PERSPECTIVE ON MEDICINE : Nurses Have Had It With Sexism : The AMA is taking a nasty tack in fighting nursing’s more autonomous role in post-reform health-care.
The American Medical Assn., which represents the nation’s most highly paid, highly specialized physicians, has worked for decades to torpedo any social legislation, including Medicare, that could increase access to and affordability of quality health care. To maintain its medical monopoly, this male-dominated profession has also opposed every attempt by the predominantly female nursing profession to gain greater authority and autonomy.
These are twin battles that, for the AMA, have grown increasingly desperate. Last spring, the AMA rose up in alarm when it learned that the two most popular health-reform proposals--the Clinton Administration’s managed-competition plan and the Wellstone-McDermott Canadian-style single-payer bill--were likely to include provisions that would give a wider role to nurse practitioners and other nurse specialists.
Last month, the AMA fired a salvo that transforms the fight between the two largest and most important professions in health care into more than just a public-health issue. It has launched a major, vicious attack on women’s rights.
The AMA’s declaration of war on the nursing profession was delivered in a slickly produced fund-raising brochure and a 30-page report attacking nurses. Political-action committees in California, Florida and Texas have sent the brochure to doctors to generate a war chest to fight any attempt to encroach on their turf.
In bold letters, the brochure bellows, “Flocks of non-physician practitioner groups are using the call for health-care reform as a decoy to lower licensing requirements and broaden their scopes of practice.” As flocks of ducks swarm across the page, the brochure declares: “It’s open season on health care in California and Washington. . . . Flocks of non-physician practitioner groups” are trying to “broaden their wingspans into medical practice.”
It goes on to say: “Flocks of daffy special interest groups are converging on Sacramento and Washington,” to “retreat from our rigid standards of medical school training . . . with the end result of endangering the lives of our patients.”
Although the brochure does not mention nurses by name, the intent is unmistakable. The duck image conjures up quackery. And you don’t have to be an intelligence analyst to substitute “chick” for “fowl,” “daffy dame” for “daffy special interest groups” or see “broad” in “broadened wingspan.”
This classic sexist attack is directed at a profession that has improved the quality of health care--particularly for those who our medical system has consistently neglected.
Nurse midwives are delivering pre- and postnatal health care to low-income mothers and their at-risk infants; nurse practitioners are delivering primary care to countless rural, Indian, poor urban and homeless Americans; certified registered nurse anesthetists are the sole anesthesia providers in 85% of rural hospitals; geriatric nurse practitioners go into the homes of the elderly to deliver care that saves the system billions, and hospice nurses care for those dying patients who physicians have so often scandalously abandoned.
These so-called advanced-practice nurses are willing to do the work that many highly specialized physicians have refused to do. However, they need the authority to write prescriptions, to work autonomously in collaboration with, rather than under the supervision of physicians, and to be directly reimbursed by insurance companies and patients. But that is exactly what the AMA opposes and no profession has been more adept at protecting its economic self-interest than physicians.
In poll after poll, ordinary Americans report that they view nurses as more trustworthy and less self-interested than physicians. White House polls found that seeing a nurse practitioner instead of a physician was a widely supported cost-control measure. And politicians have responded with legislative proposals that could remove AMA-imposed barriers that limit advanced-practice nurses’ ability to serve the public. Which is, of course, why the AMA wants to depict nurses as incompetent, bungling ducks.
Progressive physicians must begin to publicly defend nursing. Physicians cannot serve their patients as isolated individuals; the health and well-being of patients hinges on the quality of the collaborative relationship between the two professions. To drive a wedge between them is a no-win strategy.
