Standing Firm: POMA's Commitment to Physician-Led Care

October 2025 | Vol. 69, No. 3
Written by George Wolters, DO, POMA President, and Tyler Burke, POMA Senior Director of Government Affairs

Opposition to granting independent licensure for advanced practice nurses is grounded in the realities and demands of family practice. Providing comprehensive medical care for all ages and all genders requires extensive training and experience, best delivered by a team directed by a physician. Multiple physician organizations have opposed expanded licensing efforts for decades.

Advocates for independent nurse practice claim there is no difference in outcomes between independent practice and physician-led, team-based care. Other studies contradict this claim by showing poorer outcomes, lower patient satisfaction, and higher costs associated with unsupervised nurse practice. Additionally, concerns over increased diagnostic X-ray use and overprescription of antibiotics and opioids reinforce questions of patient safety. An excellent commentary and overview, published in the Journal of Osteopathic Medicine (2024; 124(12): 555-558), is well worth the read.

In 2019, POMA and other key stakeholders began negotiations regarding the scope of practice for Certified Registered Nurse Practitioners (CRNPs) in Pennsylvania. After months of challenging and complex discussions, the parties reached an agreement on a pilot program. This program would be limited to primary care and Healthcare Practitioner Shortage Areas (HPSAs), a provision POMA believed would ensure CRNPs practiced in areas with true healthcare access needs, addressing the very gaps their advocacy claimed to target.

The agreement also included several commonsense safeguards to protect Pennsylvania patients. Participating CRNPs would be required to have at least 36,000 hours of prior clinical practice before applying to the program. Oversight would be provided by a subcommittee composed of both CRNPs and physicians, responsible for approving participants and advising on program regulations.

At the conclusion of the pilot, the Joint State Government Commission would study the program’s results and report its findings to the legislature for further consideration.

Despite months of negotiations and unanimous passage in the House Professional Licensure Committee, nurse practitioner organizations ultimately walked away from the agreement, and the legislation died.

Following the rejection, physician groups continued to collaborate, ultimately funding public relations efforts to promote the established team concept of medical care. An agreement was also reached to consult with each other in the event of additional nurse licensing proposals.

This past spring, POMA was presented with a reworked plan that significantly expanded the scope of the pilot, broadening specialty areas, making subcommittee oversight optional, and enlarging the pilot practice area by 500%. This was a non-starter with POMA.

Subsequently, it was a non-starter with nursing organizations that again rejected this new proposal.

It is now clear that the nurse practitioners advocating for independent practice in Pennsylvania will not accept any limitations. While these efforts continue, we need to look at our history. Osteopathic physicians who came before us learned to keep their own counsel in POMA during the battle to obtain a medical license, battles to allow DOs to be commissioned, fighting amalgamation, and preserving osteopathic education. DOs, whether primary care or specialty-based based, cannot rely on other groups to support their interests.

Once again, POMA has upheld best practices for patient care and advocated on behalf of all Pennsylvania Physicians. Supported by an incredible staff and our members, POMA will continue to promote osteopathic principles and physician-led, team-based care.