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  • Veterans Health Administration Federal Supremacy Project: 5 Takeaways

    Physician examining man's eye with light.

    The U.S. Department of Veterans Affairs (VA) is considering defining national standards of practice for all health professionals employed by the Veterans Health Administration (VHA) that may push the boundaries of what optometrists and other nonphysician providers can do. 

    Why this matters to our profession is clear: If approved, the standards proposed under the VA’s Supremacy Project could supersede the guidelines and laws established in the respective states. That means people outside of our profession (optometrists, nurses and other nonphysicians) could perform procedures and services beyond their scope of practice.


    The VHA is the largest integrated health care system in the United States, employing over 14,000 physicians and providing care to over 9 million veterans. 

    In November 2020, the VA issued an interim final rule that asserted the VA’s authority to implement standards of health care professional practice across all VA medical facilities as it seeks to replace its new electronic health records (EHR) with one that uses these standards.

    Why the Standards Matter

    These new standards could allow different practitioners (optometrists, nurses, other nonphysicians) to perform procedures and services that may be outside of their state scope or licensure regulations. Because states often look to the VA standard of practice when scope issues arise, these standards could impact individual state scope-of-practice laws. 

    Academy Concerns Raised in Letter

    In August, a group of over 100 physician groups including the Academy and many other national and state medical societies penned a letter to U.S. Secretary of Veterans Affairs Denis McDonough detailing physician concerns with the project. 

    Although the VA has acknowledged our organizations’ concerns, the department continues to move forward with its established process for developing its national standards of practice. The Academy and physician community will continue to engage with the VA on this critical issue to ensure that veterans are not put at risk for receiving a lower standard of care.

    To date there has been no transparency into how these standards will be defined, vetted, or implemented in the various care settings. Letter writers also urged that “creating one standard for all physicians is impractical and not consistent with the practice of medicine.”

    Status of the Supremacy Project

    The VA is moving forward quickly with the project. National standards have already been developed for many occupations, including ophthalmic technicians. Standards for optometrists, certified registered nurse anesthetists (CRNAs) and physicians are set to be developed by February 2022.

    Get Involved

    Contact your U.S. representatives and senators to inform them about the VA’s Federal Supremacy Project and express your concern for veterans’ safety if the new standards don’t properly account for differences in education and training among physicians as compared to non-physician providers. 

    Get involved with your state ophthalmology society, the American Medical Association and the Academy to advocate for our patients. Our best chance is to have a voice in developing the standards to make sure that they reflect meaningful differences in education and training. 

    This is vitally important to ensure that our nation’s veterans, and all our patients, get the safe, high-quality care they deserve.

    For questions and assistance in contacting your legislators, contact Dash Delan in the Academy’s Washington, D.C., office or email him at

    About the author: Yvonne N. Okaka, MD, is a current PGY3 in ophthalmology at SUNY Downstate Medical Center. She completed medical school at the Icahn School of Medicine at Mount Sinai. She serves on the Committee of Interns and Residents at Kings County Hospital Center and is passionate about access to care and physician wellness.