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 DBalasa@aama-ntl.org or comment on this post.

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.

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.

Why Professional Regulation Laws Vary from State to State

Why do medical assisting laws vary—sometimes greatly—from state to state? Some may even argue that it would make more sense—and be better public policy—for the U.S. Congress to enact laws for each regulated profession that are nationally applicable and consistently interpreted in all U.S. jurisdictions.

However, even though national regulation of the professions has great intuitive appeal, the plain language of the U.S. Constitution would make broad federal regulation of the professions unconstitutional.

In the 2023 January/February Public Affairs article, “Why Professional Regulation Laws Vary from State to State,” I further expand on the reasons professional regulation laws vary across the nation. Read the article to learn more about how the Tenth Amendment limits laws governing professions, why the Medicare and Medicaid Electronic Health Record Incentive Programs were constitutional, how state licensing laws can become more uniform, and more.

The full article is available via the “Public Affairs Articles” webpage.  

Permissible Supervision Duties for North Carolina Medical Assistants

I recently received the following question:

[In North Carolina,] can a CMA (AAMA) be a supervisor over LPNs [licensed practical nurses] and RNs [registered nurses], as well as CMAs (AAMA)?

 To answer this question, note the following information from the “Frequently Asked Questions” webpage on the North Carolina Board of Nursing website:

Can a nurse be supervised by an unlicensed person or another discipline?

A non-nurse (other than a licensed physician) may not supervise nursing practice but could supervise basic employment issues (i.e., administrative supervision, human resource issues [such as] time, attendance, [and] dress code).