AMA’s Scope of Practice Partnership spends millions to turn independent practitioners into subservient role of “physician-extender” and billing 3rd parties at the higher MD rates for care not provide by them

by faithgibson on March 31, 2024

in AMA's SOPP, Economic Issue$

The AMA, and its new “Scope of Practice Partnership“, probably is not technically a ‘crime family”, but they sure do a great job of acting like one!

Beginning in 2006, the AMA’s policy-makers dreamed up a truly offensive and one-sided new plan for how medical services are provided by MDs in the US. Their plan was simple enough: There would be ONLY two categories of healthcare providers MDs and non-MD practitioneres. And those non-MDs, of the training or skill set, would all be referred to “physician-extenders. Under this new plan, the purpose of all non-MD healthcare profession was now to help MDs so they could see more patient and bill more 3rd pary payors.

And yes, the great statistically majoirty of people who go into “helper” professions are women. This reminds me of various marital and business arrangements in which the man depended on and leaves “the little woman” (wife, sectrtary, or office nurse, etc) to handle all the details.

Newly demoted from one role as an independent practitioners andirrespective of the many years of really expensive  professional training and being licensed as professionals in their own right, all nurse practitioners, nurse midwives, optomistrists, pharmisists, podiatrist, psychologists will henseforth be described as “physician-expenders”!

Wearing a badge on their uniform that says

So i have a suggestion uniting all thos who have been demoted without your permission to “physician-extenders” to make this crime against our humanity visable to the rest of the world.

I thing previously independent practitioners who were turned into “physician extenders” agains their will and are now forced to be an employee  in a  doctors office or medical clinic should wear a little badge on their uniform that says:

I used to be an independent practitioner and was fairly compensated for my professional services. 

And now, thanx to the AMA “Scope of Practice partnership”,  laws were changed in my state at the request of the AMA (and no doubt accompanied by 6-figure contributions to the reelection  campaign of state legislatures.

These new and very AMA friendly laws made it illegal for me, and several other categories of independent healthcare practitioners, to practice our profession as an independent provider and be directly compensated by the patient or a 3rd party payor.

Without a vote, I and all my professional colleagues have legally been demoted to the newly-invented dependent status of a “physician extender”.

This is just a newer, better way dreamed up by the AMA’s  “Scope of Practice Partnership” (more on the SOPP another time) that allows MDs to legally exploit non-MD healthcare professionals with apparent immunity

These new laws in 24 states made it illegal for advanced practitioner to provide the healthcare services we were trained for unless we are the employee on an MD and work under the doctor’s supervision.

But the most outrageous aspect of this shell game is that the medical services I provide to patients as physician-extender employee, will be billed by the doctor to insurance companies and other 3rd party payors as if they were directly provided an MD.

So my physician-employer will be getting compensated at MD rates for care that was provided by me as an advanced practitioner.

Aside from my role as making money for my physician-employer, I am legally “just” a low-paid physician extender, but when it comes to my doctor-employer billing to being personally reimbursed for services I provide, he or she will get compensated at MD rates .

If memory serves me correctly, that is the classic definition of prostitution, in which the prostitute does the “work” in order to make money for a pimp who will hurt her if she doesn’t “do her part”

As a physician-extender professional, I provide healthcare services to patients so my doctor-employer can bill insurance and be paid for work he didn’t do.

This has many similarities to the standard prostitute-pimp arrangement.

If I refuse to continue prostituting myself, I will be hurt economically by the laws passed at the request of the AMA that make it impossible for me to be legally compensated for providing the professional care I was trained for, and I might add, also paid for. Becoming a professional healthcare practitioner required many years of my life and many thousands of dollars in tuition and other educational expenses.


The AMA’s Scope of Practice Partnership (SOPP) consists of 105 medical and surgical associations whose members who have joined together and amassed millions in order to formally promote a binary medical model in which there are only two categories — MDs and everyone else who is not a doctor or “non-MD”.

Another word for the non-MD category is “physical-extender”.

In the brave new world dominated by the goals of the AMA’s SOPP, all (100%) of all medical services would be under the direction and supervision of MDs and all economic compensation –  private insurance, state, and federal government reimbursement and “out-of-pocket payment” by individuals for health-related services are paid directly to the doctor for care that factually was provided by his physician-extender employee.

Also, MDs are reimbursed at a higher MD than non-MD practitioners. This double bonus is not shared with his physician-entender employee and is paid by the hour or a salary much less than what they would have earned as an independent practitioner.

Structurally, this ticks off all the boxes for a true medical monopoly.

It also qualifies as a “pimp-prostitute” arrangement, in which ALL non-MD healthcare providers always and only would be permitted to provide healthcare service as an hourly or salaried employee of their supervising MD employer, establishing yet again that health care in America is “under the influence” (good drugs?) as it has, on purpose and with plenty of forethought, let itself devolve into a pimp-prostitute arrangement, in which a subservient, politically-disempowered class of healthcare personally provides the hands-on care/work, and their MD ”boss” gets paid for the care they rendered.

Apparently someone way up in the AMA hierarchy dreams of morphing organized medicine into a really wealthy and political crime family!

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Excerpts from background materials discussed in the body of this post:

Medical Board – October 5, 1993 Status Report: Health Policy and Resources Task ForceMDs paid for services provided by non-physician practitioners – “income for the physician but no cost-savings to the patient”

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.

Excerps from a speech by Dr. W. A. Evans at the AMA’s annual convention ~ JAMA., September 16, 1911

“The thing for the medical profession to do is … to man every important health movement; man health departments, tuberculosis societies, housing societies, child care and infant societies, etc. The future of the profession depends on it. . . The profession cannot afford to have these places occupied by other than medical men.”

AMA Vice-President James Sammons, Phil Donahue show, Nov 22, 1982: “Our reasons for being in political action are exactly the same as the AFL-CIO.  Exactly. ”

Wilk vs. AMA Class Action Suit, 1987 – AMA convicted of violating Sherman Antitrust Act

Judge Getzendanner’s on-the-record remarks about the AMA’s campaign against chiropractors: “For over twelve years, and with the full knowledge and support of their executive officers, the AMA paid the salaries and expenses for a team of more than a dozen medical doctors, lawyers, and support staff for the expressed purpose of conspiring (overtly and covertly) with others in medicine to first contain, and eventually, destroy the profession of chiropractic in the United States and elsewhere”.

 RELEVANT AMA POLICY ~ Scope of Practice Partnership ~ HOD’s Resolutions

House of Delegate-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 areUas Uof 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 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)

Bibliography and References: set #2

AMA Timeline; official AMA web site;

AMA Scope of Practice Partnership Resolutions 204, 205, 303, 239, 814, 902

AMA, NMA, and the Flexner Report of 1910; Ololade Olakanmi; Writing Group-History of African Americans and the Medical Profession; [AMA archive]

Amazing Logistics of Flexner’s Fieldwork; Mark D. Hiatt, MD, MBA Originally published in the Medical Sentinel 2000;5(5):167-168. Association of American Physicians and Surgeons (AAPS); Carnegie Bulletin #4 ~ Introduction by President Henry S. Pritchett, April 16th 1910
MEDICAL EDUCATION IN THE US AND CANADA ~ 1910; (also known as the Flexner Report) 386 pages – can be downloaded from Google Books

Wilk vs. AMA Class Action Suit, 1987 – AMA convicted of violating Sherman Antitrust Act

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