Nurse practitioners are making inroads in some states in getting more clinical authority but are still blocked in some states by physician groups fearing that giving nonphysician clinicians a wider scope of practice would cut into the income of  doctors, who remain by far the highest paid in the world.

Advanced nurse practitioners  have been fighting for years for the right to write prescriptions  and  operate practices without an agreement with a physician.

The pressure to expand the scope of nurse practitioners’ practice has intensified with studies saying that many millions of Americans live in areas with primary-care physician shortages.

A wider scope of practice would include, for instance, letting nurse practitioners diagnose patients, order tests, complete death certificates and initiate involuntary psychiatric commitment for unstable patients without a supervisory relationship with a physician.

Modern Healthcare says that “Physicians say advanced nurse practitioners can help alleviate the primary-care shortage, but only if they are a part of a coordinated team led by a doctor. ”

Robert Wergin, M.D., chairman of the American Academy of Family Physicians told the publication:

“What we’re for is team-based care where it’s the right provider, the right care at the right time. Everyone contributes to the care, but we’re not necessarily interchangeable.”

“Independent practice and team-based care take healthcare delivery in two very different directions,” an American Medical Association spokeswoman added. “One approach would further compartmentalize and fragment healthcare delivery, while team-based care fosters greater integration and coordination.”