More than 40 years ago, the American Medical Association (AMA) launched its first attack against alternative health care when it formed the Committee on Quackery in November 1963. The primary objective of the Committee on Quackery was to "contain and eliminate" chiropractic as a recognized health care service in the U.S. (Interestingly enough, the committee's original name was the Committee on Chiropractic, but the name was later changed so as to not lend credibility to the chiropractic profession.) While its efforts were ultimately unsuccessful, the committee's activities are believed to have delayed the full integration of chiropractic into the health care marketplace for several years.¹

Now, more than 30 years after the committee was disbanded, and almost 20 years after Judge Susan Getzendanner issued a historic ruling that found the AMA guilty of engaging in a conspiracy to contain and eliminate chiropractic, the medical association appears ready to embark on a new campaign to not only damage the chiropractic profession, but all CAM disciplines. In a move that appears to be aimed at stopping the growth of essentially all health care practitioners except for medical doctors and doctors of osteopathy, the AMA House of Delegates has adopted a resolution that calls for the association, in conjunction with an AMA-supported entity known as the "Scope of Practice Partnership," to study the qualifications, education and academic requirements of "limited licensure health care providers and limited independent practitioners." The resolution, adopted at the AMA's most recent interim meeting in Dallas, also calls for the association to allocate more than $170,000 to help fund and publish the study, and to provide a report of its findings when the House of Delegates convenes at the AMA's 2006 annual meeting in Chicago.²

"While nonphysician providers have been, and will continue to be, important elements in the provision of health care, it is important that our patients know and receive the care that only physicians are uniquely qualified to provide," said Dr. Michael Maves, the AMA's executive vice president and CEO." Maves added that the main purpose for the creation of the Scope of Practice Partnership is "to ensure quality care for patients."³

The AMA's alleged concerns over patient care may stem from the fact that increasing numbers of consumers, dissatisfied with the traditional system of health care in the U.S., are turning to providers other than medical doctors for treatment. According to a 2004 survey, 36 percent of all American adults (an estimated 74 million Americans) used at least one type of complementary and alternative medicine in the past year. The same survey found that 28 percent of people who used CAM did so because they believed that "conventional medical treatments would not help them with their health problem."⁴

In addition, the number of states allowing for the practice of certain types of CAM has increased dramatically in the past few decades. Thirty-six states, the District of Columbia and four Canadian provinces have all passed laws regulating the massage and bodywork profession, 15 states regulate the practice of naturopathy, 43 states allow for the practice of acupuncture by non-physician acupuncturists, and chiropractic has had scope-of-practice laws in effect in every state in the U.S. since 1974.

The AMA's resolution (Resolution 814), introduced by a delegation from the Texas Medical Association at the Interim Meeting, calls into question the standards for admission, training and testing of limited licensure health care providers on the claim that these standards "are neither well-defined nor generally known by physicians or public members" who evaluate them or review the quality of care they provide. It also questions the education and certification standards of limited licensure providers, and requests that the AMA, the Scope of Practice Partnership and members of the Federation of State Medical Boards conduct a thorough study of such providers.

As for the Scope of Practice Partnership, few firm details about the organization exist on the AMA's Web site; in some instances, it also is referred to as a steering committee or a task force. A search of the AMA's Web site finds the first mention of the partnership in a list of resolutions and report recommendations from the AMA House of Delegates 2004 Interim Meeting. The document notes that the association's Advocacy Resource Center is "actively involved in supporting the federation of medicine's efforts to oppose inappropriate scope of practice expansions that threaten the health of the public," but provides little information otherwise.⁵

In an excerpt of an Aug. 20, 2005 speech to the board of directors of the American Society of Anesthesiologists (also on the AMA's site), AMA President J. Edward Hill, MD, provides some background information on the organization's creation, saying the association helped to create the Scope of Practice Partnership to counter "various and troubling encroachments on physician practice." Dr. Hill also details some of his feelings about working with allied health professionals.⁶

"Like you, the AMA respects the health care professionals who work with us in our offices and in hospitals, and who can function as physician 'extenders,' in areas where physicians are in great demand and short supply," Hill is quoted as saying. "In my rural practice, for example, I have worked with midwives with great success. However, the operative word in the previous sentence is 'with,' meaning, 'in cooperation with,' or 'as part of a physician-led team.' However, not all allied health professionals see it this way."

According to Hill, the AMA will house and staff the partnership, and provide a basic level of support, with additional support provided by state and specialty societies.  An executive committee will be created and charged with reviewing relevant issues and prioritizing scope-of-practice concerns on a state-by-state basis.  The partnership also will fund studies to "closely examine the education and training of allied health professionals, and provide this information as a point of comparison for legislators."

Each of the 12 founding members of the partnership has pledged to contribute $25,000 annually to the entity; the funds will be used "to fund research that helps refute the key arguments allied health professionals use to advance their measures in state legislatures."  Funding also will be used to "help medical specialty societies and state medical associations fight expansions in non-medical scope of practice" and to "fund campaigns to stop scope-of-practice legislation in states where such bills appear likely to advance."

While the number of societies involved in the partnership is relatively small at present, APA Medical Director, James H. Scully Jr., MD, expects the partnership to expand to all 50 states, and to establish relationships with every state medical board and association in the U.S. It is believed that such a coordinated effort would send a message to legislators that "scope-of-practice issues are not turf issues for one or another specialty, but are concerns of the profession of medicine."

The results of the AMA/Scope of Practice Partnership study are expected to be presented at the House of Delegates' 2006 Annual Meeting in June.

References

1. Simpson KJ. The Iowa Plan and the activities of the Committee on Quackery. Chiropractic Journal of Australia 1997;27:5-12.
2. Resolution 814: Limited Licensure Health Care Provider Training and Certification Standards. www.ama-assn.org/meetings/public/interim05/refcomkannotateda05.doc.
3. Croasdale M. Physician task force confronts scope-of-practice legislation. American Medical News Feb. 13, 2006.
4. Barnes P, Powell-Griner E, McFann K, et al. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. Published by the National Center for Complementary and Alternative Medicine, May 27, 2004. http://nccam.nih.gov/news/2004/052704.htm.
5. Follow-Up on Implementation of Resolutions and Report Recommendations. AMA House of Delegates Interim Meeting, Dec. 4-7, 2004. www.ama-assn.org/meetings/public/interim05/i04status.doc.
6. Hill JE. Cooperation is critical: AMA and ASA working together. www.ama-assn.org/ama/pub/category/print/15483.html. Published Aug. 20, 2005.