AMA’s Scope of Practice Partnership ~ Work-n-progress ~ posted July 7th, 2021, last edited 07-07-2021

by faithgibson on August 7, 2020

in AMA's SOPP, Economic Issue$

Initial DRAFT version

This is Part One of a lengthy series that explores the history and contemporary activities of American Medical Association and its 50 state chapters.
This series is based on publicly available historical documents and important publications by and about the AMA (links to PDFs if available) on the history and contemporary activities of AMA and it’s affiliated organizations.
However, my main focus is the AMA’s historical monopoly over all forms of medical practice and associated healthcare services, and century-long exploitation of the nursing profession and its decades long campaign to legally control the professional practice of non-MD practitioners.
This category includes:
Naturopathic Doctors, Nurse-midwives, Nurse Practitioners, Nurse-anesthetists, Optometrists, Pharmacists, Physical therapists, Podiatrists, Physician-assistants, and Psychologists
that the AMA created during the last 150 year over the licensing and practice of allopathic medicine and associated healthcare services and its Scope of Practice Partnership (SOPP) to maintain a virtual monopoly

Nurse-midwife using bedside Ultrasound on mother-to-be to check the baby’s position and confirm adequate level of amniotic fluid

Professional non-MD Practitioners as independent providers of healthcare services or “Physician Extenders” under the complete and total control of MDs?

A very telling example of this systemized exploitation of non-MD practitioners can be seen in several resolutions published by the AMA’s House of Delegates. These official documents characterize non-MD practitioners as “physician extenders” and assert that MDs should have complete and total control over all categories of these “physician extenders”.    

Irrefutable evidence documenting the this exploitive practice as wide-spread and well-known within the medical profession itself, and its state licensing boards, is a report by the California Medical Board that characterizes this as an exploitative practice in which medical doctors are being paid for services provided by non-physician practitioners. This official MBC document characterize this as generating: “income for the physician but no cost-savings to the patient”

Medical Board – October 5, 1993 Status Report: Health Policy and Resources Task Force

Although California has experienced a dramatic increase in health care professionals, this has not solved or even alleviated the problem of underserved areas. California has more doctors per capita than any other state …. Translate[s] to 1 doctor per 1,000 patients. To put his number in perspective, Orange County HMOs signs up 3,000 patients per 1 primary care physician.

…the hiring of additional allied health care professionals has not really done anything to benefit patients. Although … the concept in principle is that allied health professionals can provide additional access to health care …. the manner in which they are being hired and used ….. they are really only serving to increase the income of physicians.

Although physicians are hiring more Physician Assistants and Nurse Practitioners, and often patients never see the physician, the patients are charged the same amount for an office visit.

This is income for the physician but there is no cost-savings to the patient.

 

EDIT LINE @ 2:46 pm 07-07-2021 @@@@@@@@@@@@@@@@@@@@@@

The 2006 Scope of Practice Partnership (SOOP) is a concerted plan by the oldest, largest, most political influential and most well-financed medical organization and political lobby in the United States  — the American Medical Association. The SOPP began with a resolution passed by the AMA’s House of Delegates to prevent the independent practice of professionally licensed non-MD practitioners, a category referred to by doctors and the HOD documents as “physician extenders.

History of the AMA’s  Scope of Practice Partnership 

(SOPP) was created by a coalition comprised of the AMA, six national medical specialty societies (American Academy of Ophthalmology, American Academy of Orthopaedic Surgeons, American Academy of Otolaryngology – Head and Neck Surgery, American Psychiatric Association, American Society of Anesthesiologists, and American Society of Plastic Surgeons) and six state medical associations (California Medical Association, Colorado Medical Society, Maine Medical Association, Massachusetts Medical Society, New Mexico Medical Society, and Texas Medical Association).
Members of this coalition (referred to as the “SOPP Steering Committee”) agreed that it was necessary to concentrate the resources of organized medicine to oppose scope of practice expansions by allied health professionals that threaten the health and safety of the public.  The SOPP Steering Committee agreed that this would best be accomplished through a wide-range of efforts, including a combination of legislative, regulatory and judicial advocacy, as well as programs of information, research and education.  Moreover, the SOPP Steering Committee was committed to creating a true partnership that operated by consensus and functioned in a cooperative and coordinated manner.
The SOPP Steering Committee has met either in person or via conference call quarterly for the last two years.  During this time, it developed various core documents that serve as the foundation for the SOPP.  Three main principles that the SOPP Steering Committee agreed to are as follows:

·      Membership:  Input from all state medical associations and national medical specialty societies will be vital to the viability of the SOPP.  The SOPP and its Steering Committee will be open for participation by any state medical association and/or national medical specialty society represented in the AMA HOD.  The greater the number of members, the greater the resources (both financial and in-kind) the SOPP will have to advance its advocacy efforts.

·      Funding:  SOPP project funding will be derived solely from the annual dues collected from all medical societies participating in the SOPP.  In other words, the amount of dues raised in any given year will dictate the SOPP’s level of involvement in scope of practice initiatives.

The AMA also sought a detailed and exhaustive legal review of the SOPP by its Office of General Counsel (OGC).  This was done in order to ensure that the creation of the SOPP was not in violation of any existing antitrust, truth in advertising, election, or lobbying laws. Understandably, this was a very extensive review.  Ultimately, the AMA OGC approved of the underlying principles governing the SOPP. 
 
consists of AMA members representing of the California state chapter of the AMA (California Medical Association — CMA), as well as several other allopathic professional organizations that represent the political and economic interests of anesthesiologists, obstetricians, orthopedists, psychiatrists, and others.
Posted below is an excerpt of  AMA House of Delegates “resolutions“ 30-page report for the year 2008 — a schizophrenic experience that included (along with the SOPP and anti-mfry-PHB / Ricki Lake roast) the following nonsense.
It that clearly expose the AMA’s campaign to control and exploit non-MD practitioners for its own convenience, prestige and profit.
It was interesting to read the other resolutions in their
(1) a resolution declaring that all speciality associations (ex. ACOG, etc) had to get an OK from their state medical association before introducing any legislation that would impact on the scope of practice of any other licensed physicians in their state (obviously doesn’t apply to any of the rest of us!) 
(2) a resolution announcing that the AMA was ‘strongly opposed’ to the policies of some insurance companies that refused to pay physicians for patient services that result in iatrogenic complications and policies of non-payment for hospital-acquired conditions that ‘may not in fact be preventable‘ (or maybe were!). The resolution authorizes development of an educational campaign to convince the public and the congress to pass laws prohibiting this egregious policy that would (obviously! create great ‘patient harm’.
“that our AMA continue its education and advocacy of Members of Congress about the unintended consequences of non-payment for hospital acquired conditions that may not in fact be preventable; that our American Medical Association oppose the use of payment and coverage decisions of governmental and commercial health insurance entities as determinative of the standard of care for medical practice and advocate that payment decisions by any third party payer not be considered in determining standards of care for medical practice.”
(3) AMA approved a policy permitting non-physicians to perform intraoperative neurophysiologic monitoring of anesthetized patients during surgery, which they simultaneously identified as a restricted ‘practice of medicine’ and OK’d to “be delegated tonon-physician personnel under direct supervision or online real-timesupervisionof the operating surgeon or another physician trained in, or who has demonstrated competence, in neurophysiologic techniques and is available to interpret the studies and advise the surgeon during the surgical procedures  (i’m assuming this is like having L&D nurses sit out at the desk and watch banks of EFM screens)
Welcome to the Alice in Wonderland world of organized medicine (and you thought ACOG was the problem!)

=======================================================================

REPORT OF THE BOARD OF TRUSTEES (of the AMA)

Limited Licensure Health Care Provider Training and Certification Standards
Duane M. Cady, MD, Chair
INTRODUCTION
At the 2005 American Medical Association (AMA) Interim Meeting, the House of Delegates (HOD) adopted as amended Resolution 814 entitled “Limited Licensure Health Care Provider Training and Certification Standards.”  Resolution 814 calls on the AMA, along with the Scope of Practice Partnership (SOPP) and interested Federation partners, to study the qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of the limited licensure health care providers and limited independent practitioners, as identified by the SOPP.
Reference Committee recommended that the initial resolve be modified to reflect the involvement of the SOPP in conducting the study called for in Resolution 814.
Definition of occupations included those that “function in a newly expanded medical support role to the physician in the provision of patient care.”
“physician-support occupations” based on ….. the physician’s capability and competence to supervise such an assistant.
[faith’s NOTE: this distinction identifies the primary function ofnurse practitioners, nurse midwives, and physician assistants as “physician extenders” or an ‘assistant’, rather than primarily meeting the needs of the patients — obviously physicians require more help than sick people]  

AMA  HOD rule #160.949 – Practicing Medicine by Non-Physicians.  H-160.949 states that “[o]ur AMA:

(1) …“substitution of a non-physician in the diagnosis, treatment, education, direction and medical procedures where clear-cut documentation of assured quality has not been carried out, and where such alters the traditional pattern of practice in which the physician directs and supervises the care given;
(3) [AMA] continues to actively oppose legislation allowing non-physician groups to engage in the practice of medicine without physician (MD, DO) training or appropriate physician (MD, DO) supervision;
(4) [AMA] continues to encourage state medical societies to oppose state legislation allowing non-physician groups to engage in the practice of medicine without physician (MD, DO) training or appropriate physician (MD, DO) supervision; and
(5) through legislative and regulatory efforts, vigorously support and advocate for the requirement of appropriate physician supervision of non-physician clinical staff in all areas of medicine.
SCOPE OF PRACTICE PARTNERSHIP
History
The Scope of Practice Partnership (SOPP) was created by a coalition comprised of the AMA, six national medical specialty societies (American Academy of Ophthalmology, American Academy of Orthopaedic Surgeons, American Academy of Otolaryngology – Head and Neck Surgery, American Psychiatric Association, American Society of Anesthesiologists, and American Society of Plastic Surgeons) and six state medical associations (California Medical Association, Colorado Medical Society, Maine Medical Association, Massachusetts Medical Society, New Mexico Medical Society, and Texas Medical Association).
Members of this coalition (referred to as the “SOPP Steering Committee”) agreed that it was necessary to concentrate the resources of organized medicine to oppose scope of practice expansions by allied health professionals that threaten the health and safety of the public.  The SOPP Steering Committee agreed that this would best be accomplished through a wide-range of efforts, including a combination of legislative, regulatory and judicial advocacy, as well as programs of information, research and education.  Moreover, the SOPP Steering Committee was committed to creating a true partnership that operated by consensus and functioned in a cooperative and coordinated manner.
The SOPP Steering Committee has met either in person or via conference call quarterly for the last two years.  During this time, it developed various core documents that serve as the foundation for the SOPP.  Three main principles that the SOPP Steering Committee agreed to are as follows:

·      Membership:  Input from all state medical associations and national medical specialty societies will be vital to the viability of the SOPP.  The SOPP and its Steering Committee will be open for participation by any state medical association and/or national medical specialty society represented in the AMA HOD.  The greater the number of members, the greater the resources (both financial and in-kind) the SOPP will have to advance its advocacy efforts.

·      Funding:  SOPP project funding will be derived solely from the annual dues collected from all medical societies participating in the SOPP.  In other words, the amount of dues raised in any given year will dictate the SOPP’s level of involvement in scope of practice initiatives.

The AMA also sought a detailed and exhaustive legal review of the SOPP by its Office of General Counsel (OGC).  This was done in order to ensure that the creation of the SOPP was not in violation of any existing antitrust, truth in advertising, election, or lobbying laws. Understandably, this was a very extensive review.  Ultimately, the AMA OGC approved of the underlying principles governing the SOPP. 
**NOTE -> faith: Their lawyers insisted that the phrase “in a manner that threatens the health and safety of the public” always be apart of the phrase “to oppose allied health professions that seek to expand their scope of practice”, so they could pass their unfair business practices off as altruistic concern over ‘patient safety’.  
From its inception, the SOPP Steering Committee has envisioned that the SOPP’s involvement in scope of practice “campaigns” would be multi-dimensional.  The members of the SOPP Steering Committee had the foresight to see that the SOPP would become involved not only in the individual state legislative, regulatory, and judicial advocacy, but also in programs of information, research and education.  From the very start, the SOPP Steering Committee’s discussions focused on two “top priority” research projects.  Both studies would be extensive and therefore, benefited from the formation of the SOPP and the concentration of the Federation’s resources.
The first of these studies would focus on discrediting access to care argumentsrepeatedly made by various allied health professionals when seeking to expand their respective scope of practice, particularly in rural states.  The second study, and arguably the more extensive of the two, would concentrate on completing educational/training/licensure comparisons of specific allied health professions and the medical profession.  Obviously the second study aligns perfectly with Resolution 814.
Official Roll-Out of SOPP
The SOPP was officially rolled out at the AMA Advocacy Resource Center’s (ARC) 2006 State Legislative Strategy Conference in January.  Up to that point in time, the SOPP had been favorably received by the Federation**-2 [of State Medical Boards] and was enthusiastically embraced by the attendees of the conference.
(2) discrediting access to care arguments made by various allied health professionals, particularly in rural areas of a state;
(3) creating maps that identify the locations of physicians, by specialty, to be used to counter claims that physicians do not exist in certain areas of a given state; and
(4) same as (1) but for the medical profession and specific complementary /alternative medicine professions.
It is notable that the draft SOPP Work Plan clearly identifies (1) as its “top priority” for SOPP projects in 2006.
Next Steps
Since the 2006 State Legislative Strategy Conference, ARC staff has sent letters to the executive directors of all state medical associations and national medical specialty societies recognized by the AMA HOD.
These letters included … the SOPP’s core documents, as well as the Statement of Legal Compliance for all medical societies to sign and an invoice for annual dues for all national medical specialty societies and the AMA to process.  ARC staff is currently fielding any questions associated with these memos and processing all dues that are sent by the Federation * [of State Medical Boards].
the SOPP Steering Committee considered the draft SOPP Work Plan at its face-to-face meeting on March 13, 2006.  The priority for this meeting was determining the amount of annual dues raised and based on that, identifying SOPP 2006 projects. 
Shortly after the SOPP Steering Committee meeting, the ARC team added a new full-time legislative attorney who was hired to focus their attention on scope of practice issues.**-1  This is an exciting addition to the ARC team and signifies the AMA’s continued commitment to addressing scope of practice issues in an effective, collaborative and cooperative manner with its Federation**-2 partners.
ARC staff will continue to monitor and track scope of practice developments at the state level, expand its Scope of Practice Campaign when deemed necessary, and work with affected state medical associations and national medical specialty societies, at their request, to oppose allied health professions that seek to expand their scope of practice in a manner that threatens the health and safety of the public. **
The Federation [of State Medical Boards] has been energized by the development of the SOPP and the AMA will continue **its work in bringing organized medicine together to fight these scope of practice battles.
Return to subdirectory for Organized Medicine ~ Tags for AMA, SOOP, Physician extenders, non-MD-practitioners

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