recognize this new type of practitioner as an independent clinician, but mandates that all dental teams be headed by a professional dentist (Fox, 2010). Likewise, physical therapists are challenging traditional scope-of-practice boundaries established by chiropractors (Huijbregts, 2007).

Physician Challenges to Expanded Scope of Practice

The AMA has consistently issued resolutions, petitions, and position papers supporting opposition to state efforts to expand the scope of practice for professional groups other than physicians.17 The AMA’s Citizens Petition, submitted to the Health Care Financing Administration in June 2000, and the AMA-sponsored Scope of Practice Partnership (SOPP), announced in January 2006, both focused on opposing scope-of-practice expansion. The SOPP in particular, an alliance of the AMA and six medical specialty organizations, was an effort on the part of organized medicine to oppose boundary expansion and to defeat proposed legislation in several states to expand scope of practice for allied health care providers, including nurses (Croasdale, 2006; Cys, 2000).

The SOPP, with the assistance of a special full-time legislative attorney hired for the purpose, spearheaded several projects designed to obstruct expansion of scopes of practice for nurses and others. These projects included comparisons between the medical profession and specific allied health professions on education standards, certification programs, and disciplinary processes; development of evidence to discredit access-to-care arguments made by various allied health professionals, particularly in rural areas of a state; and identification of the locations of physicians by specialty to counter claims of a lack of physicians in certain areas (Cady, 2006). One of the policies pursued by the SOPP is the AMA’s 2006 resolution H-35.988,18 Independent Practice of Medicine by “Nurse Practitioners.” This resolution opposes any legislation allowing the independent practice of medicine by individuals who have not completed state requirements to practice medicine.

The AMA has released a set of 10 documents for members of state medical associations to help them explain “to regulators and legislators the limitations in the education and training of non-physician providers” (AMA, 2009). One of these, the AMA Scope of Practice Data Series: Nurse Practitioners, uses the term “limited licensure health care providers.” The document argues that these providers—NPs—seek scope-of practice expansions that may be harmful to the public (AMA, 2009). Other organizations, such as the American Society of Anesthesiologists and the American Association of Family Physicians (AAFP), have also issued statements that do not support nurses practicing to their fullest

17

See for example, AMA. 2000. Res. H-360.988. “Nurse Practitioner Reimbursement Under Medicare”; AMA. 2000. H.D. Res. H-160.947, Physician Assistants and Nurse Practitioners.”

18

AMA. 2006. Res. H-35.988, “Independent Practice of Medicine by ‘Nurse Practitioners’.”



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