Scope of Practice

Varying Scope of Practice Under Physicians and Nurse Practitioners

I recently received the following inquiry:

I hold two jobs. My primary position is in a clinic staffed primarily by physicians. I also work in the office of a nurse practitioner.

I have been told that my scope of practice under a physician may be different from my scope of practice under a nurse practitioner. That seems unusual. Could you please tell me whether this is the case?

What this medical assistant has been told is correct.

When medical assistants work under the authority of physicians, their scope of practice is determined by the medical practice act and the regulations of the board of medical examiners in their state. When working under the authority of a nurse practitioner, their scope of practice is determined by their state’s nurse practice act and the regulations of the board of nursing.

For further assistance with this complicated question, email me at or comment on this post.

On the Job

North Carolina Bill Would Authorize School Medical Assistants

In April 2023, a bill was introduced into the North Carolina legislature that would create a pilot program for medical assistants to serve as “school medical assistants.” The bill, titled “An Act to Establish a Pilot Program for Allowing School Medical Assistants to Provide School Nursing Services in Public Schools under Supervision of a Certified School Nurse,” would enact the following: 

SECTION 1. The Department of Public Instruction shall establish a Supervising School Nurse Pilot Program (Program) to enable public school units to hire or contract for personnel to provide school nursing services as a school medical assistant. 

SECTION 2.(a) For purposes of the Program, a school medical assistant is a person who works under the supervision of a nurse that has been certified as a school nurse per the requirements of the State Board of Education and is currently employed as a school nurse in a public school unit. 

SECTION 2.(b) The State Board of Education shall develop eligibility criteria to serve as a school medical assistant. The criteria shall require a relevant two-year degree or an equivalent amount of training and experience. 

 To my knowledge, this is the first legislation of its kind in the history of medical assisting. 

Read the House Bill 765 for more information. 

Scope of Practice

Permissible X-Ray Duties for Arizona Medical Assistants

I recently received the following question:

I need clarification [on whether a medical assistant] can, under the supervision of a podiatrist, take X-rays. I have a small podiatry clinic in a multispecialty clinic and would like to hire [a medical assistant] but would need them to be able to take X-rays.

To answer this question, refer to R9-16-604 of the Arizona law about podiatric radiography. It states that an individual would have to meet the requirements of this section and become a practical technologist in radiography.

Scope of Practice

Permissible Venipuncture for Louisiana Medical Assistants

I received the following question from a director of compliance in Louisiana:

I was reviewing your stance on the scope of work of medical assistants and am requesting clarification on phlebotomy (blood draws) by medical assistants in Louisiana. Do you [surmise] medical assistants can draw blood under Louisiana law? Louisiana has a certification law for phlebotomists, and I am curious about whether medical assistants have to be certified as phlebotomists to perform venipuncture in a clinic.

Note the following excerpt from the Louisiana clinical laboratory personnel law:

D. This Part shall not apply to any individual performing phlebotomy or acting as a phlebotomist employed by or acting under the direction and supervision of a physician licensed by the board, a clinic operated by a licensed health care provider, a hospital, a nursing home, or other licensed health care facility.

Thus, my legal opinion is that Louisiana law allows knowledgeable and competent medical assistants working under licensed provider supervision in the settings listed above to perform venipuncture without being licensed under the Louisiana clinical laboratory personnel law.


Internal Revenue Code Classification for the AAMA and AAMA Affiliates

I received the following question from an AAMA state society leader:

Is our state society eligible for the reduced [transaction] rate from PayPal? The reduction in the rate is considerable and would help our society.

To answer this question, note the following information from PayPal:

PayPal offers discounted transaction rates for confirmed 501(c)(3) charities for most products with no monthly fees. [Emphasis added.]

The American Association of Medical Assistants® (AAMA) and its affiliated state societies and local chapters are classified under 501(c)(6)—not 501(c)(3)—of the Internal Revenue Code. Section 501(c)(6) includes professional societies, business leagues, and trade associations. Section 501(c)(3) includes religious, philanthropic, and scientific entities.

Because AAMA state societies are not 501(c)(3) charitable organizations, they are not eligible for the PayPal discounted transaction rates. The AAMA and its state and local affiliates are also not eligible for state and local sales tax exemptions.