AMA SOPP Escalates Campaign Against Nurses, Chiropractors, Naturopaths, Midwives and Others

Summary:  In June meetings, the House of Delegates of the American Medical Association (AMA) kicked off an escalating round of attacks on the advancement of other healthcare professions. Targeted this year were all disciplines with doctoral-level training, as well as licensed midwives. Chiropractors, naturopathic physicians and nurses - who cited Wilk v AMA - are among those that have been quick to challenge the AMA. The AMA actions are part of that guild's divisive AMA Scope of Practice Partnership (SOPP), announced in January 2006. Meantime, one action at the House of Delegates meeting suggests that the snake on the AMA's caduceus may be biting its own tail. Resolution 235 is an effort to keep the AMA's own specialty societies from legislative actions that seek to restrict each other's scope of practice.

Rooted in an old world view?

The American Medical Association has sought to escalate its war against advances of all other disciplines with action by their House of Delegates at their June 14-18, 2008 meeting. Four separate resolutions continued the AMA's Scope of Practice Partnership (AMA SOPP), formally established in January 2006. The AMA SOPP is a systematic campaign to limit the scope of practice of other professions, except MDs, osteopaths and dentists. In an AMA slide show made available to the Integrator, the AMA describes the

RESOLVED, That our AMA advocate that professionals in a clinical health care setting clearly and accurately identify to patients their qualifications and degree(s) attained and develop model state legislation for implementation. (Directive to Take Action)

 

RESOLVED, That our AMA support state legislation that would make it a felony to misrepresent ones’ self as a physician (MD/DO).

Resolutions #204 and #205 - Against homebirth and keeping an eye on Certified Professional Midwives 

Resolution 204, Midwifery Scope of Practice and Licensure, urges the AMA to ensure that the only midwives its members should support are those that are represented by the American College of Nurse-Midwives.  Even these, however, should be watched closely regarding their scope expansions. Not mentioned in this section in the report from the House of Delegates are the Certified Professional Midwives who

The "Friendly Fire" Resolution
#235: Physician Regulation of Other Physicians

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Whereas, The economics of medicine have put financial pressure on all physicians; and

Whereas, Some medical specialty societies have elected to seek the introduction of state level legislation that regulates or restricts other physicians’ practices; therefore be it

RESOLVED, That our American Medical Association, with the intent of improving patient care and promoting interspecialty collaboration, develop a process for national specialty groups to urge their state affiliates to work through the state medical association prior to the introduction of any state legislation that seeks to regulate or restrict the practice of other physician groups or specialties. (Directive to Take Action)

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

Received:  06/10/08

1.    Response of the American Association of Naturopathic Physicians

The American Association of Naturopathic Physicians (AANP) sent a news update to their members prior to the AMA's action entitled "AANP Response to AMA Resolution 303." (Note that 303 was later passed as 232 and significantly amended.) The AANP letter begins bluntly

underscores that this agenda is "deeply rooted in an old story and worldview that simply does not reflect today's reality" in which "MDs, NDs and nurses already work side by side, collaborating on patient care in venues across the country."

Note: I have not seen AANP commentary since Resolution 303 was changed and amended. However, the profession clearly asserts the right to be considered "physicians" and also have this as a title right in many jurisdictions.

2.     American Chiropractic Association Response

Within the chiropractic profession, concern also exists that supporters of the resolution are acting in their own self-interest at the expense of consumers, and that the new policy statement could jeopardize the inter-referral relationships many allied health providers—including doctors of chiropractic—have developed with their MD-counterparts."

ACA, known for its legislative successes against the organized medical profession, urges its state associations to be vigilant. The organization notes that it will be working with two separate coalitions to see that any AMA-backed legislation related to Resolution 232 does not advance.

3.   Nurses Respond to #303 and #214

In separate letters on June 11, to Craig Anderson, MD, chair of the AMA committee which oversaw the resolutions, the American Nurses Association opposed Resolution #214 and #303. On #303, the ANA made the point, which eventually prevailed (and which the AANP also made), that no profession owns the title "doctor." Hence, they state, the term "medical doctor" was created, to designate what types of doctor. Ditto "medical resident" and "medical residency."

The nurse association then evoked that AMA's most significant loss in its efforts to repress other professions: Wilk v. AMA - in which the chiropractic profession won a 10-year long restraint of trade battle. Said the nurses:

"If the real issue is competition, and this is an effort to make it more difficult for doctorates of nursing to train and practice in the same arena as medical doctors, that would constitute an improper - and possibly illegal - restrain of trade. In Wilk v. AMA, the US Court of Appeals for the 7th Circuit ruled that the AMA cannot "boycott" other healthcare professions, as this would violate the Sherman Antitrust Act. (Wilk v. AMA, 895 F. 2d 352 (7th Cir. 1990)

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

 Resolution 232 as Introducted

[NOTE THAT IT WAS NOT ADOPTED IN THIS FORM]

Introduced by:       Illinois Delegation

Subject:                 Protection of the Titles "Doctor," "Resident" and "Residency"

Referred to:           Reference Committee B (Craig W. Anderson, MD, Chair)

Whereas, Certain specialty societies recognize that many allied health care professions have improved their educational standards and incorporated doctorate designations in their training programs; and

Whereas, Many nursing schools have re-titled their training program as a Residency and their students as Residents, despite the traditional attribution of these titles to medical doctors and their training programs; and

Whereas, The growing trend of this title encroachment is of concern because patients will be confused when the titles of Doctor, Resident and Residency are applied to non-physicians who hold non-medical doctorates or to non-physicians in training; therefore be it

RESOLVED, That our American Medical Association adopt that the title “Doctor,” in a medical setting, apply only to physicians licensed to practice medicine in all its branches, dentists and podiatrists (New HOD Policy); and be it further [NOTE: iN DISCUSSION

RESOLVED, That our AMA adopt policy that the title “Resident” apply only to individuals enrolled in physician, dentist or podiatrist training programs (New HOD Policy); and be it further

RESOLVED, That our AMA adopt policy that the title “Residency” apply only to physician, dentist or podiatrist training programs (New HOD Policy); and be it further

RESOLVED, That our AMA serve to protect, through legislation, the titles “Doctor,” “Resident” and “Residency.” (Directive to Take Action)

Fiscal Note:  Staff cost estimated at less than $500 to implement.

Received: 04/30/08

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