John B. Neeld, Jr., M.D., Chair
ASA Delegation to the American Medical Association

SA’s delegation to the American Medical Association (AMA), consisting of nine delegates and nine alternates, is the third largest specialty delegation in the AMA House of Delegates. Our delegation is well-organized, thorough, articulate and effective. We have acquired a fine reputation for vigorous and helpful participation in debates on multiple issues while other specialties may be rarely noted unless their narrow interests are threatened. In other words, we recognize that threats to any specialty or to medicine in general are in fact threats to our future, and we respond accordingly.

A major focus of our activities for several years has been educating other specialties about the patient safety dangers posed by the continued effort of all type of nonphysician practitioners to expand their scope of practice and to avoid physician oversight. I am happy to report that our efforts have been successful not only with the “usual suspects,” such as ophthalmology and psychiatry, but with the primary care specialties as well.

We have been so successful that AMA has formed the Scope of Practice Partnership (SOPP) — which includes ASA as a member of its executive steering committee — to coordinate nationwide activities on the scope-of-practice issue with multiple specialty and state medical associations. In addition to serving as an information source for all member societies regarding scope activities in the various states, SOPP actively encourages its members to be involved in all scope issues, not merely those related to their specialty. When nonanesthesiologists lobby against expansion of nurse anesthetists’ scope of practice based on legitimate patient safety concerns, it is difficult for legislators to maintain that this is merely a “turf” battle.

Two examples illustrate the importance of unity among physicians and their organizations and the influence that can be exerted when such unity exists:

1. Early in the 2007 legislative session in Utah, S.B. 45 was introduced. It would have removed physician oversight and granted prescriptive authority to nurse anesthetists who met certain minimum requirements. As written, the bill would have set the stage for an opt-out of the Medicare physician supervision requirement for nurse anesthetists. Thanks to a timely effort by the Utah Medical Association, assisted by a number of Utah anesthesiologists, language regarding prescriptive authority was deleted. The bill as adopted makes it clear that while nurse anesthetists are now classified as advanced-practice registered nurses, or APRNS, they lack prescriptive authority. Additionally it retains physician involvement in the delivery of anesthetic care; nurse anesthetists cannot practice independently in Utah. This is a solid example of how a state medical association can successfully advocate for our issues.

2. In the most recent legislative session, Florida enacted a Truth in Medical Education, or TIME, bill (H.B. 587) based on an idea originally proposed by an ASA resolution to AMA calling for increased transparency regarding the education of health care practitioners. The current explosion in the number of Doctor of Nursing Practice programs prompted ASA and AMA to be concerned that unqualified nonphysicians who were, in fact, “doctors” might attempt to deceive patients by concealing their true training and presenting themselves as physicians. The newly enacted Florida law requires disclosure of licensure via name tag or similar means. It is notable that H.B. 587 was supported by a diverse group of organizations and specialties, including the Florida Medical Association, Florida Osteopathic Medical Association, Florida Academy of Family Physicians, Florida Society of Anesthesiologists, the Florida Academy of Dermatology and many other physician specialty groups.

It is abundantly clear that together we are stronger — I encourage you to support AMA as you support ASA.

John B. Neeld, Jr., M.D., is a staff anesthesiologist, Northside Hospital, Atlanta, Georgia. He was ASA President in 1999.