The American Medical Association (AMA) recently completed a series of position papers entitled AMA Scope of Practice Data Series. While the series purports to "...serve as a resource for state medical associations, national medical specialty societies and policymakers...", it is, more or less, a shot across the bow of any non-physician health care professional who attempts to provide patient care that could be remotely construed as being "medical" in nature. The series could easily have been entitled "what I don't like about you". Regarding the AMA's position on pharmacists, they could not have gotten this more wrong on so many fronts but the one area where the AMA falls well below the threshold for common sense is their position on collaborative drug therapy management (CDTM). CDTM programs are essentially programs in which physicians "download" certain clinical tasks to well-trained pharmacists because (a) they know the pharmacist can perform the task better than they can, or (b) they don't want to be bothered with it. The best examples of this are the various drug-dosing and management ("per pharmacy") protocols commonly in use in organized healthcare settings. In the AMA's eyes, CDTM is an unwelcome extension of pharmacists' scope of practice into what has traditionally been the physician's domain. However, based on their stance on CDTM, it appears they never got the memo on the definition of "collaborative". In order for something to be "collaborative", there has to be "collaboration", and in order to have "collaboration", both parties must agree to the terms of the collaboration. Not only do the terms have to be agreed to in advance, the terms are generally determined and enforced by medical staff committees, not pharmacy staff committees. If anybody is driving CDTM, it is the physicians themselves! A physician that does not want to participate in CDTM doesn't have to. Furthermore, a pharmacist who attempts to perform CDTM without the physician's permission runs the risk of not only ceasing to exist as a health professional, but incurs an incredible amount of professional liability should their performance result in a therapeutic misadventure.
At one time, a series of this type would have been taken as the gospel by physicians and policymakers but the AMA of today is not the AMA of 25 years ago, or even 10 years ago. Just to show how much things have changed, I contacted just about every physician I am on a friendly basis with in order to obtain the Scope of Practice Data Series in its original form (it is currently accessible only to AMA members). Guess what? Not one of them could help me because not one of them even belongs to the AMA! Each and every one had quit the organization because they no longer saw the organization as relevant to their practice. Perhaps this is why?
