representatives of six associations of regulatory boards (NCSBN, 2007).21 The monograph emphasizes that the most important—indeed the only relevant—questions concerning scope of practice are whether the “change will better protect the public and enhance consumers’ access to competent healthcare services.” In contrast to the static, exclusivity paradigm adhered to by some, the monograph notes two particularly relevant basic assumptions that should frame any scope-of-practice decision:

  • Changes in scope of practice are inherent in our current healthcare system. Healthcare and its delivery are necessarily evolving…. Healthcare practice acts need to evolve as healthcare demands and capabilities change.”

  • Overlap among professions is necessary. No one profession actually owns a skill or activity in and of itself. One activity does not define a profession, but it is the entire scope of activities within the practice that makes any particular profession unique. Simply because a skill or activity is within one profession’s skill set does not mean another profession cannot and should not include it in its own scope of practice.”22

It is to be hoped that this “safe and effective abilities” focus will supplant the “first we must start with medicine” refrain as legislative and administrative actions to foster less restrictive practice parameters for all providers are undertaken at both state and federal levels. If so, we will move closer to the goal of enhancing the public’s access to practitioners who can provide competent and cost-effective care in a wide range of practice settings.


While professional associations, legislators, and administrators are all too familiar with the difficulties encountered in reconciling regulatory authority with evolving clinical abilities, an awareness of the need for change has been slow to develop in the wider policy-making and public arenas. Now, however, with sustained efforts to increase access to care in cost-effective ways, a growing and increasingly diverse chorus of voices is calling for true reform of health care workforce regulations.


The Monograph was developed by representatives of the following organizations: Association of Social Work Boards (ASWB), Federation of State Boards of Physical Therapy (FSBPT), Federation of State Medical Boards (FSMB), National Board for Certification in Occupational Therapy (NBCOT), National Council of State Boards of Nursing (NCSBN), and National Association of Boards of Pharmacy (NABP). Full text of the document:


Monograph, p. 9.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement