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AMA Targets Nursing Doctorate and ND Licensing: Old Boys v. the Emerging Medical Matriarchy? PDF Print E-mail
Written by John Weeks   

AMA Targets Nursing Doctorate and ND License: Old Boys vs the Emerging Medical Matriarchy?

Summary: Through Resolutions #209 and #211, the AMA Scope of Practice Partnership has focused its sights on nursing doctoral programs and licensing of naturopathic physicians. Both pose different kinds of threats to conventional practice - the first via raw numbers and the second as a paradigm of integrative medical practice. Interestingly, both of the targeted professions are female dominated ...
ImageTwo targets of the Scope of Practice Partnership (SOPP) of the American Medical Association (AMA) (background article) got special attention at the AMA's recent House of Delegates meeting: naturopathic physicians and nursing's doctoral programs. Each was the subject of a focused resolution.

  • Resolution 209, "Licensure of Naturopaths," charges the AMA to "outline a policy
    Anesthesiologist John Zerwas, MD - chairing the AMA commitee
    opposing the licensure of naturopaths to practice medicine." The resolution was introduced by the Florida Medical Association, which is actively opposing a licensing statute in Florida. (See full text below.)

  • Resolution 211, "Need to Expose and Counter Nurse Doctoral Programs (NDP) Misrepresentation" focuses on ensuring there is no misrepresentation by schools or by practitioners that the education or practice is physician-level or equivalent to a physician. The resolution was introduced by the American Society of Anesthesiologists. (See full text below.)

Both of the resolutions came through the AMA's Reference Committee B, headed by anesthesiologist and officer of the American Society of Anesthesiologists, John Zerwas, MD. According to an American Medical News article ("AMA to work with scope partnership to oppose naturopath's med licensure"), both issues will be worked through the AMA's Scope of Practice Partnership.

Colleges of Nursing and Naturopathic Profession Respond

Image The American Association of Colleges of Nursing (AACN) has published "Talking Points" in opposition to Resolution. They dispute an AMA claim that an AACN school was falsely advertising its program, arguing that none of its schools claims to be preparing physicians. Instead, they note that they are following other professions (podiatry, psychology, physical therapy, pharmacy, audiology, etc.) in "transitioning to" doctoral level degree programs.  They note that this Resolution follows organized medicine's attempts to keep nurse doctoral programs getting off the ground in the first place.

The only public statement to date from the
American Association of Naturopathic Physicians in response to the AMA's SOPP was published in the most recent Integrator article. The organization's basic arguments are that no one discipline owns medicine and that the lack of licensing, by allowing mail order-degreed "naturopaths" to practice, poses a greater risk to the public than does licensing.

ImageComment: At one level, what is going on here is a war of the sexes - the Old Boys versus an emerging medical matriarchy. Both the nursing and naturopathic medical professions are led by, and dominated by, women. The AANP board is 70% women, roughly paralleling the percentage of female students in the profession's post-1975 modern era. The current president and executive director of the AANP are both women. At a recent forum on licensing campaigns, 8 of the 9 state leaders who presented, as well as the chair of the AANP's state alliance, were all women. There is no other physician level practice in the United States which comes close to this level of female leadership.

Though the percentage of female conventional medical school students has grown substantially in recent years, the AMA is still male dominated. And the portrait of the trustees of the American Society of Anesthesiology, when Zerwas took office in 2003, is nearly pure Boys Club, with 11 men and a token woman.

Maybe the Risk Is Because Women  Aren't Really Made for Math and Sciences?

My tendency to go archetypal in my analysis is fostered by the fact that we see little real evidence from the AMA of actual harm caused by either NDs practicing medicine, or of nurses practicing as Doctors of Nursing Practice. So I can only assume that part of the AMA-ASA motivation is that women, as a rule, tend to be less caring, less person-focused, and therefore more likely to put patients at risk. What?

Or maybe the techie anesthesiologists, who work with machines and data more than the people they put to sleep, should go ahead and make their core case: Of course, women aren't made to be good at math and sciences, you know.

Emerging Medical Matriarchy: An Army of DNPs, and Articulate New Paradigm Physicians

ImageA more typical, turfy analysis will note the growth in both professions which the AMA is seeking to hold in check. There are some 800,000 medical doctors and 3-million nurses. The shift toward the DNP is dramatic. Currently there are 19 nursing practice doctoral programs in 17 states that are enrolling students. Another 190 Doctor of Nursing Practice programs are in development nationwide. The prospect of such an army of DNPs must be horrifying to the AMA.

The AMA campaign against the NDs being licensed to practice medicine - the AMA appears to be willing to have "naturopaths" license themselves as low level health workers - is also time-focused. While small - just some 4000 licensed NDs and 14 states with licensing - the NDs won their first biggie recently, California. Campaigns for licenses are underway in Florida, New York, Illinois and Massachusetts. The Vietnam vets in the AMA war room must be worrying the Cold War's domino theory.

What may particularly place the NDs in sights of the AMA scope campaign is that the NDs represent the highest, physician-level, broad scope, federally-recognized standard of integrative medicine practice. So the politics are both of gender and ideology. And guess what else? The ND paradigm, while science-based, is, well, female, and all about removing obstacles to cure and supporting a person's ability to heal.

Are DNPs and NDs Actually WMDs?

The AMA must feel that it is being martyred for its truth in these battles. Media coverage tends to be sympathetic to naturopathic doctors and the skill-sets and approaches they represent. (See Poughkeepsie Journal, the Albany, New York's Legislative Gazette, and the Buffalo News.) Notably, the AMA is directly on record in opposition to NDs in Illinois via a letter to the editor of the Chicago Sun-Times protesting an article they felt to be too favorable.

Resolutions 209 and 211 are, effectively, declarations of war. It will be interesting, and quite likely dismaying, to see what the AMA rolls out after its internal, strategic committees complete the planning phase. My guess is that they've got researchers right now trying to cook up evidence that these DNPs and NDs are actually WMDs - weapons of mass destruction.

Thanks: A note of thanks to Michael Traub, ND, DHANP for sharing some information on Resolution 211 via copy he was preparing for an article on the AMA SOPP scheduled for publication in October in Holistic Primary Care.


Resolution #209

Opposing Licensure of Naturopaths to Practice Medicine

Introduced by:        Florida Delegation

Subject:                 Licensure of Naturopaths

Whereas, The American Medical Association has always stood for patient safety and the science of medicine; and

Whereas, The well-being of patients and the ability for them to be taken care of in the best manner is a goal of the AMA; and

Whereas, There is a misconception about the extent of the education and training of naturopaths; and 

Whereas, The AMA has no set policy concerning the licensing of naturopaths to practice medicine without the proper educational background; and

Whereas, Many states are now facing an onslaught of non-MDs/DOs wanting to practice medicine; therefore be it

RESOLVED, that our American medical Association work through the Board of trustees to outline a policy opposing the licensure of naturopaths to practice medicine and report this policy to the House of Delegates no later than the 210065 Interim Meeting. (Directive to Take Action)

Fiscal Note: Implement accordingly at estimated staff cost of $10,836.


Resolution #211

Need to Expose and Counter NDP Misrepresentation


Introduced by: American Society of Anesthesiologists 

      Subject: Need to Expose and Counter Nurse Doctoral Programs (NDP) Misrepresentation 


      Whereas, The patient-physician relationship is the foundation of effective medical care; and 

Whereas, Patient trust is a cornerstone of good medical care delivery; and 

Whereas, Quality medical care requires appropriate education, skills, training and experience, as recognized and upheld in state laws; and 

Whereas, State-based regulation of medicine should be aggressively protected to ensure patient safety and optimal clinical outcomes; and 

Whereas, Confusion, injury and a breakdown of quality medical care would result from persons not trained as medical doctors and doctors of osteopathy misrepresenting themselves as “doctors” in clinical settings; and 

Whereas, The American Association of Colleges of Nursing plans to convert its advance nurse practice degree from master's programs to “Doctor of Nursing Practice” (DNP) by the year 2015; and 

Whereas, Four such “doctoral” nurse anesthesia programs currently are offered in the United States and more are planned; and 

Whereas, The Nurse Anesthesia Accreditation Council has mandated doctoral training for all nurse anesthetists by the year 2015; and 

Whereas, At least one of the DNP programs is advertising its programs as “similar in concept to practice doctorates in other professions such as medicine (MD), law (JD), and dentistry (DDM)”; and 

Whereas, The quality of care rendered by individuals with a nurse doctoral degree is not equivalent to that of a physician (MD or DO); and 

Whereas, Nurses and other non-physician providers who hold doctoral degrees and identify themselves to patients as "doctors" will create confusion, jeopardize patient safety and erode the trust inherent in the true patient-physician relationship; and 

Whereas, Patients led to believe that they are receiving care from a “doctor,” who is not a physician (MD or DO), but who is a DNP may put their health at risk; therefore be it

RESOLVED, That it shall be the policy of our American Medical Association that institutions offering advanced education in the healing arts and professions shall fully and accurately inform applicants and students of the educational programs and degrees offered by an institution and the limitations, if any, on the scope of practice under applicable state law for which the program prepares the student (New HOD Policy); and be it further 

RESOLVED, That our AMA work jointly with state attorneys general to identify and prosecute those individuals who misrepresent themselves as physicians to their patients and mislead program applicants as to their future scope of practice (Directive to Take Action); and be it further 

RESOLVED, That our AMA pursue all other appropriate legislative, regulatory and legal actions through the Scope of Practice Partnership, as well as actions within hospital staff organizations, to counter misrepresentation by nurse doctoral programs and their students and graduates, particularly in clinical settings. (Directive to Take Action) 
Fiscal Note: Implement accordingly at estimated staff cost of $10,836.

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