The AMA’s 2006 Scope of Practice Partnership (SOPP) & its 2020 “Victory Letter”
The Problem: In 2006 the American Medical Association (AMA) created the Scope of Practice Partnership (SOOP), which is a coalition of 105 other professional medical lobbies representing the professional and economic interests of medical doctors.
These self-interested organizations banded together to use the legendary political influence and economic assistance of the AMA (“More than $2 million in grants awarded“ — see the organization’s online “Victory Letter” below) to make it illegal for non-MD practitioners to practice as independent providers and force them to become employees in a doctor’s office.
In 2006, the AMA’s House of Delegates passed a flurry of “resolutions” pejoratively defining non-MD practitioners as “physician extenders“. This refers to a dozen or more categories of professional healthcare providers such as optometrists, pharmacists, physical therapists, physician assistants, psychologists, and nurse practitioners (full list below).
The AMA’s new category “physician extender” allowed them to do several things that were very favorable to MDs while being extremely detrimental to independent practitioners and the public. These new and legally =-restrictive definitions of non-MD practitioners provide great economic advantages to MDs while dramatically increasing the cost of healthcare and the number of Americans who would be unable to afford medical care.
This was predicated on claims by the AMA’s House of Delegates that the independent practice of non-MD practitioners:
“…. alters the traditional pattern of practice in which the physician directs and supervises the care given;
House of Delegates resolution 160.949 – Practicing Medicine by Non-Physicians
At least as defined by the AMA, MDs are seen as being at the top of a power pyramid, thus having total control over all facets of the American medical/healthcare system. In this dystopian system, MDs make all the decisions decide what category of a non-MD healthcare provider is allowed to do, and to be sure that all the money first flows to doctors who in turn disperse this as the AMA sees fit — a system that perpetuates the role of the AMA as gatekeepers and arbitrators of the American healthcare system.
These AMA Resolutions start by claiming that the independent practice of all non-MD professionals was an illegitimate (i.e. illegal) practice of medicine.
(4) 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;
House of Delegates resolution 160.949 – Practicing Medicine by Non-Physicians
As defined by AMA House of Delegates’ resolutions, non-MD practitioners would only be allowed to provide the services they were formally educated and licensed to provide by being hired to work as employees in a doctor’s office or clinic.
In addition, these AMA House of Delegates resolutions called passage for of laws making it illegal for these practitioners to be directly reimbursed by insurance companies and the federal MediCare – MediCaid programs.
This describes a system in which MDs hire non-MD practitioners to provide medical services and then the employer-MD bills the insurance company and federal Medicare-Medicaid program, which reimburses the doctor instead of the practitioner that actually provided the services.
Meanwhile, the non-MD practitioner, who is providing this specialized care is being paid a yearly salary or hourly wage.
As defined by the AMA, these laws would give the allopathic medical profession a virtual monopoly over all medical services in the US.
Under the Trump administration, this concept was successfully carried out as state chapters of the AMA convinced the legislators of 24 states to pass laws making the independent practice of these professionally educated non-MD practitioners illegal, thus forcing formally independent practitioners become the employees of MDs, while their MD-employers billed third-party payors for services provided by them.
The Solution: Americans need to know about this travesty and take effective action to repeal this monopolist law. The dozen or so professional organizations that represent different types of independently practicing non-MD practitioners (see list below) can and should form a coalition and fight back using their combined resources to inform the public of what can only be described as a shocking abuse of power by organized medicine.
Just how big of a problem is this? Here is the list, so you can see for yourself:
Nurse Practitioners
Nurse-anesthetists
Nurse-midwives
Naturopaths
Optometrists
Physician-assistants
Psychologists
Pharmacists
Physical therapists
Podiatrists
H-160.949 – Practicing Medicine by Non-Physicians: states that “[o]ur AMA:
(1) urges all people, including physicians and patients, to consider the consequences of any health care plan that places any patient care at risk by 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;
(4) 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. (Res. 317, I-94; Modified by Res. 501, A-97; Appended: Res. 321, I-98; Reaffirmation A-99; Appended: Res. 240, Reaffirmed: Res. 708 and Reaffirmation A-00; Reaffirmed: CME Rep. 1, I-00).”
H-35.973 Scopes of Practice of Physician Extenders
Our AMA supports the formulation of clearer definitions of the scope of practice of physician extenders to include direct appropriate physician supervision and recommended guidelines for physician supervision to ensure quality patient care. (Res. 213, A-02)
H-35.988 Independent Practice of Medicine by “Nurse Practitioners”
The AMA, in the public interest, opposes the enactment of legislation to authorize the independent practice of medicine by any individual who has not completed the state’s requirements for licensure to engage in the practice of medicine and surgery in all of its branches. (Sub. Res. 53, I-82; Reaffirmed: A-84; Reaffirmed: CLRPD Rep. A, I-92; Reaffirmed: BOT Rep. 28, A-03)
H-35.993 Opposition to Direct Medicare Payments for Physician Extenders
Our AMA reaffirms its opposition to any legislation or program which would provide for Medicare payments directly to physician extenders, or payment for physician extender services not provided under the supervision and direction of a physician. (CMS Rep. N, I-77; Reaffirmed: CLRPD Rep. C, A-89; Reaffirmed: Sunset Report, A-00)
The mess that 150 years of AMA-controlled healthcare has wrought
Americans need to know about this and to repeal this monopolist law en masse. It’s the best way to control out-of-control associated with the American medical services delivery system, while dramatically improving the physical, mental, and emotional health of Americans and greatly expanding professional jobs for women of all colors and ethnicities.
Link to the AMA’s updated online VIctory Letter
AMA successfully fights scope of practice expansions that threaten patient safety
Patients deserve care *led by physicians—the most highly educated, trained, and skilled healthcare professionals. Through research, advocacy, and education, the AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.
**Faith’s Note — “led by physicians” means that the MD’s office bills the patient, insurance, or Medicare/Medicaid for services provided by non-MDs (i.e., physician-extenders) as if the pt had been seen and cared for by the doctor.
75-plus scope of practice victories in 2019-2020
- Nurse Practitioners & independent practice (AR, CA, IL, IN, LA, MS, MT, NJ, OH, TN)
- Nurse-anesthetists & opt-out of Medicare supervision (CO, MS)
- Nurse-anesthetists & independent practice (AR, IL, MS)
- Nurse-midwives & independent practice (NE)
- Physician assistants & independent practice (IL, LA, ME, MT, NV, OR)
- Psychologists & independent prescribing of psychotropic medications (CT, FL, HI, IL, MT, NE, VT)
- Optometrists & surgery (MD, MS, NE, ND, VT)
- Pharmacists & prescribing (AZ, IA, IL, IN, VT)
- Naturopaths & licensure (CT, IL, MD, OR)
- Physical therapists & direct access (AL)
- Podiatrist & surgery of lower leg (ME)
More than $2 million in grants awarded
Produced 100s of tools to fight scope expansion
Demonstrated scope expansion does not equal expanding access to care
Engagement with the FTC and administration
Launched the AMA Truth in Advertising campaign
Distributed educational wheels
Elimination of the APRN multistate licensure compact
End of the AMA’s Victory Letter
My Comments
I recently got an email from the president of our state’s midwifery organization describing a combined years-long effort by CALM and two consumer organizations to find a State legislator willing and able to carry a much-needed bill to undo the damage done by a 2013 amendment to the LMPA that was anti-midwife and anti-childbearing women and {not kidding} sponsored by American College of Obstetricians and Gynecologists (ACOG).
In simple terms, CALM representatives faced an utter impossibility, as 100% of the Democratic legislators refused to even consider carrying a bill that would be opposed by the state’s chapter of the AMA. Bad as that is, the explanation is ten times worse!
A line in a letter keeps ringing in my head — for the paltry sum of $6 million bucks — the cost of my duplex and the one across the courtyard — 100% of the Democratic legislature sold out every man, woman, and child in the state by denying Californians access to high-quality preventative health care services as would normally be provided by the very professionals on the AMA’s “victory” majority female list.
This battlefield is littered with the bodies of patients who could not get the type of preventative, health education, and health-enhancing care most suited to their needs, and so their situation continued to devolve until they needed (but often could not afford) very expensive drugs and/or surgery.
Then the taxpayers of California got to reimburse the $150,000 hospital bill and pay for a drug regime that costs $1,700 every month, and disability payment because this unfortunate soul (and the many thousands like him or her every year!) is no longer able to work. Just imagine how quickly the MediCal budget blew through a mere $6 million and yet our “Dear Leaders” (i.e. state legislatures) sold out for a stinking 6 mil.
“The doctor must be enabled to get his money from small fees received from a much larger number of patients cared for under time-saving and strength-conserving conditions;
… he must do his work at the minimum expense to himself, and he must not be asked to do any work for which he is not paid the stipulated fee. This means … doctors must be relieved of all work that can be done by others — nurses, social workers, and midwives.” [1922-A; ZieglerMD, p. 412]
“The nurses should be trained to do all the antepartum and postpartum work, from both the doctors’ and nurses’ standpoint, with the doctors always available as consultants when things go wrong;
and the midwives should be trained to do the work of the so called “practical nurses,” acting as assistants to the regular nurses and under their immediate direction and supervision, and to act as assistant-attendants upon women in labor—conducting the labor during the waiting period or until the doctor arrives, and assisting him (not the mother!) during the delivery.” [1922-A; ZieglerMD
“In this plan the work of the doctors would be limited to the delivery of patients, consulting with the nurses, and to the making of complete physical and obstetrical examinations … [1922-A; ZieglerMD, p. 413]
Note-2-self for follow-up material:
MBC Oct 05, 1993 Del Junco’s task force on state access healthcare
Ololade’s Hx of the AMA
The Impossible Journey of Abrham Flexner – 2008Story of how nurse-midwives were eliminated from virtually all American hospitals
