Updated Position Statement on Non-Physician Practitioners

The American Academy of Emergency Medicine (AAEM) believes that emergency department (ED) patients should have timely and unencumbered access to the most appropriate care led by a board certified emergency physician (ABEM or AOBEM). AAEM and AAEM/RSA oppose the expansion of scope of practice regulations at the state and federal level, and do not support the unsupervised or “independent practice” of non-physician practitioners (NPPs).

Properly trained NPPs may provide emergency medical care as members of an emergency department team and must be supervised by a physician who is board certified in emergency medicine.

As a member of the emergency department team, an NPP must not replace an emergency physician, but rather must engage in patient care in a supervised role to improve patient care efficiency without compromising safety.

The role of NPPs within the department must be defined by their clinical supervising physicians who must know the training of each NPP and be involved in the hiring and continued employment evaluations of each NPP as part of the emergency department team with the intent to ensure that NPPs are not put into patient care situations beyond their clinical training and experience.

Collaborating physicians must be permitted adequate time to be directly involved in supervision of care. They must not be required to supervise more NPPs than is appropriate to provide safe patient care. Furthermore, supervision must not be in name only. Physicians are expected, and must be permitted, to be involved in meaningful and ongoing assessment of the NPPs’ work.

Billing must reflect the involvement of the physician in the emergency visit. If the physician's name is used for billing purposes, the physician's involvement must add value to the patient visit.

A physician must not be required to cosign the chart, nor should his/her name be invoked with regard to any patient unless he/she has been actively involved in that patient’s care.

NPPs must not supervise emergency medicine residents, nor can they, nor their education be allowed to interfere with the education of, or clinical opportunities for, emergency medicine residents.

Every practitioner in an ED has a moral duty to clearly inform the patient of his/her training and qualifications to provide emergency care. In the interest of transparency, NPPs must not be called “doctor” in the clinical setting.

*This designation includes, but is not limited to the following practitioners:

  •     Acute Care Nurse Practitioner (ACNP)
  •     Adult Nurse Practitioner (ANP)
  •     Advanced Nurse Practitioner (APN)
  •     Advanced Physician Assistant (APA)
  •     Advanced Physician Assistant Certified (APA-C)
  •     Advanced Practice Registered Nurse (APRN)
  •     Advanced Registered Nurse Practitioner (ARNP)
  •     Certified Nurse Practitioner (CNP)
  •     Certified Registered Nurse Practitioner (CRNP)
  •     Clinical Nurse Specialist (CNS)
  •     Doctor of Medical Science (DMSc)
  •     Doctor of Nursing Practice (DNP)
  •     Doctor of Nursing Science (DNS, DNSc)
  •     Doctor of Pharmacy (PharmD)
  •     Doctor of Science (DSC)
  •     Doctor of Science in Nursing (DSN)
  •     Emergency Nurse Practitioner (ENP)
  •     Family Nurse Practitioner (FNP)
  •     Nurse Practitioner (NP)
  •     Nurse Practitioner Certified (NPC)
  •     Pediatric Clinical Nurse Specialist OR Psychiatric Clinical Nurse Specialist (PCNS)
  •     Pediatric Nurse Practitioner – Acute Care (PNP-AC)
  •     Pediatric Nurse Practitioner (PNP)
  •     Physician Assistant (PA)
  •     Physician Assistant Certified (PA-C)
  •     Registered Physician Assistant (RPA)
  •     Registered Physician Assistant Certified (RPA-C)
  •     Women’s Health Nurse Practitioner (WHNP)


Approved 1/29/2019

Modified 9/1/2020