[NPInfo] My Reply........To Shelby and others

[Dena]

Oh, dear, you've used a VERY bad example by bringing up chiropractors!! Do
you think they worry about MDs' position in the food chain?? You betcha!!
You think WE need to worry about MD's position in the food chain?? You
betcha!! And to think otherwise is VERY unwise. Here is an excerpt (sorry
about the length but it's VERY important stuff) from something on the
subject that I came across recently when writing about the AMA and
anti-competitive restrictions... see if any of this sounds familiar:

"The chiropractic profession has faced significant challenges by organized
medicine for over 100 years. For example, between 1963 and 1974 the AMA
operated a Committee on Quackery with an intent to "expose the charlatanism
of chiropractic." The AMA urged members to lend "their full 1support to the
continuing vigorous attack on medical quackery and to the education program
on the cult of chiropractic."(85)

Although the AMA certainly had every right to criticize medical practices
with which it disagreed, the organization soon resorted to lobbying the
government for restrictions on chiropractic practice. Today, chiropractors
are subject to numerous restrictions on their scope of practice.(86) 

In addition, the AMA recommended that Congress exclude payment for
chiropractic services from federally supported health programs.(87) As a
result, Medicare recipients are restricted from using the full range of
chiropractic services. Medicare policy limits patient access to
chiropractors this way: Medicare reimburses chiropractors for performing
"spinal manipulation" but requires that a diagnostic spinal x-ray be taken
before chiropractic treatment. The catch is that Medicare does not reimburse
chiropractors for performing x-rays, even though they have the training and
are licensed to perform x-rays in all 50 states.(88) That policy gives the
medical profession control over managing back problems among elderly
Americans. 

Ironically, the federal government's Agency for Health Care Policy and
Research (AHCPR) recently released national pain guidelines that recommend
spinal manipulation for the common complaint of acute low back pain.(89) It
is estimated that 80 percent of all adults suffer from back pain at some
time in their lives,(90) and an estimated 91 percent of older adults (ages
65 to 74) report back problems.(91) The AHCPR estimates that Americans could
save over $1 billion annually by using noninterventionist approaches for
managing back pain, even if only 20 percent of practitioners followed the
agency's recommendations.(92)

International research supports the U.S. findings that chiropractic is a
safe and cost-effective method for managing back pain. A study published by
the British Medical Journal reports that chiropractic treatment was more
effective than outpatient hospital management of low back pain. British
researchers estimate that if the 72,000 patients who show no
contraindications to manipulation but are referred to hospitals for back
care each year were instead referred to chiropractors, the British health
system could reduce days of sickness absence by 290,000 and could save 2.9
million pounds in social security payments over a two-year period.(93)

Consumers are quite satisfied with chiropractic treatment. The Western
Journal of Medicine reports that patients of chiropractors were three times
more likely than patients of family physicians to report that they were very
satisfied with their treatment for low back pain--by a score of 66 to 22
percent.(94) A 1991 Gallup poll found that 90 percent of patients regard
their chiropractic care as effective and that approximately 80 percent
consider the treatment costs reasonable.(95)

In 1976 four chiropractors filed an antitrust lawsuit against the AMA, 5 of
its officers, and 10 other medical organizations including the American
Hospital Association, charging them with criminal conspiracy to destroy
chiropractic. Plaintiffs alleged a conspiracy that included (1) preventing
medical doctors and doctors of osteopathy from associating professionally
with chiropractors, (2) defining it as unethical for MDs to accept referrals
from chiropractors, and (3) prohibiting chiropractors from using hospital
diagnostic laboratory and radiological facilities, among other things.

In 1987 the AMA was found guilty of illegal conspiracy: the AMA's
anti-quackery activity was in violation of U.S. antitrust laws,(96) yet
restrictions on chiropractic scope of practice and reimbursement remain in
place."

Blevins, S. A. (n.d.). The medical monopoly: Protecting consumers or
limiting competition? http://traditionalmidwife.com/actmmed.html

Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Carla Anderson
Sent: Wednesday, September 05, 2007 1:59 AM
To: NP Info
Subject: Re: [NPInfo] My Reply........To Shelby and others

Meg, 
   
  I agree, lets take Chiropractors. I do not know whether they worry or even
think about MDs at the top of the food chain.  But they have made a
consistent niche for themselves, in the health of the spine, and sports
medicine, nutrition, and health promotion. They are successful because there
is a large segment of the population who believes that Chiropractors share
their view of health or how to help them get and stay healthy, and therefore
become regular patrons of their service.  Our names of our professions may
or may not make it more difficult for us, and it is true that having MD
after your name does sort of pave the beginning of the road. But after that
you are on your own  I will always remember when I worked in the ER, and I
met this medical student who was older than the rest. He was very shy. I
will never forget what he told me. He said that he used to be a nurse, but
was not assertive enough in his personality, so he went to med school.  It
is like the emperors
 clothes. But then after that it is up to us. So we have to get beyond the
name issue, and get into the identity issue. We are all individuals. So
maybe instead of going about it as a group of PAs or a group of NPs we
should just go about forging our path, one person at a time while at the
same time maintaining our identity as a cohesive profession.   I know plenty
of patients that see a provider because they like that provider, not because
of their initials after their name. I also know MDs that were smart, and
tried to have their own practices and failed. So I cannot speak for others,
but I am going to continue  to follow my dream, of developing my own
practice where I can care for patients the way I feel they should be cared
for, and that is what I am going to persevere at. It feels right when I go
into my little office, there is a peace about it. No politics, no stress,
and yes, not very many patients yet, but there will be. And fine tune that
niche, as Meg said. We all
 need more education in how to do that, whether it is book learned or street
smarts, we need to get it.Whatever it takes, study someone that is doing
well, ask them how they did it, model after, get a mentor. Funny I got a
copy of the ANA/California newspaper today in my Oregon mailbox, and it was
on the front page how "Superintendent O'Connell Sells out Nurses in
California"...the article spoke how the US District Courts chose to ignore
the California Medical Act and the Nurse Practice Act by now, instead of
having the mandatory number of one (yes only one) RN per entire school
district, NOW they can train someone on the school campus without any
nursing experience to provide and administer medication to all the children!
So now there can be zero nurses per entire district!  But what is really sad
is the commentary following. We might as well just change the date every 20
yrs, it is still the same refrain. The only nurse that ever made history
apparently is Florence
 Nightengale, because they are still quoting her book "Notes on Nursing"
written in 1859 no less!  In fact the article which is written by the
President of the ANA/California chapter is talking about Florence's vision
of solidarity and does it exist in the US today.  It is encouraging nurses
to join ANA. Only 5% of the nations nurses apparently belong to the ANA.
We have heard this a million times!  We must move beyond Florence! And we
need to if we do not wish to see nursing and other boards and scopes of
practice hard fought for dismantled.   I do agree, with the concept, there
is a lack of passion and distraction, and in addition to our individual
pursuits, we do need to coalesce and become active in local, state and
federal roles to refine our professionalism. I do believe that to be true.
That we need to get involved, and make continued changes for the better,
getting educated and educating others.But we can start small.  I am sure
most of us are doing this at least
 in a small way. Every time we educate our friends, or our co workers, or
patients, or our community about issues that are important to us, we are
getting involved. So get a niche, and a passion, and then to get a louder
voice and mature as a profession (it will take discipline)  we need to join
our local and national organizations and vote for critical issues. I am
speaking about myself too, to get back to the basic outline and to do list,
just to take baby steps and set goals, and we will get better at it. Gee did
not mean to lecture, but I do think this is what it will take. Carla 

mmhelgert46 at comcast.net wrote:
  OK.....we need to have this dialogue ....Physician Assistants must have a
physician at arms length( either by phone or in the building) So says the
Board of Medicine in each and every state ....I don't see any other way
around this one....NP's in various states need a variety of similar settings
called preceptors, physician consultants...and other combinations of these
types of practices. Some states are very independent...such as Oregon (my
state)

My question will always be...what are we doing that makes us different,
unique and stand apart ?...what's the niche we fill? and what we are doing
about making this happen. It still makes little difference if physicians are
"at the top of the food chain"...this is not my concern...my concern is what
are we doing to set ourselves apart from this? this is the task that faces
us right now...this point in history when health care is in shambles...it is
a perfect opportunity to make it happen for all of us.......not continue
discussing physicians.......what makes us different then they are?...if we
can't even figure this out...we're doomed. The dialogue cannot continue
along the lines of "we are cheaper"...that's old and it doesn't quite
describe us....money should never be in the description........

This is the part...where it gets really tough...'cuz I'm describing a
professional...and that brings up the DNP program and that whole
issue..........which is the future......and this is where we take our
rightful place shoulder to shoulder with all other professionals....such as
lawyers, physicians, CPA...to name a few......we set the standards, describe
educationally what we need, we provide the statements that the public must
see...and this must happen so we don't go the way of the dinosaurs...Meg

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************



Carla R. Anderson, FNP-C
  Healing Presence Family Practice, PC  
  carla_rayne at yahoo.com
  503 819 9726
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************