AMA and scope of practice

[bancho]

Except from: Cooperation is critical: AMA and ASA working together

August 20, 2005

American Society of Anesthesiologists

Board of Directors Meeting

Rosemont, IL

J. Edward Hill, MD

President

American Medical Association

Scope of Practice

The work we have done together in Washington gives evidence to the AMA's rallying cry "Together we are stronger."

Yet we are also working together on issues of mutual concern outside the Beltway.

One of these shared concerns is ensuring appropriate scope of practice for health professionals.

I have noted with interest your recent efforts to foster improved relations and dialogue with nurse anesthetists.

I appreciate your desire to keep the line of communication open, but to draw the line when it comes to patient health and safety.

Like you, the AMA respects the health care professionals who work with us in our offices and in hospitals, and who can function as physician "extenders" in areas where physicians are in great demand and short supply.

In my rural family practice, for example, I have worked with midwives with great success.

However, the operative word in the previous sentence is "with," meaning, "in cooperation with," or "as part of a physician-led team."

However, not all allied health professionals see it this way.

And so, like you, the AMA has grown increasingly concerned about various and troubling encroachments on physician practice.

In response to these concerns, we have been working with state and national medical specialties to create what has been named the Scope of Practice Partnership.

ASA has played a leading role in its formation and provided us with vital input, thanks to the work of Ron Bruns and Ron Szabat.

This is what the partnership will do:

It will provide financial or in kind support to federation members facing significant scope of practice battles.

It will also fund studies:

To determine whether allied health professionals truly fill health care voids in rural and other underserved areas.

To closely examine the education and training of allied health professionals - and provide this information as a point of comparison for legislators.

The partnership also will serve as an information and advocacy clearing house for the Federation on scope of practice issues.

Our AMA will house and staff the partnership, as well as provide a basic level of support.

Additional support will come from state and specialty societies.

Each initiative - be it a state-specific concern or a research study - will be considered by the partnership on a case-by-case basis.

An executive committee will:

Review the issues

Assist in prioritizing scope-of-practice concerns

Ensure adherence to anti-trust laws AND

Focus on maintaining the highest level of cooperation, coordination and consensus between federation members

I know we will continue to work closely with one another on scope of practice - as well as on two other issues of critical importance to medicine: Medical liability reform and Medicare payment.

[sirI, MSN, APRN, NP]

Except from: Cooperation is critical: AMA and ASA working together

August 20, 2005

American Society of Anesthesiologists

Board of Directors Meeting

Rosemont, IL

J. Edward Hill, MD

President

American Medical Association

Scope of Practice

The work we have done together in Washington gives evidence to the AMA's rallying cry "Together we are stronger."

Yet we are also working together on issues of mutual concern outside the Beltway.

One of these shared concerns is ensuring appropriate scope of practice for health professionals.

I have noted with interest your recent efforts to foster improved relations and dialogue with nurse anesthetists.

I appreciate your desire to keep the line of communication open, but to draw the line when it comes to patient health and safety.

Like you, the AMA respects the health care professionals who work with us in our offices and in hospitals, and who can function as physician "extenders" in areas where physicians are in great demand and short supply.

In my rural family practice, for example, I have worked with midwives with great success.

However, the operative word in the previous sentence is "with," meaning, "in cooperation with," or "as part of a physician-led team."

However, not all allied health professionals see it this way.

And so, like you, the AMA has grown increasingly concerned about various and troubling encroachments on physician practice.

In response to these concerns, we have been working with state and national medical specialties to create what has been named the Scope of Practice Partnership.

ASA has played a leading role in its formation and provided us with vital input, thanks to the work of Ron Bruns and Ron Szabat.

This is what the partnership will do:

It will provide financial or in kind support to federation members facing significant scope of practice battles.

It will also fund studies:

To determine whether allied health professionals truly fill health care voids in rural and other underserved areas.

To closely examine the education and training of allied health professionals - and provide this information as a point of comparison for legislators.

The partnership also will serve as an information and advocacy clearing house for the Federation on scope of practice issues.

Our AMA will house and staff the partnership, as well as provide a basic level of support.

Additional support will come from state and specialty societies.

Each initiative - be it a state-specific concern or a research study - will be considered by the partnership on a case-by-case basis.

An executive committee will:

Review the issues

Assist in prioritizing scope-of-practice concerns

Ensure adherence to anti-trust laws AND

Focus on maintaining the highest level of cooperation, coordination and consensus between federation members

I know we will continue to work closely with one another on scope of practice - as well as on two other issues of critical importance to medicine: Medical liability reform and Medicare payment.

Hello, bancho.

Is this for the CRNA forum? Or did you want all advanced practice nurses to see this? Just wondering. What are your views?

[bancho]

Hello, bancho.

Is this for the CRNA forum? Or did you want all advanced practice nurses to see this? Just wondering. What are your views?

The AMA position pertaints to all none-physician healthcare providers as indicated by the statament "the AMA respects the health care professionals who work with us in our offices and in hospitals, and who can function as physician "extenders"". Obviously, this a movement to place limits on advanced nursing practice which includes all APN's such as CRNA's and NP's. The Federation he refers to is the Federation of State Medical Boards. They came out with a similar position statement earlier this year. According to their position, APN's are acceptable if they just "remember their place" as part of a "physician directed team". In other words, APN autonomy is out of their equation.

[sirI, MSN, APRN, NP]

The AMA position pertaints to all none-physician healthcare providers as indicated by the statament "the AMA respects the health care professionals who work with us in our offices and in hospitals, and who can function as physician "extenders"". Obviously, this a movement to place limits on advanced nursing practice which includes all APN's such as CRNA's and NP's. The Federation he refers to is the Federation of State Medical Boards. They came out with a similar position statement earlier this year. According to their position, APN's are acceptable if they just "remember their place" as part of a "physician directed team". In other words, APN autonomy is out of their equation.

Hello again, bancho,:balloons:

Yes, this debate has been around the block and back again for years. I believe if we as APNs stay focused and lobby in the political arena with our respective nursing organizations, we can stay any blanket attempt by some physicians to thwart our ever reaching advances.

Sad that there is so much conflict amongst APNs and MDs. So much good can be done if the latter would just accept the former.

[lalaxton]

What's even sadder is the perception that the shortage of health care providers in rural and underserviced areas is a myth! Do we need yet another study to show that NP's, PA's, CRNA's and CNM are valuable and needed?????

[sirI, MSN, APRN, NP]

What's even sadder is the perception that the shortage of health care providers in rural and underserviced areas is a myth! Do we need yet another study to show that NP's, PA's, CRNA's and CNM are valuable and needed?????

No, we do not.:)

[cgfnp]

It's just a juvenile turf war. You don't see people in AZ, IA, AK, or any other state where 'mid-levels' can practice independently dying all over the place.

What we should do is form a group that merges all mid levels together to strengthen lobby power. APN, PA, CNM, CRNA, AA, and everyone else that the AMA is against practicing without asking permission from the high and mighty doctor.

[Papadoc]

:chuckle This is a great idea. But the problem I see with that is that at least PAs and AA are not governed by the BONs. They are under medical boards, and may have a problem going directly against those who essentially had created them, and must directly supervise them. But the idea of uniting ALL advanced practice nurses NPs, CRNAs, CNMs, WOHNs (sorry if I left anybody out) is really great. This way anytime AMA comes up their turf miniwars they will be going against ALL advanced practice nurses. Something tells me they may not want to face such a power :angryfire :chuckle

It's just a juvenile turf war. You don't see people in AZ, IA, AK, or any other state where 'mid-levels' can practice independently dying all over the place.

What we should do is form a group that merges all mid levels together to strengthen lobby power. APN, PA, CNM, CRNA, AA, and everyone else that the AMA is against practicing without asking permission from the high and mighty doctor.

[cgfnp]

:chuckle This is a great idea. But the problem I see with that is that at least PAs and AA are not governed by the BONs. They are under medical boards, and may have a problem going directly against those who essentially had created them, and must directly supervise them. But the idea of uniting ALL advanced practice nurses NPs, CRNAs, CNMs, WOHNs (sorry if I left anybody out) is really great. This way anytime AMA comes up their turf miniwars they will be going against ALL advanced practice nurses. Something tells me they may not want to face such a power :angryfire :chuckle

It's true PAs and AAs aren't under any part of nursing, but it really shouldn't matter. It would be similar to having something about your job you don't like and not wanting to tell your boss because they created the position and hired you. And, many states APNs are governing by the board of medicine and/or pharmacy as well.

None of this really matters though, as it will never happen. Everyone wants to form their own little group and by doing so are turning a potential yell into nothing more than a whisper.

[jer_sd]

As much as i have some problems with the clinical doctorate in nursing practice idea for advanced practice nurses..... One aspect I do like is having a more standard education basis for us. Ensuring that all advanced practice nurses have some foundation courses such as pathophysiology, pharmacology, patient assesment that cover a broad patient population and then have further more specialized training. This may help even out the playing field on physicans complaints against our abilities. I have gone through two NP programs and a RNFA (personaly I consider this also advanced practice) and I recieved excellent education but there are areas I have had to gain post graduate to acount for some defiencies in my programs. (someone please help talk me out of going for a third NP program just for fun)

Another side note I know that we are advancing our abilities but I am always frustrated with the tendency in NP text books to frequently refrence referal of complex cases to physicians. Why not have referal of complex cases to a clinician with expertiese in the problem. Sorry for two soap boxes but I feel if we stay oraganized and be more proactive it will do more good for advanced practice nurses in the long run.

Jeremy

[cgfnp]

As much as i have some problems with the clinical doctorate in nursing practice idea for advanced practice nurses..... One aspect I do like is having a more standard education basis for us. Ensuring that all advanced practice nurses have some foundation courses such as pathophysiology, pharmacology, patient assesment that cover a broad patient population and then have further more specialized training. This may help even out the playing field on physicans complaints against our abilities. I have gone through two NP programs and a RNFA (personaly I consider this also advanced practice) and I recieved excellent education but there are areas I have had to gain post graduate to acount for some defiencies in my programs. (someone please help talk me out of going for a third NP program just for fun)

Another side note I know that we are advancing our abilities but I am always frustrated with the tendency in NP text books to frequently refrence referal of complex cases to physicians. Why not have referal of complex cases to a clinician with expertiese in the problem. Sorry for two soap boxes but I feel if we stay oraganized and be more proactive it will do more good for advanced practice nurses in the long run.

Jeremy

The extra schooling won't please the physicians as their complaints of quality don't hold water anyway as it is. It's a stupid turf war and a childish game when we all know there are plenty of patients for all of us to stay busy.

What I would like to see is a complete change in the curriculum of the FNP. I'd like to take the N out of it completely and change the degree to a Master's in Family medicine or something like that. It should be year round vigorous primary care training for 2 years (much like the PAs get but w/o all the other inpatient-type rotations).

I think the textbook thing is more of a CYA thing. I'd write the same thing as I'm sure my attorney would advise, even though it may not be reality.