Copy of the AMA’s Victory Letter ~ How organized medicine increases doctors’ income by controlling access to non-MD healthcare practitioners

by faithgibson on May 26, 2023

TinyURL to original web page by the AMA on its Scope of Practice partnership ~

AMA successfully fights scope of practice expansions that ?threaten? patient safety

Patients deserve care *led by physicians—the most highly educated, trained and skilled health care 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 doctor’s offices hires non-MD-practitioners such as nurse-practitioners, nurse midwives, and physician assistants to provide direct patient care.

Then the MD’s office bills the patient directly or 3rd parties such as insurance companies and Medicare/Medicaid for the services provided by non-MDs (i.e., physician-extenders) as if the patient had been seen, examined and treated by the doctor, when in actual fact the care was provided by the non-MD practitioner.

As a legal hedge against the possibility being accused of being fraudulently reimbursed for medical care that they did not provide, some MDs walk into the treatment room during the appointment and ask the patient is they have any questions or comments. 

However, this rouse is just that — a rouse that does not change the facts. They are using billing codes and being financially reimbursed for medical care and treatments that were provided by non-MD employees and not themselves.  

Link to my post:  “Background information on the AMA’s SOPP and my criticism

Return to text of the AMA’s 2020 “Victory Letter”

60-plus scope of practice victories in 2019-2020

Over the last two years, the AMA secured over 60 state legislative victories stopping inappropriate scope expansions of non-physicians.

This work was done in strong collaboration with state medical and national specialty societies, including:

Nurse Practitioners & independent practice
(10 states ~ AR, CA, IL, IN, LA, MS, MT, NJ, OH, TN)

Nurse-anesthetists & opt-out of Medicare supervision
(2 states CO, MS)

Nurse-anesthetists & independent practice
(3 states AR, IL, MS)

Nurse-midwives & independent practice
                                                                   (one state ~ NE)

Physician assistants & independent practice
(6 states IL, LA, ME, MT, NV, OR)

Psychologists & independent prescribing of psychotropic medications
(7 states CT, FL, HI, IL, MT, NE, VT)

Optometrists & surgery   (5 states (MD, MS, NE, ND, VT)

Pharmacists & prescribing    (5 states AZ, IA, IL, IN, VT)

Naturopaths & licensure   (4 states CT, IL, MD, OR)

Physical therapists & direct access (1 state AL)

Podiatrist & surgery of lower leg (1 states ME)

More than $2 million in grants awarded

The AMA recognizes the importance of the house of medicine working together, which is why it formed the Scope of Practice Partnership (SOPP) in 2006.

Today, the SOPP is comprised of 105 national, state and specialty medical associations. The SOPP has awarded more than $2 million in grants to its members to fund advocacy tools and campaigns.

Produced 100s of tools to fight scope expansion

The AMA is one of the only national organizations that has created more than 100s of advocacy tools for medicine to utilize when fighting scope expansion legislation and regulation including model bills, legislative templates, state laws analyses, issue briefs and more.

Demonstrated scope expansion does not equal expanding access to care

The AMA has created over 1,000 geomaps, along with the Health Workforce Mapper (members-only and non-members versions), to demonstrate that expanding scope does not equal expanding access to care.

For instance, AMA research shows the following:

Nonphysician providers (such as NPs) are more likely to practice in the same geographic locations as physicians. This is true even in states that allow NPs to practice independently.

Despite the rising number of NPs across the country, health care shortages still persist, even in states that allow NPs to practice independently.

Engagement with the FTC and administration

The AMA has proactively engaged the Federal Trade Commission (FTC) when necessary and responds to FTC enforcement against state licensure board actions related to scope of practice.

Also, the AMA is working with the administration to preserve physician supervision of non-physician professionals in Medicare.

AMA Truth in Advertising campaign

The AMA launched the Truth in Advertising campaign, which has been enacted in over 20 states, informing the public about who is and is not a physician. The campaign is designed to ensure patients clearly understand who is providing their health care.

Distributed educational wheels 

The AMA has distributed thousands of “Education Matters” wheels, to legislators and regulators across the country, that compare the education and training of physicians and non-physicians.

Elimination of the APRN multistate licensure compact

After convening states and specialties, the AMA eliminated the 2015 Advanced Practice Registered Nurse Multistate (APRN) Licensure Compact by defeating every proposed state bill over the last two years.

Unlike other health care professional Compacts, the APRN Compact would have circumvented state scope of practice laws.

Editor’s Note: the original version of the AMA document included the specific type of “victory” — exactly what was prevented — for each of the different practitioners and in each of the state legislatures:

End original AMA document

Here is the simple list non-MD that have lost their legal right to practice as a result of the AMA’s asymmetrical political influence and large campaign contribution:

Nurse Practitioners
Physical therapists

Editor’s Note: By my count, the only categories of practitioners left off this list (but still smack in the middle of the AMA’s crosshairs) are chiropractic, acupuncture, dietitians, and x-ray technicians.

Part Two ~My Comments about the forced indentured servitude of non-MD practitioners and the economic relationship between pimps and their “employees”


My Comments ~ The forced indentured servitude of non-MD practitioners and the economic relationship between pimps and their “employees”

This is a legalized system of prostitution in which the AMA gets laws passed that makes it illegal to non-MD practitioners to practice unless they are employees of an MD, and then the doctor bills third-party payors (insurance companies and Medicare-Medicaid programs) at MD rates as reimbursement for his or her services, which in fact, the doctor him or herself did not provide the care for which they are being reimbursed.

In prostitution rings, this is the role of the pimp — not do the “work” but get paid as if they had!

Here is how this pimping scheme was described in an official  memorandum published by the  California Medical Board in 1993:

State of California Department of Consumer Affairs

Memorandum to: Members, Division of Licensing Date: Oct0ber 19, 1993

From: Medical Board of California — Robert del Junco, M.D. Chair (former president of the MBC)


Excerpts from the minutes of the meeting of the Task Force held on October 5, 1993. Additional participants included Dr. Camille Williams and MBC staff Janie Cordray. Also present were representatives from the Office of Statewide Health Planning and Development (OSHPD), the Department of Health Services (DHS), the California Association of Hospitals and Health Systems, and the California Medical Association.

DRAFT REPORT (excerpt)

Medical Board of California October 5, 1993

Excerpted from Page 2 of the Minutes:

Topic: Increasing size of the medically underserved and uninsured population and the dubious billing practices by physicians who charge for a doctor’s office visit even when the patients is cared for by a nurse practitioner and is never seen by the doctor.

“…. Between 1980 and 1991, the population increased 26% while physicians increased 29%, Chiropractors and Physician Assistants increased 171%. …

Although California experienced a dramatic increase in health care professionals, this has not solved or even alleviated the problem of the underserved areas.

….the hiring of additional allied health care professionals has not really done anything to benefit patients.

the manner in which they are being hired and used now, 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 saving to the patient.”

“Follow the money”

I’ve been regularly attending the Quarterly Board Meetings of the Medical Board of California since May of 1993. I personally knew Dr Del Junco, who really was humanitarian as well as former president of the Board.

However, neither of these attributes was able to stop the technically legal but nonetheless ethically bankrupt “pimping” by MDs who hire non-MD practitioners to do the work and then they get themselves reimbursed at the higher MD rate for medical care they they did not provide.

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Needed: A public education campaign about the abused of the AMA & a political process that restores public’s access to care provided by independent  healthcare practitioners

We need a public information campaign that exposes the AMA plan legally forces non-MD healthcare practitioners into the role indentured servants for MDs.

These advanced healthcare practitioners already paid for many additional years of education, with all the expense and disruption that entailed for their families, because they wanted to be independent professionals in their own right. A very significant number of those non-MD practitioners would not have spent all that time and money just to be an employee in a doctor’s office.

Second, we need to restore practical and political balance to the  system  — an equally well funded and well represented “American Association for Independent Healthcare Practitioners“ {AAIHP}.

When you consider just how broke AND unproductively expensive  our healthcare system is — a monopoly created the AMA 150 years ago crafted an MD-centric medical system — a sickness system  that they describe as a “healthcare” system that is maintained by its propaganda — we should get a foundation to underwrite these efforts.

The Bill and Melinda Gates foundation is my first choice. Our country needs a very large grant to study and recommend the most effective way to control out-of-control expenses associated with our current “medical services delivery system”.

We need to go way beyond treating “healthcare” as an ongoing process for delivering “medical services” to people after they get sick and start thinking about how we keep people healthier and intervene early by making small changes that keep or bring people back to a state of wellbeing .

At the same time, we need to dramatically improving the physical, mental and emotional health of Americans and greatly expanding professional jobs for women, especially the most marginalized in our culture, BIPOC women .

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 Democratic legislature sold out every man, women 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 that could not get the type of preventative, health education and health-enhancing care most suited to their needs, and so their situation continues to devolve until they need (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 unfortunately soul (and the many thousands like him or her every year!) is no longer able to work.  Just imagine how quickly the MediCal budget blows thru a mere $6 million dollars and yet our “Dear Leaders” (i.e. States legislatures) sold out for a stinking 6 mil.

Like the historic role of nursing, this story is basically about a system of indentured servanthood, in which powerful mostly men take advantage of mostly women as low-paid helpers to support medical doctors so they can make the big bucks and become politically influential so as to perpetuate this vicious cycle.

Or in the words of Doctor Ziegler, MD; 1922  p. 412-413

“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]


original web page on AMA website


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 Abraham Flexner – 2008
  • How nurse-midwives were eliminated from virtually all American hospitals {}