Professional Organizations
American Medical Association (AMA)
AMA Mission & Guiding Principles
Mission: To promote the art and science of medicine and the betterment of public health.
Our guiding principles set the aspirations that we endeavor to achieve:
- AMA is one enterprise, highly capable, well-coordinated and focused on high impact results.
- AMA believes that there is a national imperative to chart a successful course for health care delivery that will improve the health of the nation.
- AMA embraces the need for change and believes physician leadership is critical to the successful evolution of health care in a patient focused delivery system.
- AMA will build on its legacy of leading physician ethics, setting standards for medical education, and advancing medical science to serve as the premier voice for the core values of the medical profession.
- AMA has the unique combination of talent with practical skills and intellectual capabilities, the financial resources, and influential multi-sector relationships to be a leading voice in the transformation of health care.
From www.ama-assn.org/ama/pub/about-ama/our-mission.page
The AMA is a large and powerful physician organization. The leverage of the AMA and state medical associations far surpasses the ability of individual physicians to influence practice and policy. Historically the AMA has protected the interests of physicians and often lobbied against health insurance, expansion of scope of practice for non-MD practitioners, and health reform. The AMA is certainly not the only influential health care lobbying group, but they are one of the more influential. Other players include associations of hospitals, associations of insurance groups and the pharmaceutical industry. The non-governmental organizations involved with education, lobbying and research three different types:
- Disease focused (American Cancer Society)
- Professional membership (American Hospital Association)
- Consumers (American Association of Retired Persons)
Lobbying On Health Care Issues Falls In 2010
Source:: www.kaiserhealthnews.org/Stories/2011/January/27/health-care-lobbying-spending-chart.aspx
Professional Monopolies
Physicians have an exclusive scope of practice based on training and expertise. State laws uphold the rights of physicians to stake claim over areas of clinical practice. There are challenges, or turf wars, between groups of MDs and between MDs and non-MD providers. On the surface these battles may center on competency, quality, and safety. There is usually an underlying aspect of finance and protecting one's revenue source. If a group has exclusive rights to perform procedure X that group is not going to welcome other provider types into that market. The group often brings up concerns about quality. When there are also concerns about money, or turf protection, those are not made explicit.
The national shortage of primary care MDs is expected to worsen as health care reform expands access to currently uninsured Americans. One logical solution would be to extend the scope of practice for nurse practitioners (NPs) to allow for more independent practice.
Expanding scope of practice for NPs often creates pushback from associations on the national and local level for physicians. The goal of an interest group for physicians (or any other profession) is to protect the financial interests of its members. If NPs are able to provide more care independently this could threaten physician market share.
There are countless examples of this behavior across the medical professions. Several are bound to pop up on Kaiser Health News over the course of the semester. The specifics differ by state as scope of practice and licensing rules are under state jurisdiction.
They are all variations of the same theme:
- Status quo results under the purview of a strong well-represented profession.
- There is inequitable access, often to disadvantages populations.
- A bill is proposed to improve access by using a new or different section of the workforce.
- The dominant profession protests.
Here are some examples:
In Massachusetts Certified Nurse Midwives had an expansion of scope of practice allowing them to work more independently and to partner with family practice MDs (previously had to be with OB/GYNs). The Massachusetts Medical Society testified against the bill. The bill passed.
A second bill was proposed related to Professional Midwives or Lay Midwives. The Massachusetts Medical Society protested. Local associations for nurse midwives (Certified Nurse-Midwife or CNM) were also against the legislation. The bill did not make any progress.