Scope of Practice Overview

Behavioral health providers assist people with a variety of mental health and substance use needs, in settings from prevention programs to community-based and inpatient treatment programs. Behavioral health providers can also work with primary care teams to facilitate healthy behaviors, address behaviors associated with health risk and improve pain management by focusing on non-drug coping strategies.

The University of Michigan's Behavioral Health Workforce Research Center provides a comprehensive report (2017) on scopes of practice for 10 behavioral health providers. In addition to the report, the center developed an interactive 50-state map outlining scope of practice requirements for the behavioral health workforce for all 50 states.

Advanced Practice Registered Nurses (APRNs) are registered nurses with post-graduate education and training in nursing. Nurses practicing at this level may work in either a specialist or generalist capacity.

According to the American Association of Advanced Practice Registered Nurses, nurse practitioners have provided primary, acute and specialty health care to patients of all ages for the past 50 years. As of November 2022, there are more than 355,000 licensed nurse practitioners in the U.S. Nurse practitioners assess patients, order and interpret diagnostic tests, make diagnoses, initiate and manage treatment plans—including prescribing medications. Nurse practitioners blend clinical experience in diagnosing and treating health conditions with an added emphasis on health promotion, disease prevention and health management.

According to the American College of Nurse-Midwives, certified nurse midwives (CNMs), also referred to as nurse midwives or NMs, are providers of primary care and sexual and reproductive health care throughout the lifespan, with a special emphasis on pregnancy, childbirth and gynecological and reproductive health. As of May 2021, there are approximately 7,750 licensed certified nurse midwives practicing in the United States. CNMs provide initial and ongoing comprehensive assessment, diagnosis and treatment-including prescribing medication.

Eye care is one form of primary care. Doctors of optometry, or optometrists, serve patients in more than 10,000 U.S. communities and are the sole eye care providers available in 3,500 of those communities. They are licensed to practice as independent primary eye and vision care providers in all 50 states and territories and can identify over 270 systemic diseases through a comprehensive eye exam. Optometrists undergo training that consists of four years of post-graduate, doctoral-level study concentrating on the eye, vision, and associated systemic diseases. Providing more than two-thirds of all primary eye and vision health care in the U.S., optometrists are an important access point to the health care system for many patients.

While not commonly referred to as surgery, several procedures that optometrists are trained and certified to perform are assigned surgical reimbursement codes. The authority to perform these procedures (such as the removal of foreign bodies), alongside other ophthalmic surgical procedures, expands access to necessary eye care in communities where optometrists may be the only eye care providers available. The authority to use an injectable drugs may be necessary to perform certain ophthalmic procedures, including treatment of the lacrimal drainage system, chalazion or concretions. The authority in many states to prescribe, use and administer prescription drugs, over-the-counter drugs and narcotic substances is similar to other independent, doctoral-level professions, like allopathic or osteopathic medical physicians, dentists and podiatrists.

Dental hygienists are oral health providers working together with a dentist to provide preventive and routine care. Since each state has its own specific regulations regarding the responsibilities of dental hygienists, the range of services performed varies from state to state. As of May 2018, the Bureau of Labor Statistics reports approximately 215,000 dental hygienists working in the U.S.

Dental therapists are primary care oral health professionals able to conduct assessments and provide preventive, restorative and limited surgical care. The precise role varies and depends on the therapist's education and the various state dental regulations and guidelines. There is a growing professional association for dental therapists, the American Academy of Dental Therapy. There are currently few reliable estimates of the number of professionals serving in this capacity.

Dental hygienists and dental therapists practice in private settings, community-based clinics and rural areas. They all practice under varying levels of supervision by dentists, allowing these providers to meet needs in nontraditional, tribal, school-based and community settings.

Pharmacists must have advanced education and hold a doctor of pharmacy degree. They must also be licensed, which requires passing the North American Pharmacist Licensure Exam (NAPLEX) and, in most states, the Multistate Pharmacy Jurisprudence Exam (MPJE). Pharmacists who administer vaccinations and immunizations must also be certified in most states. As of May 2019, there are more than 311,000 licensed pharmacists working in the U.S.

Pharmacists may enter into collaborative practice agreements with other health care providers, such as physicians and nurse practitioners. These collaborations can increase care coordination and access to more services and providers. For example, providers can delegate tasks to pharmacists such as chronic care management and medication refill authorization. Allowing pharmacists to prescribe certain medications is a growing trend among states seeking to increase access to important medications.

According to the American Academy of Physician Assistants, physician assistants diagnose illnesses, develop and manage treatment plans and prescribe medications, among other things. As of May 2023, there were more than 168,300 physician assistants practicing in the U.S., working in all areas of medicine. In rural and underserved areas, physician assistants may be the only primary care providers at clinics where a physician is present only a few days a week. Physician assistants collaborate with physicians and other health care providers in a team environment.