reflect their evolving competencies (Finocchio et al., 1998, p. 50).11 Understandably, lawmakers have grown weary of the fight, especially when there may be little to gain and much to lose in championing reform.

Organized opposition to change These two factors—legislative inertia compounded by weariness and risk-aversion—define the arena within which a more active and powerful force has been brought to bear, and that is the advocacy efforts of several national medical organizations and their state affiliates.

Countless thousands of individual physicians (including two who helped create the new roles of nurse practitioner and nurse anesthetist) have long recognized and supported the full practice capabilities of APNs. It is the official policy of several national medical organizations, however, to actively oppose legal recognition of any other providers’ expanded authority to practice without physician supervision and be paid directly for their services.

Seemingly unmoved by the demonstrably safe and effective practice of unsupervised and directly paid APNs in many states, organizations such as the American Medical Association, the American Society of Anesthesiologists, and the American Academy of Pediatrics continue to oppose rational realignment of APNs’ state practice authority and eligibility for reimbursement. The following sampling of policies, and public statements by their officers, is illustrative.

  • The American Medical Association has adopted and continued to reaffirm resolutions which direct the organization to pursue, “through all appropriate legislative and other advocacy activities,”12 measures designed to

    • “oppose the enactment of legislation to authorize the independent practice of medicine by any individual who has not completed the state's requirement for medical licensure,”13 (a position that may seem unremarkable until one remembers that, under the medical practice acts, everything is “the practice of medicine”);

    • “oppose any attempt at empowering non-physicians to become unsupervised primary medical care providers and be directly reimbursed”;14 and

    • support physicians who oppose efforts by alternative providers to obtain increased medical control of patients by legislatively expanding


Finocchio et al., 1998, hereinafter, the Taskforce Report. Others have characterized these considerations as “scope-of-practice firefights” and “akin to war.” Jay Greene, Physician Groups Brace for Allied Incursion, Am. Med. News, Dec. 11, 2000, at 1; LaCrisha Buttle, Nonphysicians Gain Clout, Am. Med. News, Jan. 17, 2000, at 1, 26.


Am. Med. Ass’n, H.D. Res. H-360.988 (2000).


Am. Med. Ass’n, H.D. Res. H-35.988 (1982).


Am. Med. Ass’n, Independent Nursing Practice Models, Proceedings of the House of Delegates 141, 152 (1990).

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