Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD

January 8, 2015: Physicians Desperately Need an American Medical Association

By Rob Tenery, MD on January 8, 2015

Physicians need a national organization that speaks with a united voice on issues that are corporatizing this once-noble profession. For without that representation, they become nothing more than independent contractors answering to the highest bidder, and not to their patients.

In the early 1950s, the American Medical Association’s (AMA) membership was almost 75% of the eligible physician population. Today that number hovers in the upper teens, which also includes medical student and resident members. From 1980 to 2002, the membership of the American College of Surgeons (ACS) had grown by 55.6% and, from 2002 to the present; it has grown by an additional 16%.

Although these statistics don’t exactly equate, they point out a glaring difference: While the AMA’s market share of eligible physician members continues on a long downhill slide, the ACS continues to grow its membership. Understanding this difference is important, since the AMA, even with its low market share, is still usually considered the spokesman when it comes to national issues that affect the medical profession. At some point, and with the continuing trend, that may no longer be the case. Either some other voice will take the AMA’s place, or the disparate entities that make up the body of practicing physicians will then have to feign for themselves.

With respect to its charter, the American College of Surgeons is targeted to advocate for issues that particularly affect the surgical specialties. The AMA tries to represent the needs and desires of all the disciplines that comprise its broad membership, which, all too often, puts it in a no-win situation with at least some of its constituency.

The reasons physicians join organizations generally fall into four general categories: Education, certification, representation and duty are the most notable. The first three are obvious, although they vary, depending on area of interest and locality. It is this duty to the profession that has changed this paradigm--- this moral obligation that supersedes personal reward.

The American public’s support for this country’s efforts during World War II, versus the Vietnam conflict, seems to be the most analogous comparison. In the former, there was an almost 100% support, both on the battlefield and at home. During the Vietnam effort, the goals shifted from defending liberty to protesting--- an attitude shift from public good to self-fulfillment.

It is the responsibility of the leadership of these two similar organizations, that claim to speak for and to the physicians they represent, to reevaluate and make adjustments when necessary to the three basics of responsibility, relevance, and representation: Responsibility to their members--- just as important to the patients these physicians serve. Staying relevant to the current needs and wishes of the medical profession and their membership. Finally, representing the physicians’ best interests in those areas that impact the profession.

These basics require ongoing diligence by the leadership to the changing norms and expectations of both their physician populations and society as a whole--- an understanding of the big picture. Unfortunately, that is where the entrenched leadership often fails. So caught up with their own, personal agendas and the precepts established when the climate was different, they often try to lead rather than follow.

Isn’t that the question? When should leadership lead and when should it follow the wishes of its constituency? When does the collective knowledge of those that are elected to lead out weigh the apparent wishes of the membership?

        While the ACS continues to grow its membership, the drop in AMA penetration from close to 75% of eligible members in the 1950s to somewhere in the upper teens, deserves a closer look.

Although the AMA is more representative of the body of physicians as a whole, it is less representative of many specific groups that make up its membership. Thus, the major reason the ACS grows its penetration rate in the surgical sectors of the profession.

The membership drop in the AMA speaks particularly to apathy on the part of today’s physicians and lack of perceived value. Potential members feel that they can get more targeted representation through other organizations and alliances. But it is the loss of allegiance to duty that is the most critical. This social trend is not only with medical organizations, but traditional churches, many social organizations and volunteer efforts too. It is a re-prioritization away from traditional allegiances and into arrangements that create more direct benefit to the participants

Because of its diverse audience, the AMA has always had difficulty with communication. With the loss of AM News, revelations about the regulatory and political issues that are impacting the medical profession have deteriorated even further. These subjects are not routinely part of JAMA’s purview or even the specialty periodicals they publish. It’s not through the minutes of the AMA meetings. Those are usually distributed through the state organizations’ periodicals and the minutes of some of the specialty societies. If there ever was a wake-up call, it is for the AMA to prove its relevance.

The Patient Protection and Affordable Care Act (ACA) appears to be the ‘sword’ on which the AMA has chosen to make its stand. Virtually every poll conducted of physicians was and continues to be opposed to the legislation in its current form. Still, the AMA publicly stands in support of most of the mandates in the ACA.

Although no one, except maybe the authors of the original legislation, understood the full implications of the proposed law, the AMA’s almost blind support set the path for a new era for the organization--- compliance. Their position, put forward by their BOT and supported by their House of Delegates, is one of compliance---evaluate ways that physicians, as providers of care, and small business employers, can maintain compliance with the proposed Employer and Individual Mandate clauses. The proposed intent was to do this without eliminating the choice of their doctors and many of their health care plans. At least, that’s what the American public was told as the plan was initially touted.

Instead of supporting changes to those aspects of the law that potentially create access and financial hardships to employers and patients (the Employer and Individual Mandate clauses), the AMA appears to look for ways to improve compliance with those mandates. Instead of saying ‘no’ to the government mandates concerning ICD 10 guidelines (which they have recently put out objections), EMR stipulations, and punitive rules concerning hospitals that treat Medicare recipients, the AMA appears to sit idly by, apparently afraid to ‘ruffle the feathers’ of the Centers for Medicare and Medicaid Services (CMS) and the Administration that are the root causes of these intrusions into health care delivery.

We must question why the AMA membership continues to lose penetration in the physician population, while the ACS still maintains and grows theirs. Maybe, it’s because the ACS is seen as an advocacy organization with their frequent postings to their membership with the ACS NewsScope and other methods of communication, while the AMA loiters in relative silence of compliance.

This concern is not about the number of members in either organization, but about being able to protect the precepts of this noble profession and the health and wellbeing of the patients they serve.

Some might claim the AMA is too big, because it tries to represent too many divergent interests. With a member penetration of only in the upper teens, some would say it’s not big enough. The numbers may not be important, just being able to deliver the message!

Physicians desperately do need an American Medical Association, but is it the one we have now?

For additional thoughts:

Why the AMA Endorses Obamacare--- But Your Doctor Does Not, Lee Heib, M.D. @ http://www.theblaze.com/contributions/why-the-ama-endorses-obamacare-but-your-doctor-does-not/

Our Changing Health Care System Since the Inception of the Affordable Care Act, The American College of Surgeons, @https://www.facs.org/advocacy/federal/health-care-reform.

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