Protecting the Patient-Physician Relationship

Issue: Promote policies that protect and preserve patient-physician relationships, including access to reproductive health care, LGBTQ+ and gender-affirming care, and ensure non-physician health care professionals perform within their scope of practice.

Why Action is Needed

The U.S. Supreme Court’s decision to overturn Roe v. Wade’s guaranteed federal right to abortion in Dobbs v. Jackson Women’s Health Organization set back reproductive health care by restricting access to abortion services and potentially jeopardizing access to other related medical services and privacy protections, such as contraception or fertility treatments in some states. As a result of the decision, which the American College of Physicians (ACP) strongly opposed, abortion access has been severely curtailed or banned in at least 24 states. Its implications have also included criminalizing the provision of a range of health care services, severely harming the patient-physician relationship.

Further intruding upon the patient-physician relationship are restrictions to gender-affirming care. Since 2021, 13 states have restricted gender-affirming services for minors and/or adults, and at least 30 states introduced legislation in 2023 that would restrict access to this care. There has been a proliferation of anti-LGBTQ+ legislation at the state level, with more than 450 anti-LGBTQ+ bills introduced last year.

Additionally, federal and state policymakers are also increasingly introducing legislation to expand the scope of practice for non-physician health care professionals. For example, 27 states and the District of Columbia have adopted a “full practice model,” which, despite significant differences in training, allows all nurse practitioners to provide a broad range of medical services without appropriate physician supervision, which includes evaluating and diagnosing patients; as well as ordering, and interpreting diagnostic tests; and initiating and managing treatments, including prescribing medications and controlled substances.

ACP’s Position

ACP believes policymakers should respect the principle of patient autonomy and ensure access for all patients to the full range of reproductive health care services, including abortion. ACP also believes that reproductive health care decisions are foundational to the patient-physician relationship. We strongly oppose medically unnecessary government restrictions on any health care service. In the recent paper “Reproductive Health Policy in the United States: An ACP Policy Brief (2023),” ACP makes recommendations to protect patient access to care through the freedom to travel to seek medical care, the ability to receive prescription medication in the mail or via other shipping and delivery services, and to oppose efforts to criminalize the practice of medicine and restrict access to care.

ACP opposes restrictions on health care for transgender individuals, who already may face extreme barriers to accessing care, and strongly objects to any unnecessary government interference with any health care services. ACP has decried discriminatory policies against LGBTQ+ people and objected to interference with the patient-physician relationship and penalization of evidence-based care. ACP policy also calls for coverage of comprehensive transgender health care in private and public insurance plans. ACP has joined amicus briefs in legal challenges to laws discriminating against transgender people.

ACP also supports a physician-led, team-based approach to health care as published in its December 2023 paper in the Annals of Internal Medicine “Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care.” It affirms that health care teams should be led by physicians, underscores the need for payment models to promote team-based care, and recommends interprofessional training to foster collaboration and cooperation among health care professionals. ACP supports efforts to protect the patient-physician relationship by ensuring that health care teams are led by physicians.