The Next Attempt to
“Contain and Eliminate” Chiropractic?
AMA Creates “Partnership” to Limit Other Providers’ Scope of
Practice; Dynamic Chiropractic; June 6, 2006, Volume 24, Issue 12
More than 40 years ago, the American Medical Association (AMA)
made its first attempt at destroying the chiropractic profession when it formed
the Committee on Quackery in November 1963. 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. The primary
objective of the Committee on Quackery was to “contain and eliminate”
chiropractic as a recognized health care service in the
Now, more than 30 years after the committee was disbanded, and
almost 20 years after Judge Susan Getzendanner issued an 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 damage the chiropractic profession, not by engaging
in an illegal boycott or prohibiting its members from associating with
chiropractors, but by restricting what chiropractors and other health care
providers are allowed to do in the course of their own practice.
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” such as doctors of chiropractic, acupuncturists and
naturopathic physicians. The resolution, adopted at the AMA’s most recent
interim meeting in
“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
In addition, the number of states allowing for the practice of
certain types of
The AMA’s resolution, 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.
The full text of the resolution 2 is as follows:
Resolution 814 -
Limited Licensure Health Care Provider Training and Certification Standards
Whereas, The physicians of America voluntarily perform a vital
role through initial and subsequent credentialing and privileging of limited
licensure health care providers at health care facilities and through peer
review of the quality of care provided by these providers at these facilities;
and
Whereas, In comparison to the uniform national standards of
undergraduate and graduate medical education and board certification for
physicians, the education and certification standards for limited licensure
health care providers may not be uniform nor well-defined nor generally
understood by physicians and the public; and
Whereas, The American public and health care facilities’
governing boards rely upon physicians to be well-informed about the education,
training, and certification standards of all health care professionals when
performing voluntary credentialing, privileging, and peer-review; and
Whereas, State legislatures, courts, and regulatory agencies
frequently call upon the opinions and/or testimony of informed physicians when
they consider the public’s safety and qualifications in relation to the
statutory limitations of practice of limited licensure health care providers;
and
Whereas, While our American Medical Association has well defined
the training and certification of 65 allied health professionals in its 33rd
edition of Health Professions Career and Education Directory, 2005-2006, there
is no similar source of information on such limited licensure health care
providers as chiropractors, optometrists, nurse anesthetists, advanced practice
nurses, podiatrists, or psychologists; and
Whereas, The standards for admission, graduate education,
postgraduate training, education, testing, graduation, board certification,
board governance, ethics, professional discipline, and licensing of limited licensure
health care providers are neither well-defined nor generally known by
physicians or public members who voluntarily evaluate and recommend them, grant
them privileges, and conduct peer review of the quality of care they provide;
and
Whereas, the uniformity of training, autonomy of accrediting
organizations, independence of peer review, and the role played by the
professions’ trade associations of limited licensure health care providers are
neither well-defined nor generally known by physicians or public members who
voluntarily evaluate and recommend them, grant them privileges, and conduct
peer review of the quality of care they provide; therefore be it
RESOLVED, That our American Medical Association along with the
Scope of Practice Partnership and interested Federation partners, study the
qualifications, education, academic requirements, licensure, certification,
independent governance, ethical standards, disciplinary processes, and peer
review of the limited licensure health care providers, and limited independent
practitioners, as identified by the Scope of Practice Partnership, and report
back at the 2006 Annual Meeting.
A fiscal note that accompanies the resolution allocates $171,975
to fund the work associated with Resolution 814, including staffing, publishing
the results of the study, and input of legal counsel.
Interestingly, the original version of the resolution singled
out chiropractors as one of six groups of health care providers – and the only
one that could be considered “alternative” – to be studied by the AMA. (The other five were advanced practice nurses,
nurse anesthetists, optometrists, podiatrists and psychologists.)
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
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 that 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.”
An article in the March 2006 issue of Psychiatric News, the
American Psychiatric Association’s newspaper, includes further details on the
partnership’s structure and purpose.7 According to the article, the partnership
was formed “in an effort to marshal the medical community’s resources against
the growing threat of expanding scope of practice for allied health
professionals.” It currently is comprised of six state medical associations (
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
nonmedical 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
When combined with the $170,000 the AMA has allocated to pay for
staff and study publication as part of its “basic level of support,” the Scope
of Practice Partnership is already believed to have a minimum of $470,000 at
its disposal. Based on the pledges from its founding members, the partnership
will continue to receive a minimum of $300,000 in additional funding each year
– an amount expected to increase as more societies and associations join its
ranks.
The Profession
Comments on Partnership
The introduction of Resolution 814 and the formation of the
Scope of Practice Partnership have been met with skepticism by the chiropractic
profession’s leaders, who believe the AMA’s intention is not to “ensure quality
care for patients,” as claimed by Dr. Maves, but to use the partnership and the
study to discredit chiropractors and other health care providers in the eyes of
state and federal legislators. As of press time, Dynamic Chiropractic had
received several statements from chiropractic organizations and individuals:
“After nearly a century of struggling with the relentless
negativity by allopathic medicine against chiropractic medicine, I thought the
Wilk trial would bring an end to it, and for awhile, it seemed that the ‘turf
war’ was diminishing,” remarked James F. Winterstein, DC, president of National
University of Health Sciences. 8 “However, within the past several years ,it
seems to be expanding once again, as organized medicine is encouraging its
members to engage in legislative strategies to contain and restrict expansion
of practice scope of various nonallopathic health care providers. This is being
done under the guise of patient protection, just as it was during the Wilk
trial. Meanwhile, allopathic iatrogenic disorders and loss of life continue
unabated.
“I wonder if the irony is lost on the public. If patient care is
the true concern, then it is well past time that physician members of all
professions find a way to work in concert – to become colleagues rather than
competitors. No one has all the answers – there is no panacea for human
illness. The allopathic profession, in my opinion, brings great shame upon
itself with this reversion to self-aggrandizing turfism.”
The American Chiropractic Association expressed similar concerns
about the partnership and its potential effect on the practice of chiropractic:
“The ACA and state chiropractic associations will vigorously
oppose any efforts by the AMA to limit or otherwise restrict the state
authorized care provided to patients by licensed doctors of chiropractic. These
actions by organized medicine will only limit access to providers who have the
education, expertise and experience to provide safe, quality health care
services to the public.”9
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. In the meantime, expect a veritable slew of responses from leaders and
organizations within the chiropractic and other health care professions. Look for an update on the AMA Scope of
Practice Partnership and its potential effects on the practice of chiropractic
in an upcoming issue of ’DC.
References
Simpson KJ. The Iowa Plan and the activities of the Committee on
Quackery. Chiropractic Journal of
Resolution 814: Limited Licensure Health Care Provider Training
and Certification Standards. www.ama-assn.org/meetings/public/interim05/refcomkannotateda05.doc.
Croasdale M. Physician task force confronts scope-of-practice
legislation. American Medical News Feb. 13, 2006.
Barnes P, Powell-Griner E, McFann K, et al. CDC Advance Data
Report #343. Complementary and Alternative Medicine Use Among
Adults:
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.
Hill JE.
Daly R. AMA forms coalition to thwart non-M.D. practice
expansion. Psychiatry News March 2006;
41(5). http://pn.psychiatryonline.org/cgi/content/full/41/5/17-a.
E-mail from Dr. James Winterstein to Dynamic Chiropractic, May
10, 2006.
E-mail from the American Chiropractic Association to Dynamic
Chiropractic, May 15, 2006.
Written by Michael Devitt
Dynamic Chiropractic
June 6, 2006, Volume 24, Issue 12