Strong educational standards are core of our profession

A message to all physicians from the chair of the AMA Board of Trustees, J. James Rohack, MD.

By J. James Rohack, MDis senior staff cardiologist at the Scott & White Clinic in Temple, Texas. He was AMA president during 2009-10 and served as chair of the AMA Board of Trustees during 2004-05. Posted April 4, 2005.

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Not many Americans know this, but before the establishment of legally recognized educational standards for doctors, virtually anyone could hang up a shingle and claim to be a physician. Likewise, not many people realize that the American Medical Association has always been concerned about individuals who attempt to practice medicine without the appropriate education and training.

In short, we have always seen it as our duty to protect patients from those who would offer medical care without adequate grounding in science and clinical practice.

This desire to protect the public, and preserve the art and science of medicine, helped inspire the founding of our American Medical Association in 1847.

Besides creating and adopting basic ethical principles of medicine, the AMA also established rigorous standards for medical education.

Not long after, it also created a Committee on Quackery to protect patients from would-be healers who, while gifted in the arts of publicity and self-promotion, had no actual training in medicine.

Thanks to the work of the AMA and the state medical associations, each state passed laws to set the standards for medical licensure. These laws used the educational standards set by AMA as the basis for deciding who could practice medicine within the state's borders. In this way, the AMA has stood at the forefront of both medical education and medical licensure in the United States.

Today, we have new challenges to face, particularly in the area of scope of practice.

While the AMA has nothing but respect for the allied health care professionals who work with physicians as part of the health care delivery team, we continue to be concerned about various -- and troubling -- encroachments on physician practice.

Some would-be practitioners, who lack the many formal years of medical education and clinical training that physicians are required to have, are attempting to use the legislative process to expand their privileges. For example, optometrists in Oklahoma, who have no surgical training, are working to finalize an emergency regulation that would allow them to perform more than one hundred surgical procedures with a scalpel.

The organizations promoting expanded scope of practice usually have a one-issue legislative agenda. They attempt to influence state regulatory agencies to grant their members expanded medical privileges. If that ploy fails, they lobby their elected legislators to pass laws to the same effect.

Since the issue of medical licensure is one of state rights, scope-of-practice battles ordinarily take place at the state level. However, we have also seen national issues arise in terms of Medicare definitions, for example, as well as in the practices of the military and Dept. of Veterans Affairs facilities.

So what is your AMA doing to help protect the public and preserve the standards of our medical profession?

Drawing on the various models of cooperation between state medical societies, national specialty societies and our AMA, we are together spearheading the creation of a Scope of Practice Partnership.

The partnership will likely:

  • Collect information on scope-of-practice activities in the states.
  • Monitor existing state laws and regulatory activities.
  • Work with specialty societies to provide research and clinical information on specific scope-of-practice issues.
  • Maintain an easily accessible database.
  • Work with state medical associations to gather information on local issues, such as the opposition's research, future activities and political strength.

Our AMA will house and staff the center, as well as provide a basic level of support. Additional support will come from the state and specialty societies, using the same model of financing that currently supports the AMA/State Medical Societies Litigation Center (link). Eventually, an executive committee will review issues and assist in prioritizing scope-of-practice concerns, as well as provide advice, should a state and specialty society disagree on an issue.

In terms of those who wish to practice medicine without the appropriate education and training, our challenge is to maintain constant vigilance.

If at times you feel that the assault on our profession and its standards never stops, I would remind you of what the 20th-century philosopher Bishop Fulton Sheen once said: "When you are getting kicked in the rear, it means you are in front."

With your support as a member, we will stay in front for our profession, for those who will follow us into medicine and, most important, for our patients.

Because together we are stronger. Together, we can and will make sure that the only people practicing medicine or performing surgery are thoroughly trained physicians.

J. James Rohack, MD is senior staff cardiologist at the Scott & White Clinic in Temple, Texas. He was AMA president during 2009-10 and served as chair of the AMA Board of Trustees during 2004-05.

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