I recently learned about something very disturbing...the American Medical Association formed a group called the Scope of Practice Partnership (SOPP), whose mission is to launch investigations of unlicensed “midlevel providers” and to support initiatives to fight legislation expanding the current scope of practice for licensed “midlevel providers”. If you search "Scope of Practice Partnership" you'll find some interesting and really scary stuff -- unlicensed "midlevel providers" would include non-Certified Nurse Midwives ("lay" or "direct entry" midwives) in states where licensure isn't available, even if those midwives were CPMs and thus, license "ready". If you read between the lines (and on top of them too) you can see that "investigations" is a nice way of saying prosecution and of course, they also oppose legislation introducing licensure to these sorts of health care providers. Licensed "midlevel providers" include the following: chiropractors, advanced practice nurses (aka nurse practitioners), nurse anesthetists, optometrists, podiatrists, physical therapists and psychologists. This whole thing is being sold as an attempt to "ensure quality health care" but my answer to that would be deal with your own lousy health care before you started trying to "fix" someone else's. We all know how well most physicians do with individualized care...Log in the eye anyone?
Alternatively, I've seen it described as a "clearinghouse of information about non physician providers' educational preparation, licensure requirements, and state legislation and regulation regarding scope of practice." The big question is, what do they plan on doing with the information? Oh, well, whenever there is a "scope of practice question" (that would be some non-physician profession encroaching on the income source of the physicians in that state or states) this information can be used to "address the issue" or even better "develop model legislation that can help resolve that concern." A specific example would be nurse practitioners -- currently, the education level to be a nurse practicioner is at the Master's level. There is a move in the nurse practitioner community to move to a Doctor of Nursing Practice degree, rather than a Master's degree. Why is this a bad idea? Why, it would allow nurses to call themselves doctors! And heaven knows, we can't have that...gosh, are they going to come after me too? After all, I call myself doctor....I'm sorry, but physicians don't have a lock on the generic term "doctor".
I think it is most baldly put in this direct quote from AMA resolution 902 : “that state medical boards shall have full authority to regulate the practice of medicine by all persons within a state, notwithstanding claims to the contrary by boards of nursing, mid-level practitioners or other entities.” Needless to say, they define "practice of medicine" very very broadly. Resolution 902 also asserts that “patients may be put at risk for injury or death . . . receiving care from persons who are not physicians (MD [medical doctor] or DO [doctor of osteopathic medicine])” It is important to realize that there is NO evidence to support this statement and the AMA has been unable to substantiate it. But then again, we all know that patients are never "put at risk for injury or death" by the actions of physicians....who practice only the most scrupulously careful, up-to-date, gold standard medicine, of course.
This is a bully stealing the lunch money from the smart kid, who also happens to be a really nice kid too.
If you'd like to read some analyses of this, I've collected links here:
Coalition for Patients' Rights
Dynamic ChiropracticJune 6, 2006, Volume 24, Issue 12
Dynamic ChiropracticDecember 31, 2006, Volume 25, Issue 02
National Alliance of Professional Psychology Providers
Clinical Journal of Oncology Nursing • Volume 11, Number 2
American Dietetic Association
The Integrator Blog
Maryland Optometric Association
American Association of Nurse Anesthetists
Interestingly enough, I had a chance to discuss the quality empathetic and humane care pregnant women get from "doctors" the other night. For those who don't already know, I'm a Veterinarian and I work at a Veterinary ER Center -- I'm the person you see when your dog gets hit by a car or your cat blocks in the middle of the night (or on the weekend or the holiday, of course). I really love my work and the hours allow me to be other things besides a Veterinarian as well. When I'm working a weeknight overnight shift, I usually have 1 LVT (Licensed Veterinary Technician -- basically the Veterinary equivalent of a Registered Nurse -- they have 4 year degrees and have to pass a written and practical exam to be licensed). Anyway, we were discussing the recent birth events of another employee and I was expressing my disgust at how predictable things are most of the time -- this woman ended up with a cesarean she really didn't want at all and the way she got there was distressingly familiar to me. And my LVT, who is single, childless and in her 50's said all the right things...she was absolutely horrified that over 1 in 3 babies is born surgically. She was amazed that anyone could possibly think its a better way to have a baby. She was shocked that more women are dying in childbirth now than they were a year earlier...she was disgusted at the way OBs manipulate women at the end of their pregnancies when they are tired and and exceedingly hormonal.
Too bad I'm not surprised anymore.
Gretchen
I've had a little time to play around online and discovered that I've been tagged! A fellow blogger (http://labortrials.wordpress.com/) has asked some questions about homebirth....so I'll go for it.
My answers:
Anyone else out there want to play? Pass it along...
I’ve fielded several emails and other sorts of inquiries regarding VBAC bans this week. Sometimes it gets SO depressing…because these women are hoping against hope that if they just ask nicely, or get their research facts in order in a letter to the hospital administration that they’ll be “given permission” to have a VBAC…and that just isn’t what will happen. The only hospitals in the U.S. that I know of who’ve rescinded VBAC bans did so because of intense negative publicity, brought about by groups of women who were willing to work very hard and play the publicity game with no holds barred. All of these hospitals had other hospitals in the area that they competed with, which is a pretty big incentive to not get tagged the hospital in the area that doesn’t treat women well. Good luck convincing the smaller, rural or semi-rural hospital with a monopoly in that community to change their VBAC ban policy. And truthfully, why should they? More often than not, women just roll over and go ahead and schedule the repeat cesarean…even women who’ve had a VBAC already! THAT blows my mind…how a woman who knows the difference between the two can “make” that decision (if you consider it even a decision to be made to go along with the only option your hospital gives you.) At any rate, unless and until women start making an effort to not go this alone, it’s going to be really hard to change on any important level. And honestly, it’s unfair to expect a woman who’s likely in the second half of her pregnancy to have the energy and drive to take on a large corporation who really doesn’t care what any given individual does. ICAN is trying to be the central point in this….if our name would get out there more, maybe we could start creating local action groups…again, the only hospitals I know of who’ve rescinded their bans were also in communities with active ICAN chapters. If you care about this, get involved – either with your local pre-existing ICAN Chapter or go ahead and start one, it isn’t hard at all.
The other thing in my ICAN life that I had a chance to think about today was the “abortion” controversy. I’d received a query from a newer chapter leader about whether ICAN has an official policy or stance with regard to abortion. The answer is no, we do not. Unless “We do not have an official policy on abortion” is an official policy. The reason is really very simple. Our constituency is diverse and falls all along the spectrum of opinions about this issue. If we make being pro-choice or pro-life an issue of “what ICAN supports” we alienate a large proportion of our membership – both those who hold an opposite view to this hypothetical “opinion” and those who simply believe that it isn’t within ICAN’s mandate to have an opinion on abortion one way or the other. But there’s an emerging problem – the language of “choice” really does lend itself to describing the VBAC ban issue – any woman should have the *choice* to plan whatever she desires with regard to her births (yes, this includes non-medically indicated cesareans, though with certain restrictions on who pays for that specific choice). VBAC bans really are an issue of “choice”. But, the language of “choice” comes with some baggage…people associate “choice” with abortion, pretty universally. Anyway, I had an email exchange with someone who wanted reassurance that ICAN doesn’t have an official stance on the abortion debate and I could easily reassure her of that. But we are going to have to deal with this sometime. I think we need a well crafted statement about not having a position – that any woman, regardless of her opinions on abortion, does have a right to determine the birth she will plan, that in our opinion, abortion and birth choices are not inherently linked. Oh, yes, it does close off the argument that “if a woman has the right to terminate an unwanted pregnancy, surely she has a right to plan the birth associated with a wanted pregnancy” and it does open us to the (spurious in my opinion) argument that if the fetus has inherent rights that society needs to protect and speak for with regard to abortion, then surely society has the right and duty to also protect this fetus from dangerous choices made regarding birth. Of course the obvious difference here is that the woman who is planning to terminate the pregnancy isn’t particularly concerned with the fetus being kept “safe”….whereas the vast majority of women who plan a VBAC or heaven forbid, a homebirth (after a cesarean or not) are making those plans just because they believe the evidence says a VBAC (or homebirth or both) are a safer choice for the baby and themselves. There is a basic difference in where the mother’s concern lies between the two issues.
Unfortunately, the way things are right now, the politics of abortion get in the way of ICAN forging alliances with the more prominent (and influential) women’s rights organizations. Well, their complete and apparently utter disinterest in maternity care issues is certainly a problem as well, as is the insistence on linking birth choices and abortion rights. I’d like to see that change. It might be a difficult line to walk but surely we do share a common goal in working to prevent the civil rights abuses inherent in the maternity care system as it exists the U.S. right now. I’m just not quite sure how to start.
