Coalition: AMA's attempt to limit non-MDs' scope of practice is wrong

AAOHN president says bid to oversee APNs and others is "curious"

Steps by the American Medical Association (AMA) to monitor the scope of practice of other health care providers, including advance practice nurses (APNs), and to lobby for legislation limiting the practice of non-physicians, is both curious and potentially divisive, according to the head of the American Association of Occupational Health Nurses (AAOHN).

Organizations representing more than 3 million health care professionals in the United States are calling on the AMA to end what the organizations views as divisive actions aimed at limiting the scope of practice of APNs, nurse practitioners, optometrists, and other non-physician health care providers.

According to Susan Randolph, MSN, RN, COHN-S, FAAOHN, president of the Atlanta-based AAOHN, which supports the Coalition for Patients' Rights declaration, the AMA appears to be doing some overstepping of bounds itself.

"It seems curious to me how the AMA would provide some sort of oversight of advance practice nurses and others," observes Randolph. "How would [the AMA] know what the licensure laws are for other [licensed providers]?"

AMA's monitoring of other licenses decried

APNs, as well as other health care professions targeted by the AMA in its Resolution 814, are licensed by their states and certified nationally, Randolph points out, and are under no jurisdiction of the AMA.

"At least for nursing, we already have oversight through our Boards of Nursing; that's who regulates us," she explains. "They know the nurse practice act and any rules that govern our practice that others outside our practice don't know."

The AMA has, for the last year, conducted research and lobbying in support of its Resolution 814 and the Scope of Practice Partnership (SOPP) it created and funds in conjunction with other physician organizations. Resolution 814 and SOPP are aimed at limiting the scope of practice of health care providers the AMA calls "allied health practitioners," "limited licensure health care providers," and "non-physicians," and seek to undertake monitoring of the education, academic requirements, licensure, and certification of a host of health care professionals.

Two dozen organizations representing nurses, chiropractors, optometrists, nurse anesthetists, podiatrists, psychologists, and others have formed the Coalition for Patients' Rights in an effort to persuade SOPP member organizations to "cease their divisive efforts and, instead, work with us to advance the health and well-being of patients."

The AMA did not respond to Occupational Health Management's request for comment. However, according to the AMA Board of Trustees "Report 814 A-06" presented at the AMA's 2006 annual meeting, the SOPP work plan for 2006 encompasses "possible SOPP projects" that include "education/training/ certification/licensure/ethical standards/disciplinary processes/peer review/etc. comparisons between the medical profession and specific allied health professions" and "discrediting access to care arguments made by various allied health professionals, particularly in rural areas of a state."

"This has the potential to be of concern for us because occupational health care is provided by a team," says Randolph. "Here in North Carolina [where Randolph works in the University of North Carolina-Chapel Hill School of Public Health], nurse practitioners are licensed as nurses through the state board of nursing, and then to function as nurse practitioners there is a joint practice agreement between the Board of Nursing and the Board of Medical Examiners."

The AMA's steps regarding limits on and monitoring of scope of practice could chill relations among health care practitioners, critics say.

Randolph says "the important issue for all of us is provision of safe care by all health care practitioners."

As far as the AMA's concerns with other providers exceeding their scopes of practice, Randolph suggests that evolving scope of practice is inherent in all fields of health care, as knowledge and technology advance.

In a declaration issued earlier this year, the Coalition for Patients' Rights demanded the AMA cease its Resolution 814 efforts.

"It is inappropriate for physician organizations to advise consumers, legislators, regulators, policy makers or payers regarding the scope of practice of licensed healthcare professionals whose practice is authorized in statutes other than medical practice acts," the Coalition organizations jointly announced. "The erroneous assumption that physician organizations should determine what is best for other licensed healthcare professionals is an outdated line of thinking that does not serve today's patients." The AMA has said the SOPP plans to provide its research into scopes of practice to legislators "as a point of comparison."

The Coalition also takes the AMA to task for using terms such as "allied health practitioner," "limited licensure health care provider," or "non-physician," which the Coalition says "reflect an anachronistic view of healthcare professionals who are not physicians."

"Our members are not physician adjuncts, and are independently responsible for their actions, regardless of whether physicians are involved," the Coalition stated.