AMA wants to eliminate efforts of non-physician providers that want to increase scope of practice

The American Medical Association is experiencing another moment of outrage, recently pushing back over proposed legislation which would expand the scope of practice for "non-physicians". Since physicians' perch at the top of the health care hierarchy began to wobble, the American Medical Association, in its physician advocacy role, have gone on the attack. Those specifically targeted, this time, are pharmacists, optometrists, psychologists, PA’s, and advanced practice nurses, seeking to raise their practice profiles and skills through State legislation.1

What the AMA is seeking to obliterate are a "record number" of scope-of-practice bills presented to State legislatures throughout the country. Advanced practice providers are, appropriately, lobbying to expand select aspects of their scopes of practice. It is an ongoing effort to expand care services to patients. The AMA is not pleased.

A recent AMA article, released on the Association's News Wire, is titled: "They're back: Wide Array of Scope Creep bills proposed in 2024". 2 The sinister reference to POLTERGEIST II must mean that they are dead-set against these legislative proposals. Pharmacists want to 'test for' and prescribe medication for select patient conditions, and treat substance-use disorders. Optometrists want to perform surgery. Psychologists and naturopaths want to prescribe meds and, most shocking of all, Nurse Practitioners, other advanced practice registered nurses, and Physician Assistants are backing bills that would allow them to practice "without ANY physician involvement at all". Shocking.

Typically, the AMA isn't mentioning, or providing much detail, regarding specific circumstances or care situations and how these proposed practice enhancements would be implemented. This makes it difficult to ascertain how truly heinous these proposed scope of practice proposals might actually be. However, an AMA physician spokesperson, who chairs the AMA Board of Trustees, has insisted that "Bills that would weaken physician supervision, consultation, and collaboration with non-physician providers seek to replace physician-led, team-based care with a weakened form of collaboration, essentially removing physicians from the care team".3

Certified Nurse-Midwives have conformed to many collaborative agreements with physicians, for decades. In every instance, CNM scope of practice has never encouraged removal of physicians from care decisions, although physician "involvement" is not always necessary in CNM care management. At no time have CNMs required being "led" by a physician collaborator. Mutual efforts to encourage problem solving and respect have assured best care.

With team-based care, there is always a leader, but not necessarily the physician. Health providers of all backgrounds can lead and work collaboratively to accomplish shared goals. "Effective teams require a clear leader, and these teams recognize that leadership of a team in any particular task should be determined by the needs of the team and not by traditional hierarchy". 4 There is nothing weak about clear roles, mutual trust, and effective communication. It is doubtful that the AMA actually approves or agrees with this notion of teamwork.

It is easy to recognize that the AMA regards any collaboration with "non-physicians" as threatening to their appointed status as the most crucial members of every care team. Collaboration is a process that involves a free exchange of ideas and a cooperative give and take among all members ( what AMA considers a weak form of collaboration). But patient outcomes improve in these settings. Clearly, AMA members do not see themselves as team players and any efforts to elevate the care of advanced practice providers is an outrage and threat to physicians' standing. For them, team-based care is weak and ineffective unless the physician is leading it and making all the care decisions.

The AMA has been clear that there is no place for advanced practice providers unless physicians dominate (a.k.a Lead) every aspect of decision-making. Of course, Advanced Practice Providers recognize and respect physician training, knowledge, and skill, but that does not mean they need, or require, physician domination, suppression, or control in each situation of health care. Even in acute situations, team care draws upon each member's strengths and background. This is why team care has improved overall patient health. "The high-performing team is now widely recognized as an esential tool for constructing a more patient-centered, coordinated, and effective health care delivery system."5 Team members also recognize differences in training but do not believe that one type of training or perspective is superior to the training of others. They recognize that they are human and will make mistakes. Therefore, a key value of working in a team is that fellow team members can rely on each other to help recognize and avert failures, despite their position in the hierarchy.6

Support the “scope creepers”. They have been shown to improve the delivery of healthcare. Furthermore, they will be there when you need them.

1. URL:https://www.ama-assn.org/practice-management/scope-practice/they-re-back-wide-array-scope-creep-bills-proposed-2024

2. Ibid. page 2

3. Ibid. page 3

4. Mitchell, P. Wynia M. Golden R. Core Principles & Values of Effective Team-Based Health Care. Institute of Medicine of the National Academies. October 2012. p. 12

5. Ibid. at pg 3.

6. Ibid. at pg 5.

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