Last week, on July 20, 2021, the American Medical Association (AMA) was joined by over 100 other medical organizations, including the American College of Radiology, in writing to the Department of Veterans Affairs (VA) to express the organizations' serious concerns with the VA's "Supremacy Project." The Supremacy Project would develop national standards of practice for physicians and other health professionals that supersede state scope of practice and licensure laws. Last November, the VA issued interim final rulemaking to confirm the VA's authority to establish national standards of practice for health care professionals that will standardize a health care professional's practice in all VA medical facilities.

Historically, the VA has operated as a national health care system that authorizes VA health care professionals to practice in any state as long as they have a valid license, registration, or certification, or fulfill other state requirements in at least one state. In doing so, VA health care professionals practice within the scope of their VA employment regardless of any state licensure requirements. 

The AMA and other signers of the coalition letter believe the VA did not provide a transparent process that gave public stakeholders an adequate opportunity to review and provide meaningful input into the VA's new national standards of practice. They urge the VA to reconsider its implementation of national standards of practice. They note the 40 specialties and 87 subspecialties for physicians whose training and practice are overseen by the Accreditation Council for Graduate Medical Education, residency programs, state licensing boards, and countless other entities that have developed and implemented education requisites, practice standards, and licensing requirements. The coalition believes the VA is not taking into account the many different requirements for each specialty and subspecialty as the VA national standards are set.

In addition to their policy arguments against the VA's development of national practice standards, the coalition letter signatories question the legality of the initiative. They argue the interim final rule issued last November violated the Administrative Procedure Act (APA) since the rule was published without prior notice and opportunity for public comment. Additionally, they argue, the requirements to preempt state law, set forth in Executive Order 13132, have not been met. The VA has acted arbitrarily and capriciously, they claim, by failing to adequately consider the rights of the states and the long-term safety of the nations' veterans.

The interim final rule was effective on November 12, 2020 and comments were required on or before January 11, 2021. Nevertheless, for the reasons outlined above, organized medicine is campaigning for the VA to either end its national practice standards project or dramatically alter its process to be more inclusive of stakeholder input.