician pocketbooks,” AANP President Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, told the Clinical Advisor.

The AAPA and AANP pointed out that the timing of the post, during a surge in cases of coronavirus disease 2019 (COVID-19), contributes to the anger felt by APPs who encountered the #StopScopeCreep movement. The AAPA stated that now more than ever, patients need access to high-quality care, and PAs have been there to fill this need throughout the pandemic.

“Three out of 5 PAs have tested, treated, and diagnosed COVID-19 patients. Like physicians, PAs have experienced furloughs, layoffs, reduced hours — and have contracted and died from the virus. So, AMA’s whimsical graphic with the PA profession represented on Scrabble tiles with the message ‘because patient safety isn’t a game’ was unconscionable,” the AAPA wrote.

According to the AAPA, movements like #StopScopeCreep undermine public confidence by breaking up the united front physicians and APPs should have when working together to battle a public health crisis. The organization pointed out that if patients do not feel comfortable seeking care from an APP during the pandemic, they may put their health in jeopardy.

“Most egregious is AMA’s tone-deaf attempt to instill more fear and uncertainty in the public at a time of already heightened anxiety. As we have seen across the country, patients continue to delay life-saving care due to COVID-19. Using scare tactics to disincentivize patients from accessing healthcare during a pandemic is disconcerting and reckless to public health,” the AAPA wrote.

Dr Thomas echoed this sentiment, and called for better teamwork and respect between the AMA and APPs in the future.

“It is unbelievable that at a time when the healthcare community is collectively battling a pandemic, the AMA is engaging in a coordinated disinformation and smear campaign of their fellow healthcare professionals. We’re not playing games; we’re saving lives and building a healthcare system that works. NPs call on physicians to get out of the mud and join us in those efforts,” Dr Thomas said.


Smolko BR, Gables LM. AAPA response to AMA’s #StopScopeCreep campaign. American Academy of Physician Assistants. https://www.aapa.org/news-central/2020/11/aapas-response-to-amas-stopscopecreep-campaign/ Published November 2, 2020. Accessed November 3, 2020.