1. Nelson, Roxanne BSN, RN

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Recent actions by the American Medical Association (AMA)-particularly a resolution adopted at its annual meeting in June that states the "quality of care rendered by individuals with a nurse doctoral degree is not equivalent to that of a physician"-have led to concern among some health care practitioners. Critics say that the AMA is laying the groundwork for a systematic challenge to the independence, credibility, and scopes of practice of nonphysician providers. The AMA maintains that it is merely discharging a responsibility to preserve health care quality and protect the safety of patients.


Resolution 814.

At its 2005 annual meeting, the AMA confirmed Resolution 814 ("Limited Licensure Health Care Provider Training and Certification Standards"), which directs the AMA and a newly formed coalition, the Scope of Practice Partnership (SOPP), "to study the qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of limited licensure health care providers." The SOPP includes the AMA, six national medical specialty societies, and six state medical associations; its stated purpose is "to concentrate the resources of organized medicine to oppose scope of practice expansions by allied health professionals that threaten the health and safety of the public." The AMA allotted more than $170,000 to pursue this study, with the goal of reporting the findings at its June 2006 annual meeting.


"The purpose of this resolution was never the oversight of nurses," says David Teuscher, MD, an orthopedic surgeon from Beaumont, Texas, who worked on drafting Resolution 814. "It may be that some nurses are now practicing medicine in a limited form, but this will have no effect on the majority of nurses."


In medicine, says Teuscher, training is uniform and standardized, but this may not be the case in other health care professions. "We now have more and more people practicing medicine who haven't gone to medical school, and patient safety is a primary concern," he says. "The public may not be aware of this, and they trust doctors to handle the ship, so to speak."


Resolution 211

("Need to Expose and Counter Nurse Doctoral Programs [NDP] Misrepresentation") was introduced by the American Society of Anesthesiologists (ASA) and approved and adopted at the AMA's June meeting. Positing that "nurses and other nonphysician providers who hold doctoral degrees and identify themselves as 'doctors' will create confusion, jeopardize patient safety and erode the trust inherent in the true patient-physician relationship," the resolution calls for the AMA to work with state attorneys general "to identify and prosecute individuals who misrepresent themselves as physicians" and to counter misrepresentation by nurse doctoral programs.


Mitchell Tobin, JD, senior director of professional practice affairs at the American Association of Nurse Anesthetists (AANA), says Resolution 211 is riddled with inaccuracies and misleading statements.


"It says that the 'Nurse Anesthesia Accreditation Council has mandated doctoral training for all nurse anesthetists by the year 2015,' but there is no such mandate for nurse anesthetists to have a doctoral degree by 2015," says Tobin. (The correct name of the accreditation council is the Council on Accredit-ation of Nurse Anesthesia.) "The title of the resolution is inflammatory and misleading and implies that there is a nurse doctoral program that needs to be exposed and countered," he continues. "But there is no evidence that there is going to be misrepresentation or that patients are going to be harmed."


Jan Towers, PhD, CRNP, director of health policy at the American Association of Nurse Practitioners agrees: "We already have nurses educated at the doctoral level, and I've never heard of any of them trying to hide their identities and pose as physicians."


If the ASA has concerns that they would like to discuss, then why not sit down with organizations such as the AANA and have a dialogue, asks Tobin. "Instead, they're calling for getting a state's attorney general involved."


When contacted by AJN, an ASA spokesperson said that the resolution was self-explanatory. The association declined to answer any questions on problems or safety issues, or whether any record exists documenting cases in which health care professionals with doctoral degrees misrepresent themselves as physicians.


Collective outcry.

In June, 25 organizations representing over 3 million licensed health care professionals formed the Coalition for Patients' Rights (CPR). The CPR was initiated by the ANA, created in order to counter what its members see as a move by the AMA to limit the scope of practice of nonphysician practitioners and to hinder patients from seeking care from advanced practice nurses, nurse midwives, psychologists, and chiropractors. The CPR also opposes "legislation at the state level that would reduce provider options for patients." (For more information, visit


"Nurse practitioners have an excellent track record and we're not asking to do anything beyond the scope of our practice," says Towers, who points out that the education and clinical training of NPs is very standardized and their scope of practice well defined. "We are working with the Coalition for Patients' Rights," she says, "but we would really prefer if the AMA would sit down and talk with us. We have over 40 million people in this country without health insurance, we have underserved areas, and the need for health care professionals is going to increase as baby boomers get older."


The eventual findings and uses of the study initiated by Resolution 814 are not yet clear. In addressing Resolution 814 at its meeting in June, the AMA concluded that it would continue to monitor and track scope of practice developments at the state level and work with state medical associations and national medical specialty societies to oppose "allied health professions" that seek to expand their scope of practice in a manner that could threaten public safety.


"There's frustration and sadness," says Tobin, "since these are colleagues whom we should be working together with. Instead, we are wasting time and resources. Neither the SOPP nor Resolutions 814 and 211 can cite any credible evidence that the scopes of practice of the coalition members are unsafe or problematic or warrant special scrutiny or study."


Roxanne Nelson, BSN, RN


Members of Coalition for Patients' Rights*

A new coalition opposes the AMA's resolutions.

American Academy of Nurse Practitioners


American Association of Colleges of Nursing


American Association of Nurse Anesthetists


American Association of Critical-Care Nurses


American Chiropractic Association


American College of Nurse-Midwives


American College of Nurse Practitioners


American Nephrology Nurses Association


American Nurses Association


American Physical Therapy Association


American Psychological Association


American Psychiatric Nurses Association


American Speech-Language Hearing Association


Association of Rehabilitation Nurses


Association of Women's Health, Obstetric and Neonatal Nurses


Emergency Nurses Association


National Association of Clinical Nurse Specialists


National Association of Pediatric Nurse Practitioners


National League for Nursing


National Nursing Centers Consortium


National Organization of Nurse Practitioner Faculties


National Association of Nurse Practitioners in Women's Health


Oncology Nursing Society


Preventive Cardiovascular Nurses Association


Wound Ostomy and Continence Nurses Society


*As of June 12, 2006, according to [Context Link]