Erik Goldman10.01.06
AMA to Oppose ND Licensure
The AMA has put forth several initiatives to restrict the work of alternative healthcare practitioners, and even nurses.
ByErik Goldman
The American Medical Association (AMA), the nation’s largest medical organization, appears to be girding itself for battle against non-MD healthcare practitioners, so anyone interested in the healthcare practitioner channel of the natural products industry would do well to pay close attention.
The AMA’s goal, it would seem, is to reassert itself—and by extension, conventional MD-dominated medicine—as the ultimate arbiter on all healthcare policy issues. On grounds of “patient protection” and “public interest,” the AMA has taken several steps over the last year to restrict the growth and expansion of naturopathic doctors (NDs), doctorate level nurse practitioners, and professionals who, together with the mainstreaming of “alternative” medicine, represent a threat to the longstanding hegemony of conventional, drug-based allopathy.
The AMA’s House of Delegates is considering a resolution that would formalize a policy of direct opposition to licensure for naturopathic physicians. Resolution 209 opposing ND licensure was introduced to the House of Delegates in May by the AMA’s Florida delegation. It reads as follows:
“Whereas, The American Medical Association has always stood for patient safety and the science of medicine; and Whereas, The well-being of patients and the ability for them to be taken care of in the best manner is a goal of the AMA; and Whereas, There is a misconception about the extent of the education and training of naturopaths; and Whereas, The AMA has no set policy concerning the licensing of naturopaths to practice medicine without the proper educational background; and Whereas, Many states are now facing an onslaught of non-MDs/DOs wanting to practice medicine; therefore be it RESOLVED, That our American Medical Association work through its Board of Trustees to outline a policy opposing the licensure of naturopaths to practice medicine and report this policy to the House of Delegates no later than the 2006 Interim Meeting (to be held Nov. 11-14, in Las Vegas).”
Fabrications & Misrepresentations
At issue are the state-level efforts by NDs and NMDs to establish licensure laws that would define clear scopes of practice and educational standards for anyone calling him or herself a naturopath. Currently, only 14 states have naturopathic licensure laws.
Michael Traub, ND, a naturopath based in Hawaii, who has served as president of the American Association of Naturopathic Physicians, believes the AMA’s resolution is based on fabrications and misrepresentations. “Education standards for NDs and NMDs seeking state-level licensure laws are well documented, but the AMA’s resolution simply uses the term ‘naturopath,’ and fails to distinguish between graduates of a 4-year naturopathic medical school accredited by the Council on Naturopathic Medical Education and others who use the title of ‘naturopath,’” he said.
People who earn an ND or NMD from one of the four accredited schools (National College of Natural Medicine, Bastyr University, Southwest College of Naturopathic Medicine and University of Bridgeport) receive thorough training in anatomy, physiology, biochemistry, diagnosis and related health sciences, in a curriculum that closely overlaps conventional allopathic medical training. They also receive intensive practical training in nutrition, botanical medicine, physical medicine and pharmaceutical therapies. But in states without licensure laws, there’s nothing to stop anyone from using the term “naturopath,” regardless of their level of training.
“If there is any ‘misconception’ about naturopathic medical education, it is because those who drafted Resolution 209 failed to do their homework,” said Dr. Traub, who pointed out that the new resolution originated in Florida, where an ND licensure bill has come close to passing.
He and other leaders in the naturopathic community believe that by opposing rather than supporting ND/NMD licensure, the AMA and its affiliated state associations actually threaten the very public well-being they claim to be protecting.
Jane Guiltinan, ND, current president of the American Association of Naturopathic Physicians (AANP), stated that her organization “Fully supports the AMA’s stated goal of providing the highest quality of care for patients. Indeed, that is why AANP is committed to passing licensure laws for naturopathic physicians in all 50 states. Licensing laws that clearly define scope of practice ensure patients have access to trained professionals held accountable by regulation and state oversight.” By blocking licensure of NDs, the AMA “actually places patients at greater risk for misdiagnosis and improper treatment from those who call themselves naturopathic doctors, but have not attended accredited institutions or have not received the clinical training required to diagnose and treat.”
Some NDs, like Dr. Lise Alschuler, president of the Illinois Association of Naturopathic Physicians, view Resolution 209 as nothing short of an act of war. “It makes their (AMA’s) position on naturopathic medicine very clear. It is going to make our jobs a lot harder for the next few years, but we’re doing this for one reason: licensure is necessary to provide public access to high-quality natural healthcare,” she said, adding, “Formal AMA opposition could derail ND/NMD licensure efforts in New York, Florida, Pennsylvania, Illinois, Massachusetts, North Carolina and several other states.”
The AMA’s opposition to the growing strength of non-MD practitioners is nothing new, but it does run counter to the vision of “integrative” medicine that has gained credence over the last decade. AMA certainly does not represent the views of the many MDs who wish to develop a more collaborative relationship with NDs, oriental medicine practitioners and other “alternative” providers.
Larry Palevsky, MD, president of the American Holistic Medical Association (AHMA), said he has personally written letters supporting ND licensure to New York State legislators, stressing that AHMA is “committed to building relationships with the community of licensed naturopaths.” However, his organization has yet to issue a formal statement on ND licensure or the AMA resolution opposing it.
Despite the AMA’s stated concerns for the public well-being, there is no evidence that well-trained NDs and NMDs practicing in licensed states threaten public health in any way. Dr. Traub believes Resolution 209 must be viewed in a broader context.
In 2004, the AMA joined forces with six subspecialty societies and six state medical societies to create the Scope of Practice Partnership (SOPP) with a stated mission “to oppose scope of practice expansions by allied health professionals that threaten the health and safety of the public.” SOPP’s activities have potentially far-reaching implications. Scope of practice expansions are the legislative means by which various practitioner groups seek formal licensure to provide patients with a greater range of services. Historically, scope of practice issues engender some of the most vicious inter-disciplinary turf battles.
Nurses with Doctorate Degrees
The AMA also recently passed Resolution 211, identifying a “Need to Expose and Counter Nurse Doctoral Programs Misrepresentation.” The target here is nursing schools offering Doctor of Nursing Practice (DNP) degrees.
According to John Weeks’ The Integrator Blog (www.theintegratorblog.
com), 19 nursing programs in 17 states now offer DNPs, and another 190 doctorate level nursing programs are in the works. Not surprisingly, the MD establishment, represented by the AMA is none too happy with the idea of nurses who can be called “doctor.”
The AMA argues that these programs misrepresent DNP training by implying that a DNP is equivalent to an MD degree. This, despite the fact that The American Association of Colleges of Nursing (AACN) has clearly stated that the DNP is not intended to substitute MD, nor do the schools represent it as such. The nursing profession, the AACN insists, is simply following precedents set by pharmacists, psychologists, and other non-MD health professions with doctorate-level education.
The Healthcare Truth & Transparency Act
The AMA’s current push to re-establish itself as the final determinant on all things related to healthcare practice is best evidenced by HR#5688, the “Healthcare Truth and Transparency Act,” a bill introduced into the House of Representatives in June by Rep. John Sullivan (R-OK). The AMA and SOPP were the prime drivers behind this bill, which would make it a crime for any licensed healthcare professional who does not have an MD, DO, DDS or DMD degree, to “make any deceptive or misleading statement, or engage in any deceptive or misleading act, that deceives or misleads the public” into thinking the he or she is an MD, DO or dentist, or possesses the same education, skills or training.
According to Dr. Traub, this is reasonable in principle. But the bill’s intention and possible interpretations if passed are another matter. “Its broad categorization of deceptive or misleading acts, and its vagueness on state level policies could conceivably turn this bill into a tool to override existing state laws recognizing chiropractors and NDs as physicians,” he explained.
Dr. Traub believes that beneath all the high-minded rhetoric about patient safety, the AMA’s true motives are based on arrogance, ignorance, fear and resentment. “The arrogance is in the deep-seated conviction that conventionally trained physicians are somehow extraordinary, and should be the ONLY gatekeepers for ALL other healthcare professionals. The ignorance is in the substitution of fabrications for well-researched understanding. The fear and resentment relate to perceived loss of control some MDs feel in reaction to the evolution of non-MD/DO healing professions,” he said.
Long-term Effects of AMA Opposition to Alternative Healthcare
How will all this affect the practitioner channel within the supplement industry? It is difficult to say at this point. But NDs, chiropractors, and to some extent nurse practitioners have been very strong advocates for nutrition-based medicine and broader use of herbs. Restriction of their abilities to practice freely and legislative roadblocks to the further evolution of these professions could hinder the growth of the practitioner channel to the detriment, I believe, of public well-being.
Formal AMA opposition against those who provide natural healthcare alternatives could also have a chilling effect on holistically-minded MDs, the ranks of which have been growing in recent years. The AMA’s current sword-rattling, if it becomes state or federal policy, could put the “kibosh” on many integrative medicine endeavors aimed at creating a more egalitarian healthcare system that honors individual freedom of choice.
In the coming years, the naturopathic, chiropractic, nursing and holistic MD communities may very well need support—political and financial—from the natural products industry. I strongly hope that leaders of our industry will stand in solidarity with practitioners on the front line of what is shaping up to be a major challenge to the viability of natural medicine in this country.
The AMA’s policies will only isolate conventional medicine and promote discord, rather than harmonizing healthcare under the basic purpose of patient care and patient choice. They will foster fanaticism and blind loyalty, rather than intelligent dialog. Recognizing the high level of responsibility all healing professionals must assume, we should affirm our commitment to promote appropriate standards for education, licensure and certification, to support appropriate practice and care management guidelines, and to facilitate communication and collegial relationships between all healthcare professionals.
The new resolution is under review by the AMA’s House of Delegates, and is one of several political moves clearly indicating the AMA’s intention to restrict non-MD healthcare practitioners and re-assert its role as the sole arbiter of healthcare practice.