The AMA and Sermo break up, and how it’s getting ugly

When the online physician discussion site, Sermo, and the American Medical Association joined forces in 2007, it was heralded as a promising partnership for both entities.

In fact, as Sermo’s CEO Daniel Palestrant said back then, “As a company, we had to take a very rational perspective on that by saying we’re a small software company, not an advocacy organization. Who is the best entity to turn voice into action? Without a doubt that’s the AMA.”

And the AMA was no less enthusiastic: “Engaging with Sermo’s virtual community adds to the resources the AMA can call upon to rapidly assess and respond to the issues and concerns of physicians across the United States.”

Well, fast forward to July 2009, and now they have parted ways. And like many divorces, it’s messy.

Scott Shreeve has published a missive that Dr. Palestrant posted on Sermo on July 1st, rebuking the AMA:

As physicians, our first step in the healthcare debate needs to be clearing the air about who speaks for us on what topics. Today, I am joining the increasing waves of physicians who believe that the AMA no longer speaks for us. As the founder and CEO of Sermo, this is a considerable change of heart, given the high hopes that I had when we first partnered with the AMA over two years ago. The sad fact is that the AMA membership has now shrunk to the point where the organization should no longer claim that it represents physicians in this country.

I asked the AMA to comment on the situation, and last night, they answered with this reply:

The AMA has decided not to continue its business relationship with Sermo.

The AMA is always looking for effective ways to communicate with physicians. After an evaluation of the initial relationship with Sermo, we have decided that the value was not there to justify the investment of AMA members’ dues dollars. We continue to explore ways to communicate more effectively with all physicians.

Furthermore, they also sent me their response to Dr. Palestrant’s remarks, writing, “As for Dr. Palestrant’s sudden ‘change of heart’ regarding the AMA, one can only speculate. He ardently courted the AMA when launching his business two years ago, and now he expresses scorn immediately following the end of that business relationship.”

I am a member of Sermo, and support what they are trying to do. They’ve made great strides since their inception several years ago.

I also support the AMA’s initiatives, and indeed, they are regular contributors on this blog. It’s a shame that the situation has degenerated into such an ugly situation.

I also understand the sentiment within the physician community that the AMA may not represent the majority of doctor’s interests, and wrote about it a few weeks ago. But, they’re the best advocacy organization we have, like them or not, which is important in the current health reform environment. As such, perhaps it’s not the best time for physicians to bicker among themselves.

Politicians will find it easier to ignore multiple, fragmented physician advocacy groups rather than a single, unified physician voice.

So, while I can sympathize with Dr. Palestrant’s concerns, which undoubtedly echo those of many other doctors, I’m not sure bashing the most influential physician advocacy organization in the country, in terms of Congressional lobbying power and money, is the most productive strategy right now.

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  • Supremacy Claus

    I strongly urge any doctor thinking of joining Sermo to read the Terms of Service.

    http://www.sermo.com/aux/terms

    These are potentially legally damaging.

    The security of the site is reviewed here.

    http://medgadget.com/archives/2007/09/a_note_and_a_follow_up_on_sermo.html

  • Dr. Mary Johnson

    I may have registered at sermo way back when, but I’ve not used it, so I’ve got no dog in this fight.

    That being said, any time the AMA is publicly dissed for its pathetic representation of physicians – individually and collectively – in Washington, I am THERE.

    As a “single unified voice”, the AMA sold out “the little people” in medicine long ago . . . students . . . residents . . . primary care providers . . . public servants . . . minorities . . . FMG’s . . . anyone on the wrong end of corporate medicine . . . the AMA just was not there.

    And all along the way, the AMA made it crystal clear it did not “do” individual advocacy.

    Politicians are going to ignore doctors any chance they get because most of them are lawyers and it makes them feel superior.

    I shudder to think that the AMA is “the best” we have. Maybe if all the fragmented voices out there united AGAINST the AMA’s top-heavy, fat-cats-rule brand of “advocacy” (worse than the worst of the trade unions), we’d be a real force to deal with in terms of getting the reform we need.

  • ray

    AMA certainly treats primary care as step children. They should at least come out openly about it so that primary care physicians can look elsewhere. I can not imagine doctors of all fields in one category anymore. There is a tier system, only after years of suffering in the trenches that they are talking about 5% increase in primary care income. AMA ripped them of any dignity while they helped some specialists income go up 20-30% in past few years. Does anyone really know how many true practicing members are in AMA ?

  • http://www.thehappyhospitalist.blogspot.com Happy Hospitalist

    Isn’t the AMA a disability insurance company?

  • Doc99

    On a related issue, this from ObGyn.net -

    I’m tired, mad as hell and just not going to take it anymore.

    I’m tired that I cannot practice medicine the way medicine is meant to be practiced: with care, quality and timeliness. Economically I feel handicapped as most of the health care dollar goes for administrative costs to health insurance companies, and a large part going to the salaries and bonuses of the executives of these companies, money meant for patient care. It disgusts me that so much money goes to pay medical malpractice premiums and tails, and that our livelihoods are at risks as attorneys consider us lottery tickets, using their clients as entry fees. It bothers me that pharmaceutical companies now look for diseases on which to use their patented chemicals, rather than looking to improve patient care with lower cost, but equally effective medications.

    Little of the health care dollar even goes pharmacies and hospitals, much less to physicians. Now the current administration wants to decrease payments to these three, in order to ‘save’ the health care system. We already have enough capable people leaving our profession, or declining the arduous journey to become an American trained physician; not to mention the huge number of physician who discourage their own children from following in their footsteps. How sad when we don’t want our own progeny to follow us all because we are treated like thieves, or worse, as children who cannot govern ourselves. And don’t get me started on the AMA or the specialty colleges, who rarely stand up for the regular, non-ivory tower doctors that roll up their sleeves and care for patients on a daily, fee-for-service basis. The attitude in our county towards physicians does nothing but create a loss of quality, well trained, American-trained physicians.

    Doctors get far less of the healthcare dollar than do pharmacies or hospitals, yet without us they would be out of a job. What is the joke: hospitals would be great places to work if it wasn’t for all those doctors? There are around 1 million doctors in the country, yet there are over 25 million people in the health care industry. Each physician supports about 25 people. few actually treat or care (for) about patients. Once we actually get reimbursed, we have our medical school loans and ever rising business costs to pay for with our ever decreasing dollars.

    Our patients suffer as physician must see more patients every year just to make the same amount (or often less) money than last year; physician burnout is a well documented and a worrisome trend in our profession. This affects our ability to treat patients properly. Then, adding the paperwork and increased regulations put upon us by the state and federal governments, we have even less time to treat patients, read journals, go to seminars or get sleep. Quality of care suffers.

    On top of everything else we need to deal with malignant hospital administrators and medical staff members or nursing staff members who can, just for untoward facial grimaces, suspend us and report us to the National Practitioner Data Bank, thus irrevocably ruining our careers, well before any investigation or fair hearing needs to be called. We worked our butts off to get top grades in college, to get into medical school, then residency programs where we often worked 80, 100 or even 120 hours a week, for what? So we could give up nights, weekends, holidays, birthdays, anniversaries and even miss the birth of our children to practice that vocation to which we were drawn. And how are we treated? We are considered the most vile criminals, cheats and depraved practitioners with no sense of integrity or consciousness, only out to harm those we have struggled so long to serve. If we are so bad, so vile and so depraved, shouldn’t we let our patients get treated by witch doctors with voodoo medicine. But of course, that is already being practiced in US hospital.

    I really don’t need to feel guilty that the profession I have chosen also puts food on my table, clothes my wife and kids, and allows my children to get a college education (not premed of course.) Yet what am I to do when 25% to 50% of my procedures, which are ‘authorized’ by insurance companies, are not reimbursed because, although authorized, they are now determined to be uncovered benefits. Sometime we have to sell vitamins and other services to make up for the loss of payments.

    Quality of care suffers with less time to see patients and less reimbursement received when we do see patients. We cannot do pro bono work as we have in the past as we have to see an ever increasing number of patients. This extra work is forced upon us when insurance companies, especially Medicare and Medicaid, constantly refuse to pay us in a timely fashion for our time and efforts. And, then once we do see patients our clinical acumen is stifled as we must follow a cookbook approach to patient care.

    When healthcare insurance companies siphon money away from patient care and into the hands of the their executives, to support a life style that demands sometimes more than $30 million/year, this decreases money to medical schools for training and research that might create advances in medical care that actually benefit patients. Insurance companies have no incentive to provide better care if it in turn might make patients live longer. Medicine is going corporate, and we, physicians are just flipping burgers so corporations have an improved bottom line.

    It is time that we stand up for ourselves. Our founding fathers gave up their lives to fight for their liberty and freedom, so that we, their progeny could live in the land of the free and home of the brave. But we are passively giving up our noble lives as physicians, without the liberty to practice as we know we could, and without the freedom to stop the government and the insurance companies from turning us in to hourly workers rather than the true professionals we believe we are and forever should be.

    I am going Washington DC. At noon, on Thursday, October 1 2009. I will be on the mall with a few other physicians. We simply decided that we will not work that day and perhaps the day before and maybe even the day afterward. We are not ‘organizing’ anything other than a vacation from the stress of work, so we can enjoy our nation’s capital and perhaps even say hello to our congressmen or members of the administration. Perhaps we will show the country that physicians are worth more than a $5 co-pay; that physicians are more important than a mid-level healthcare worker; and that our profession is needed, our services are required and our practice is a calling to be respected, not a trade that is to be negotiated to the lowest bidder.

    I want our services adequately reimbursed so that we may spend more time with our patients, and I want less paperwork. I want less money going into the hands of insurance companies administration costs, less money going into the hands of pharmacy companies for the development of drugs that are either unsafe or targeted for ‘diseases’ they seem to invent. I want brand named drugs that are as affordable in the US as in Canada or Mexico. I want medical malpractice reform, with caps on all damages, so that we can practice without the fear of needless and unwarranted lawsuits that only benefit the attorneys. I want the National Practitioner Data Bank reformed so entries are made AFTER all administrative remedies have been executed, so due process is given to all physicians and that all entries are reviewed by an independent board of physicians without any ties to the accusing hospital, nor state or local medical societies, prior to submission. And I want compensation for services that pay us enough to allow us to continue formal and informal continuing education, and that pays us enough to manage our practices and allow us a living that compensates us for our years of study and training.

    And, most of all, I want you to join me for a vacation in Washington, DC. I want us to get together, informally, so we can share experiences with each other. I am inviting you to come there for a vacation. I want you to invite 10 of your physician colleagues and let them know that you are going to be in Washington DC on October 1 2009, and invite them to come themselves. I want you to tell them to invite 10 more their physician colleagues to join them, and so on.

    I have purchased my flight to Washington, DC. I have informed my patients that I will not be available to care for them the week of October 1, 2009, and suggest that they make alternative arrangements for care. Perhaps they can find a good mid-level healthcare practitioner to take care of their traumas, emergencies or deliveries.

    Perhaps we can actually have a ‘million med march’ however spontaneously it may be. See you in DC.

    http://forums.obgyn.net/ob-gyn-l/OBGYNL.0906/0345.html

  • twaw

    Dr Johnson is correct. 40 years ago I had a bad experience with a poorly made GM car. I’ve never purchased one since. I was one consumer among millions. Over the last 20+ years I have/do belong to 5/6 of the categories Dr. Johnson mentions, and believe that the AMA has never represented me. I am one doc among thousands. Regardless of its influence in the economy, GM should not have had a bailout and neither should the AMA.

  • dr kvc

    I agree with most of what Doc 99 posted. The way our system has evolved, our services have been devalued so much by many people, that they would rather pay for cable TV than to see the doctor. Yet despite this, we as a society are being asked to subsidize or completely fund services, that on one hand are deemed so important and necessary, and on the other hand, people will not sacrifice things that are not necessary for this care.

    My patients complain about paying the co-pays for their visit, even when they are as low as a $1-2. They will skip an appointment because the weather is nice outside and they want to do something else. They will show up late and get upset when asked why they are late. And I have gotten tired of people who think that my fees for services are outrageous, but will spend as much or more going to a sporting event, amusement park, or even at a casino.

    My education and expertise has been too devalued, and I will not tolerate anymore. I will not allow the government to lower my reimbursement, control the doctor-patient relationship, dictate how I treat my patients, and force me to see more patients each day just to get by, anymore than they already have.

    I believe medicine does need an organized voice, and while the AMA is not perfect, it is all we have. Congress likes to play the specialties against one another. A divide and conquer strategy that pits primary care against other specialists. The truth is WE Primary Care Docs need the Specialists, and they need US. This being the case, we all need to work together for the best interest of all specialties, and ensure that we do not sacrifice one group for the benefit of another.

    The unions from all of the various industries stand behind each other, and because of this have become a very powerful lobbying force. Medicine needs to do the same.

    AMA policy is made by the membership, and if you are not a member, than how do you expect to be able to change their policy. It is not the Board that makes policy. They are directed in their action by the House of Delegates which includes representatives from the States and Specialty societies. Why would anyone expect the AMA to let non-members direct policy?

    If every physician was a member of the AMA, than it could fairly accurately reflect the position of a majority of physicians. There is no other accurate way to determine what the majority of Physicians actually want as policy. And it is not possible for an organization to represent every physician’s belief on everything. But at least you have the opportunity to make your voice heard.

  • Dr. Mary Johnson

    Dr. KVC, my point is that, the way the AMA works and has ALWAYS worked, EVEN IF every physician in the USA were a member, some members are more important than others.

    Policy is made by “the right people”.

    The state medical societies are the worst offenders of all. It’s all about paying-to-play or who you know. I had my fill of that when I served on a North Carolina Medical Society “peer review task force” back in 2002 (after my horrible, as yet-to-be-rectified-or-prosecuted experience in my own hometown). Oh, we sat around the table . . . a few burned doctors, some “most-favored” hospital CEO’s, and (of course) the lawyers. And we made some very good recommendations pertaining to fair play and due process and better oversight. But in the end, the organization that was supposed to represent me as a physician in North Carolina CAVED to the state hospital association (which, of course, balked at putting any teeth behind the recommendations).

    And/so this pearl (from Doc 99′s post) rings truer than ever: ” On top of everything else we need to deal with malignant hospital administrators and medical staff members or nursing staff members who can, just for untoward facial grimaces, suspend us and report us to the National Practitioner Data Bank, thus irrevocably ruining our careers, well before any investigation or fair hearing needs to be called.”

    Meanwhile, in the pocket of coorporate medicine, the AMA has totally ignored the issues of bad-faith peer review and/or “right-to-work” employment laws putting physicians at a distinct disadvantage in any battle with a hospital . . . they’ve slurped down the “disruptive physician” Koolaid (a mostly-bogus “diagnosis” invented by way-beyond-malignant hospital executives & expensive law firms in order to weed out dissenting voices & whistle-blowers) as if it were Dom Perignon.

    Rather than continue to pay dues to an “advocacy” organization that did NOTHING/ZERO/ZIP/NADDA to help me when I needed help most, I decided to vote by walking out the door with my dues (I need them to make the bills anyway). I knew at the time that others as angry and disillusioned as me were doing the same thing – and sooner or later it was going to HURT.

    Perhaps the strategy is beginning to work. The AMA is hurting – and our voices are finally starting to be heard – after been supressed and drowned out (even on some of the big-gun medical blogs) for so long.

  • Doc99

    I might remind the group that the AMA HOD balked at a resolution to “Take Back The Profession.”

  • PNHP doc

    The AMA is *not* all we have. Check out the National Physicians Alliance.

  • Diss_AMA

    http://www.docboard.com knoew this way back in 2007, see this poll
    http://www.docsboard.com/forums/showthread.php?t=1880

    Sermo had its big infusion of members thanks to the AMA

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  • huffington has this on its site

    This is getting into main stream news slowly. i think AMA is gonna be quite unpopular when the beans are spilled because public still thinks they represent majority of doctors

  • Supremacy Claus

    http://www.sermo.com/ui/product/comments.html

    Apparently, docs were not talking among themselves, completely in accordance with the Terms of Service.