Practicing medicine without a license is illegal in all 50 states. The AMA is a major gatekeeper of this process. It's one thing to prosecute people for falsely passing themselves off as being licensed, quite another not letting them perform procedures on consenting patients.

That was tried before and resulted in horrible levels of death and suffering. Which is exactly why we now have the AMA and laws against the unlicensed practice of medicine. No one who understands the history of medicine wants to go back.

The AMA lobbies to limit the type of work nurse practitioners can do and they are licensed.

http://articles.baltimoresun.com/1994-06-14/news/1994165047_...

That's a false dichotomy, no one said anything about going back.

Never mind that Josef Mengele was a licensed physicians, or that the AMA was well established before the Tuskegee syphilis experiments occurred, also with work performed by licensed physicians.

Just that the bureaucracy has resulted in an industry that fails patients. Heart surgeons refuse difficult surgeries to juke the stats. Good for their mortality ratings (not that anybody could blame individuals doctors)[1], not so great for patients.

Even just the notion of specialties hurts the patient - it makes perfect sense that the deep knowledge involved means that an orthopedic doctor can't (and shouldn't!) treat issues that should be seen by a podiatrist. But at the end of the day, the patient is in chronic pain, and has such a low quality of life, that to them, the risks of street heroin are acceptable. This isn't a moral failing by the patient's, nor is it a lack of intelligence, this life being too much to bear otherwise, and if you've never considered suicide as an option, be grateful.

Dr. David Casarett's talk[2] takes a closer look at an alternate, but accepted medical practice, and gives some thoughts about how our medical bureaucrats have resulted in worse patient care.

[1] https://www.telegraph.co.uk/science/2016/06/03/one-in-three-... [2] https://www.ted.com/talks/david_casarett_a_doctor_s_case_for...

I am not repeating this to be pedantic - this is simply a common misunderstanding in the public:

> Never mind that Josef Mengele was a licensed physicians, or that the AMA was well established before the Tuskegee syphilis experiments

The AMA has no role in licensing physicians, a task which is left to the states.

> Heart surgeons refuse difficult surgeries to juke[sic] the stats.

This is far more complicated than it seems. For example, consider that the sickest/most difficult patients are the most likely to die, irrespective of an intervention. At a certain point, the harm inherent to surgery outweighs any potential for benefit that the surgery might yield.

The Heart surgeon thing is likely referring specifically to a UK press article recently featured on HN that was about surgeons in the UK reacting to a policy change that means their stats are shown to the general public. A large minority of those surveyed said that as a result they now refuse to do surgeries they think will be very bad for their stats, even if clinically the surgery might be appropriate and within their competence. A majority said they knew a surgeon who had made such choices.

As a patient in that system (the NHS) I would prefer my surgeons not to make decisions based on trying to game the statistics. If I need heart surgery, I want whoever is competent and available. So if these stats block that, I'd rather we don't have the stats.

Frankly it's weird anyway because surgery is a team activity, not solo. Nothing serious is done by one bloke in a surgical gown, there's a team. I had a relatively minor operation and the named surgeon will have spent most of that operation _talking_ not operating. All the sewing and some of the cutting will be the nice younger doctors I met, a woman who'd been doing this a few years and was well on her way to being an actual surgeon, and a new bloke who seemed like he'd probably graduated just a couple of years ago. The old bloke with the paperwork saying he's allowed to cut people open is mostly there to watch over them both and step in if things go to shit. The woman is doing most of the work, showing the noob what she's doing and maybe overseeing while he stitches me back up at the end. There's some Eastern European doctor lady making sure I neither die nor wake up, and two or three nurses making sure everybody has what they need, and counting things to make sure nothing is left inside me that shouldn't be there. But if I'd died (very unlikely for minor surgery) it would count against my named surgeon and not the rest of the team.

Medical licensing is performed at the state level. The AMA, a non-governmental organization, does not perform the function of ensuring physicians' qualifications.

The AMA even explains this process: https://www.ama-assn.org/education/obtaining-medical-license

I'm aware. I was careful with my language about saying they are a gatekeeper, not that they set the law. But your info is appreciated.

I'm not aware of how the AMA acts as a gatekeeper to the medical profession - what did you have in mind?

In the broad sense that they are an influential industry group that has taken a number of political positions that impact laws. Chiropractors and osteopaths have in particular felt discrediting hostility from them, as I read. Now to be clear, I for one do not personally hold either of those two fields in as much esteem as much of the American public might, so I don't meant to be partisan, but to simply say that the AMA has used it's influence to maintain the standards of what should or should not be licensed medical practice. They are free to maintain their own standards, which I do much respect.

You've made good arguments in this thread, but you lose a lot of credibility when you imply that a DO is not as good as an MD.

I guess they aren't referring to DOs with that remark, there's a field quite like chiropractic that is called "Osteopathy", in the US such practitioners wouldn't be DOs.

People suffer real harm at the hands of unlicensed doctors.

For example, this guy was prescribing powerful meds with severe side effects.

http://www.chicagotribune.com/suburbs/daily-southtown/crime/...

While that's certainly true, people also suffer great harm at the hands of licensed doctors.

But more to the point, almost everyone suffers harm because of the way our medical system is set up.

Maybe some ailments don't need 8 year degrees to cure. Just throwing out ideas here.

But anyhow, more transparency is almost always good. Particularly in the morass that is the American medical system. I keep wondering how ever let something so important get like this.