Physicians are in a losing war to protect their turf as more more states (with Nebraska now the 20th) let nurses in a variety of medical fields practice without a doctor’s oversight, reports The New York Times. This change is especially attractive in rural states where physicians are often far, far away from patients.

So the nurses can order and interpret diagnostic tests, prescribe medications and administer treatments.

“The doctors are fighting a losing battle”  against the nurses’ new powers, Uwe E. Reinhardt, a health economist at Princeton University, told The  York Times. “The nurses are like insurgents. They are occasionally beaten back, but they’ll win in the long run. They have economics and common sense on their side.”