Nonphysician Unsupervised Practice of Medicine: Examining the Evidence

Medical school graduates must complete extensive supervised residency training before practicing independently. In contrast, many states allow nurse practitioners (NPs) and physician assistants (PAs) to engage in the unsupervised practice of medicine (UPM) with significantly less clinical experience. Despite decades of such legislation, data on safety, quality, and outcomes remain limited. This article reviews current evidence evaluating nonphysician UPM, finding that most studies used to support UPM legislation involve physician oversight, low-risk patients, or measure minor outcomes. Recent data suggest higher costs, increased resource use, and potential safety concerns when NPs and PAs practice independently. Malpractice trends further underscore the need for caution. Robust, high-quality research is urgently needed to assess the safety and effectiveness of nonphysician UPM.