AMA Callback Regarding Forbes and WSJ Article

[Coastie]

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Went through two people who took down info, including the forum address here.

The initial two people (screeners) "hadn't heard of the articles", and "never heard of SDN".

Got a call from an AMA higher-up on his personal cell who will remain anonymous.

Edited points of discussion:

- These two articles, especially the Forbes, have been under the watchful eye of the list-serves and the board of trustees.
- The strategy since seeing them in November, and before, are that fighting this publicly would look like the "big, bad doctors" are trying to take away from the nurses. They feel any overtly public strategy would be self-defeating.

- I retorted that a) the DNP's are playing hardball, and so should we, b) we (the residents, young attendings, etc) have no idea what the AMA is doing for us, and therefore, feel disinclined to participate financially or with our time and c) we are ready, willing, and eager to help out.

- Responded that they send out coordination tools via the AMA voice (snail mail)
- Retorted that nobody reads those, and that they should get an official SDN account to keep us updated and disseminate information. They concurred, and said we will be hearing from them within a few days on here in an official capacity.
- Said that publicly, the 2220 issue (the loan deferment program) was important as well, and that we should focus on that too.
- I told them we had, and that we want more on the DNP issue. They reiterated that "a lot" is going behind closed doors on the state and national levels. I requested that they write a rebuffing article in Forbes and WSJ, as my non-med friends were pretty well fooled by the Mudslinger article, claiming that they were actually FOR DNP's, until I explained exactly what that meant, at which time they were utterly repelled.

Overall Discussion Take-Away:
- AMA needs an SDN presence for communication and dissimination of information to busy residents who check SDN @ 3 AM on call
- We need physicians involved with AMA, so we who are concerned can direct the organization appropriately
- AMA is fighting this heavily privately, but I disagreed in that I think there should be a more public force. Unless they get a lot more phone calls, I think it will all stay "behind closed doors".
- AMA says they are working a lot for us on issues such as loan deferment, residency benefits in the open, as well as a lot behind closed doors, and as such, need our support

Points of Action for SDN members:

-I say we contact AAFP and ASA, who were quoted in the article
-Encourage coordination across sub-specialty group lines.
-Support the AMA and join up if you aren't there so you have a voice at the table
-Call the AMA so Coastie doesn't sound like a lone ranger



If you have any other questions or thoughts, just post in this thread.

 

[distracted]

I was curious about what other info was out there on this topic so I did a quick search on Google. It's amazing how many "official" responses there are to these articles from other nursing lobbying groups. They are overwhelmingly negative. Current NPs are offended by Mundinger and feel devalued. Others feel that it is just a ploy by the universities to increase their revenue streams. Some others feel it is simply unnecessary. It seems that most nurses just want to be nurses. I haven't personally met any who desire to be doctors.

Here's a link to a thread on a nursing message board:

http://allnurses.com/forums/f34/doctoral-degree-become-np-160044.html

If you read a few pages, you'll notice that the conversation is very rational and calm until someone from a medical background pounced onto their board all defensively. Once this happened, the nurses started defending their turf and the conversation became very polarized. I think the lesson here is that the AMA may be correct in not publicly going after the nurses. It seems that other nursing groups may be doing this for them -- you know, give them enough rope to hang themselves. Nothing will unify the nurses like a group of angry doctors.

 

[Winged Scapula]

Strong work Coastie (full of retorts 😀 )!!

 

[Kubed]

Awesome job! 👍

 

[lord_jeebus]

Thanks Coastie

 

[Tired]

- AMA is fighting this heavily privately, but I disagreed in that I think there should be a more public force. Unless they get a lot more phone calls, I think it will all stay "behind closed doors".
- AMA says they are working a lot for us on issues such as loan deferment, residency benefits in the open, as well as a lot behind closed doors, and as such, need our support

See, this is why I didn't join AMSA and will not join the AMA. They are fighting this "heavily" in private. Really? Really? Why should I believe this? I go down to the metro station near my apartment and the walls are plastered with that stupid "47 million" campaign that is really a morass of half truths and poorly-conceived political PR. But not a word about DNPs, CRNAs, nursing strikes, or physician reimbursement. Nothing.

What the f*** is the AMA anyway? Are they a social advocacy organization, or a professional organization? You know when I most hear about the AMA? When (1) the death penalty or abortion come up in the news, or (2) they want my money. That's it.

"Behind the scenes". WTF? If they are really a national organization representing physician interests, then their power comes from our numbers, not private conversations in locked rooms. They're not politically connected insiders; they're the professional equivalent of union bosses: without loud voices and public fights, then they're nothing. And this is precisely why I don't believe they are doing anything at all.

I hope I am proved wrong. I hope they actually get on here and explain themselves. But as of right now, in my mind, they are irrelevant to my career and I do not support them at all. I will not be calling them, because they do not represent my interests.

 

[smq123]

- AMA is fighting this heavily privately, but I disagreed in that I think there should be a more public force. Unless they get a lot more phone calls, I think it will all stay "behind closed doors".
- AMA says they are working a lot for us on issues such as loan deferment, residency benefits in the open, as well as a lot behind closed doors, and as such, need our support

Points of Action for SDN members:

-I say we contact AAFP and ASA, who were quoted in the article
-Encourage coordination across sub-specialty group lines.
-Support the AMA and join up if you aren't there so you have a voice at the table
-Call the AMA so Coastie doesn't sound like a lone ranger

See, this is why I didn't join AMSA and will not join the AMA. They are fighting this "heavily" in private. Really? Really? Why should I believe this? I go down to the metro station near my apartment and the walls are plastered with that stupid "47 million" campaign that is really a morass of half truths and poorly-conceived political PR. But not a word about DNPs, CRNAs, nursing strikes, or physician reimbursement. Nothing.

"Behind the scenes". WTF? If they are really a national organization representing physician interests, then their power comes from our numbers, not private conversations in locked rooms. They're not politically connected insiders; they're the professional equivalent of union bosses: without loud voices and public fights, then they're nothing. And this is precisely why I don't believe they are doing anything at all.

I will not be calling them, because they do not represent my interests.

Strong work, Coastie.

However, I am inclined to agree with Tired. I don't want to join the AMA or AMSA - why should I spend that money when they don't seem to have my interests at heart?

Fighting this heavily in "private"? That sounds shady. There has been PLENTY of national exposure for that stupid ad campaign of theirs, where people are holding stethoscopes up to their mouths...but fighting for easier loan repayment options and protecting the profession from DNPs is something that is better fought "in private"? That's ridiculous.

And I also find it VERY hard to believe that the people at the AMA still believe that snail mail is the best way to contact members. In the era of email, I can't believe that they'd rely on snail mail to spread the word of what they're doing. And they didn't realize that they could use SDN to reach med students and residents all over this country? I mean, if local folklore is correct, a television sitcom writer found and utilized SDN! And the AMA couldn't do the same thing?

I will happily support the AAFP and the ASA. Heck, I will even lobby ACOG, ACP, and ACS to issue some kind of public support.

And yes, the AMA does need our support - but they're not doing ANYTHING to earn it.

 

[Miami_med]

See, this is why I didn't join AMSA and will not join the AMA. They are fighting this "heavily" in private. Really? Really? Why should I believe this? I go down to the metro station near my apartment and the walls are plastered with that stupid "47 million" campaign that is really a morass of half truths and poorly-conceived political PR. But not a word about DNPs, CRNAs, nursing strikes, or physician reimbursement. Nothing.

What the f*** is the AMA anyway? Are they a social advocacy organization, or a professional organization? You know when I most hear about the AMA? When (1) the death penalty or abortion come up in the news, or (2) they want my money. That's it.

"Behind the scenes". WTF? If they are really a national organization representing physician interests, then their power comes from our numbers, not private conversations in locked rooms. They're not politically connected insiders; they're the professional equivalent of union bosses: without loud voices and public fights, then they're nothing. And this is precisely why I don't believe they are doing anything at all.

I hope I am proved wrong. I hope they actually get on here and explain themselves. But as of right now, in my mind, they are irrelevant to my career and I do not support them at all. I will not be calling them, because they do not represent my interests.

Unfortunately, this pretty much echoes my sentiments exactly. I received my renewal recently in the mail, and I will not be maintaining my membership. Prove to me that you have ANY value, and I'll consider it. I can't even find any misguided efforts. They seem to have none of my personal interests at heart, lobby hard for social issues with which I tend to disagree, and they do nothing to correct the underlying problems.

For those that want to maintain the current payment system, I see NOTHING improving the Medicare/Medicaid situation, nothing fighting the DNPs, independent PAs, etc....

For those of us that want to change the system completely, I see NOTHING fighting the Stark Laws, trying to reform EMTALA, etc....

Occasionally I see some push to impose some cap on non-economic damages in lawsuits, with nothing happening to change the whole system.

If they've been fighting these things "behind closed doors," then they really are quite terrible at it. As far as the nursing thing, there are a million ways to fight this publicly without coming down hard on nurses. An example might be:

"we are worried that this inferior training path to independent practice will be dangerous to our patients, and while we respect our nursing colleagues and the unique skillset that they possess, we are concerned that this exceeds their capacity and will diminish access to quality primary care for the average american. We are also concerned that this will exacerbate the already critical nursing shortage and encourage our colleagues in the nursing profession to return to the positions at which they are truly needed for the betterment of both professions and the patients."

You can quote that AMA.

 

[mig26x]

I also have to say that I dont like the way AMA has express itself about how they are approaching this situation. I also received my AMA renewal subscription and I wont be filling it out anytime soon.

figthing someting heavily behind close doors doesnt do if when it comes to my professional future and family. sorry.

Thanks to the poster that called AMA for your work and time.

 

[Tired]

"we are worried that this inferior training path to independent practice will be dangerous to our patients, and while we respect our nursing colleagues and the unique skillset that they possess, we are concerned that this exceeds their capacity and will diminish access to quality primary care for the average american. We are also concerned that this will exacerbate the already critical nursing shortage and encourage our colleagues in the nursing profession to return to the positions at which they are truly needed for the betterment of both professions and the patients."

You can quote that AMA.

They will.

But only behind closed doors.

Really. They promise. Pinkie swear. 🙄

 

[surg]

Not to be an apologist, but the AMA really led the way in getting the 20/220 pathway extended this last year when it was bumped off "inadvertently". This occurred WITHOUT new legislation via a regulatory path, so essentially it happened "behind closed doors." This is concrete.

They (via their Foundation, and their PAC) just subsidized about 300 med students and residents to come to DC on March 31st to talk to their legislators about it, as well as the uninsured. That's putting money into issues that matter to the students and residents.

I also went to the Hill for my specialty society recently at our joint surgical advocacy meeting on the Medicare payment problem. There was virtually no mention of 20/220 or the rising cost of tuition.

AMA leaders are elected and students, residents, and young physicians control a large number of votes and each have a member of the board of trustees. Few specialty organizations have slots in the upper echelon of leadership for people of our level. I agree that the AMA is behind on electronic bulletin board participation (although they did invest/commit to Sermo this year), but that doesn't mean they aren't doing anything.

I've had communications with the lobbyists for both the AMA and my specialty society, and the thing that I'm always impressed with is how much can be accomplished in the back halls of Congress. Defeating bad provisions is an endless and thankless task, but it is what the bulk of their work is. Occasionally you get a nice public win, but the bulk of time you don't get that. But sometimes you get to restore Medicare funding, even temporarily and get each doctor in the US between $4,000 and $10,000/year in Medicare revenue alone (let alone all the other stuff that is tied to the Medicare pay scale). They did this in 7 out of the last 8 years (failing once). That's worth the $420 in dues I send them yearly alone.

The AMA is not perfect. It loses in DC as often as it wins. But in my mind, I'm not sure who else even has a prayer of fighting for us and coordinating specialty groups when needed.

 

[Faebinder]

👍 Great work Coastie! Now if we can get some of the AMA to actually get out of the CLOSED DOORS!

Look folks, the key difference between a physician and a nurse going after medicine is the degree to which the science is followed. If this issue is to be put to rest we need to show scientifically how it is in the public interest to stop this facade.

1) AMA sponsered research to show the true difference between the level of education in primary care. Published evidence that can be utilized to prove our point which is that the scope difference matters between mid levels and physicians in primary care.

2) The AMA needs to be an active public organization. Hiding in the dark only weakens you. It's bad for physicians, the organization and medicine in general.

 

[yippyskippy]

I am pretty freaked out by this whole nurse thing as well - especially the framing of the role of the DNP as someone with the knowledge of a physician and skills of a nurse...

As for AMSA and AMA doing things behind closed doors, I think that is to be expected of any organization lobbying on capitol hill. I don't really have a position on either organization per se, but I have worked in DC and I think surg has a good point. Most federal legislation happens behind closed doors, before anything hits the house or senate floor, and actually most bills are lucky to survive subcommittee and committee and actually make it to the floor... and the whole process is incredibly sloooooooow.
I do know that the AMA and AMSA both have a strong DC presence, but press of what they do is often vague, probably because it is not really in their best interest to publish all the things they lobbied for that never made it into legislation - in part because it looks like a failure, but more because you don't really want to publicly paint the legislators that didn't support that particular bill as bad guys if you're going to go lobby to them the next day about your other important issues....
As for the stuff outside of DC, I don't really know about it. It's possible that it works the same way. Politics are politics wherever you go.

Anyway, I don't like that most of the laws that we live by are decided and bargained for behind closed doors either, but I am not sure we can blame it on our medical organizations just because they're trying to manipulate the game in our favor.

Just a thought.

 

[DrDawg]

Not sure if I will renew. AMA spent millions on its last membership campaign with little success. Although I think it is impossible for them to 180 on issues, they have got to come to the conclussion eventually that their view points are not inline with many physicians.

 

[Miami_med]

Nurses have a VERY public publicity campaign, and it is WORKING. I don't think we have anything to hide. I think that the majority of people (those who vote for the legislators) would actually agree that someone with a bachelors degree and some classes in nursing theory shouldn't be their doctor. The public is just clueless as to what is going on. The government will do everything in their power to steer people to midlevels to save money, regardless of what the AMA does privately in Washington. However, no politician is going to want to sign anything that publicly attaches his name to any mandates that diminish access to medical doctors. That's why we need to make it public. The public will largely agree with us as long as we control ourselves and don't attack all nurses because a small minority of disgruntled midlevels in NY want to play doctor.

I think that if we can remain civil, the majority of midlevels will agree with us. A midlevel job is a good job. Fewer years of training, often limited work hours, close to or above six figure salary, etc... Most of them like their jobs and don't want the added responsibility, work, and liability that comes with independent practice. A public campaign is the right choice if there is anyone with a remote amount of tact ANYWHERE in physician professional leadership.

 

[mig26x]

Nurses have a VERY public publicity campaign, and it is WORKING. I don't think we have anything to hide. I think that the majority of people (those who vote for the legislators) would actually agree that someone with a bachelors degree and some classes in nursing theory shouldn't be their doctor. The public is just clueless as to what is going on. The government will do everything in their power to steer people to midlevels to save money, regardless of what the AMA does privately in Washington. However, no politician is going to want to sign anything that publicly attaches his name to any mandates that diminish access to medical doctors. That's why we need to make it public. The public will largely agree with us as long as we control ourselves and don't attack all nurses because a small minority of disgruntled midlevels in NY want to play doctor.

I think that if we can remain civil, the majority of midlevels will agree with us. A midlevel job is a good job. Fewer years of training, often limited work hours, close to or above six figure salary, etc... Most of them like their jobs and don't want the added responsibility, work, and liability that comes with independent practice. A public campaign is the right choice if there is anyone with a remote amount of tact ANYWHERE in physician professional leadership.

I agree with you 100%. We should make this public.

 

[deleted6669]

I think that if we can remain civil, the majority of midlevels will agree with us. A midlevel job is a good job. Fewer years of training, often limited work hours, close to or above six figure salary, etc... Most of them like their jobs and don't want the added responsibility, work, and liability that comes with independent practice. A public campaign is the right choice if there is anyone with a remote amount of tact ANYWHERE in physician professional leadership.

agree- I'm all for reasonable autonomy within your area of experience with physician backup but independent practice based on the very weak dnp curriculum isn't ok.

 

[toughlife]

Nice work buddy! 👍

 

[filter07]

I disagree that we all need to be gods of science in order to treat patients. What is it about the first two years of medical school, and the fact that I crammed for Step1 with First Aid for the Boards, makes me so much more qualified to treat someone's migraine than someone else? Virtually everything I know, I learned from my clinical rotations or from First Aid for the Boards. How does that make me automatically more qualified than a Doctor Nurse who has similar half-assed training and an additional few years of clinical experience?

Sorry to be the devil's advocate here, but do you really need an MD or DO to write a prescription for Oxycodone? To prescribe allergy meds? To perform screening physical exams? To do well-baby exams? To measure someone's uterus and sign off on an ultrasound tech's reads? To provide MAC in the OR? The era of the physician supergod is over folks. It's time to compete just like everyone else. Just because you slaved away during your 20s doesn't give you the right to everything. Political turf battles are petty. Prove your worth, don't lobby for it.

 

[daru1]

Sorry to be the devil's advocate here, but do you really need an MD or DO to write a prescription for Oxycodone? To prescribe allergy meds? To perform screening physical exams? To do well-baby exams? To measure someone's uterus and sign off on an ultrasound tech's reads? To provide MAC in the OR?

short answer, "yes." long answer, "yes you do."

No one is claiming to be gods, we have a set of rules and procedures to credential oneself to be able to do all of those things above. What's next? Nurses doing complete knee reconstructions? See the slippery slope mentioned before. As a wise doctor before our time said, "I went to 'write it school,' you went to 'do it school,' the pharmacist went to 'fill it school.'" Deal with it, or go to nursing school and then you can truely say you have a physician's knowledge with a nurses touch.

 

[Faebinder]

I disagree that we all need to be gods of science in order to treat patients. What is it about the first two years of medical school, and the fact that I crammed for Step1 with First Aid for the Boards, makes me so much more qualified to treat someone's migraine than someone else? Virtually everything I know, I learned from my clinical rotations or from First Aid for the Boards. How does that make me automatically more qualified than a Doctor Nurse who has similar half-assed training and an additional few years of clinical experience?

Sorry to be the devil's advocate here, but do you really need an MD or DO to write a prescription for Oxycodone? To prescribe allergy meds? To perform screening physical exams? To do well-baby exams? To measure someone's uterus and sign off on an ultrasound tech's reads? To provide MAC in the OR? The era of the physician supergod is over folks. It's time to compete just like everyone else. Just because you slaved away during your 20s doesn't give you the right to everything. Political turf battles are petty. Prove your worth, don't lobby for it.

Somewhat agree but you are wrong to think that you _ALWAYS_ need to prove your worth because the word "worth" is measured differently for different perspectives. Insurance company (those 5% odd diagnosis in primary care are not worth it, let them die and if they sue we will just settle) vs. Common patient (it's my life and if I got the disease then al others can go to hell) vs. Government (Using as little money as we can, where can we draw the line so that the Insurance company and the common patient are not pissed).

Also... This is real life. In real life, the person could be the BEST person for the job, doing a GREAT work, making EVERYONE (patients/coworkers/scientists) happy but in the end lose to someone who knows someone important and got the promotion. You might be happy just being that great person, but it is foolish to think that a great product will always sell itself without promoting it.👎

 

[mig26x]

I really dont understand when nurses say that they have the same knowledge as Doctors but our hours of training and studying are way more than that of a nurse. It makes me laugh.

 

[mig26x]

And another thing, nurses states that they have qualities that doctors dont have, well, they might listen better to a patient because they have 20-30 more minutes per patient than docs have, but I want to see them when they have to see x amount of patients in one hour just to make it financially, and I also would like to know if DNP's are going to have a 9-5 schedule or are they going to be there until they see the last patient, fill out the last prescription etc etc. I have seen alot of nurses running out of the hospital when there shift has ended. are they willing to stay the extra time? are they willing to work 6 days a week ? Thats someting that I see in docs and not in nurses.

 

[Blade28]

Wow, great work, Coastie!

 

[dynx]

I disagree that we all need to be gods of science in order to treat patients. What is it about the first two years of medical school, and the fact that I crammed for Step1 with First Aid for the Boards, makes me so much more qualified to treat someone's migraine than someone else? Virtually everything I know, I learned from my clinical rotations or from First Aid for the Boards. How does that make me automatically more qualified than a Doctor Nurse who has similar half-assed training and an additional few years of clinical experience?

Sorry to be the devil's advocate here, but do you really need an MD or DO to write a prescription for Oxycodone? To prescribe allergy meds? To perform screening physical exams? To do well-baby exams? To measure someone's uterus and sign off on an ultrasound tech's reads? To provide MAC in the OR? The era of the physician supergod is over folks. It's time to compete just like everyone else. Just because you slaved away during your 20s doesn't give you the right to everything. Political turf battles are petty. Prove your worth, don't lobby for it.

Here's the problem with this line of thinking.

Maybe anyone can do a well baby check, pop out some allergy meds etc. But thats the low lying fruit that keeps FPs afloat. They need to see what? a patient every 10-15 minutes? Dx allergy and scripting some allegra in a quick fashion frees up time to see that guy that has a serious problem that needs to be appropriatly worked up and maybe refered. And pays the SAME. Now some nurse comes along..."I can pop out a viagra prescription same as you"...scoops up all those visits. Now the FP is left with the "real" patients. Can they still average a 10 minute visit? Not likely. They'll probably fold. Who's gonna step up now to fill the void? The NP? They'll probably be to in-love with thier 5 minute well patient checks 9-5 schedule and decent pay-stub. Besides, im sure they will make a good case for being unqualified to take care of these patients (if the argument suits thier needs) so that they won't be forced into slave labor like physicians. Talk to me about competition when prices aren't controlled by medicare rates and HMO's, but as it is, if you're going to cap someones earning power per case then you need to protect thier earning power by volume if you think they are worth keeping around...or maybe you think we have a glut of primary care in this country?