Resident Physicians’ Attitudes Towards State Advanced Practice Provider Independence Laws

Introduction

In response to physician shortages, many US states have enacted legislation expanding the scope-of-practice for advanced practice providers (APPs), including nurse practitioners (NP) and physician assistants (PA). While these policies aim to increase healthcare access, little is known about how they are perceived by resident physicians nearing independent practice. This study assessed resident perspectives on APP-delivered care, legislative impacts on clinical practice, and professional consequences.

Method

A 20-item anonymous survey was distributed to resident physicians in internal medicine, family medicine, pediatrics, obstetrics and gynecology, emergency medicine, and psychiatry across the USA between March and April 2025. The survey assessed demographics, familiarity with APP legislation, perceptions of APP-delivered care, and attitudes towards legislative and workforce implications. Quantitative analysis included descriptive statistics and chi-square testing.

Results

A total of 522 residents from 39 states and the District of Columbia completed the survey. While 62% believed that APP independence laws would improve access to care, 89% and 86% rated NP- and PA-delivered care, respectively, as lower quality than physician care. A majority opposed independent practice for APPs (92%), citing concerns over care quality (90%), weakened collaboration (85%), and job security (66%). Forty percent indicated they would be less likely to practice in a state permitting APP independence. Residents pursuing fellowship training were significantly more likely to report that state legislation would influence their practice location (p = 0.031).

Conclusions

Resident physicians express broad concern regarding the clinical and professional implications of APP independence legislation. These concerns, especially regarding care quality, workforce dynamics, and geographic practice decisions, suggest that current trainees may be disincentivized from working in states with expanded APP autonomy. Policymakers should consider these perspectives when designing scope-of-practice reforms to avoid unintended impacts on physician distribution and interprofessional collaboration.