If American physicians were to speak with one voice, what would they say?

Who speaks for American physicians? I really don’t know? Do you?

I used to think and say that the American Medical Association (AMA) spoke for American physicians. Of course, that was when I was an employee of the AMA.

I disclose that I remain a more than four decade-long member of the AMA, and I believe that it should speak for American physicians. But physicians speak with many voices; most are fiercely independent. And they, as a highly diverse group, are angry that no one seems to hear their voices.

The obvious reason that the AMA does not speak for American physicians is that a declining minority of them are dues paying members of the AMA.

It is true that, via the votes of representatives of state and specialty societies in the House of Delegates that makes AMA policy, a large number of American physicians are “represented.” But, by and large, those delegates are not elected by their various memberships either.

Here’s a further rub:

If American physicians were to speak with one voice, what would they say?

If the voice were primarily self interest, it should be ignored, since physicians historically are and should continue to be learned professionals.

If such a united voice of physicians were actually representing the best interest of all patients and the public, it would be powerful indeed, listened to, and likely influential.

But the strongest voice would be patients and physicians, united in the best interest of patients as individuals, patients collectively, the health of the public, and the financial health of the nation.

Such a message would of necessity include enlightened shared sacrifice.

Such a united voice could drown out the now dominant commercial and business interests of the vast medical-industrial complex, no matter how much high-priced PR and how many politicians it would buy.

Maybe we could call this new organization the National Association of Patients, Physicians and Other Health Care Professionals (AAPPOHCP)?

There actually already is an organization something like that. It is The Lundberg Institute.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.comfor more health policy news.

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  • http://www.sagebenefitgroup.com Joyce Dobervich

    Kevin, a physician recently pointed out to me that only 15% of physicians belong to the AMA – I was astounded!! Not sure how accurated the stat is, but perhaps it’s in the ball park? Something needs to change concerning this.

    You may soon follow my efforts on twitter as my team attempts to “reconstruct” Medicaid in the state of Texas – both in terms of delivery and payment to hospitals and physicians. We have a proposal in place that will seek much higher reimbursement to physicians….

    • Leo Holm MD

      The stat is true. It does not need to change…the AMA does. I am a physician in Texas, so please feel free to contact me for input on your efforts.

      • Molly Ciiliberti, RN

        Thanks Leo, I would agree that AMA needs to change. My husband (ED doc) has never belonged to it and never will as long as it stays the way it is.

  • Sandra Barton MD

    Problem is, physicians DON’T speak with one voice. They speak with a cacophony of individual prima-donna-like voices, each one superior to and suspicious of all the others. I agree, if only the cats could be herded!

  • Vox Rusticus

    Why do not more physicians think the AMA represents their interests enough to make them wish to be members?

    I would think the AMA ought to be asking this question. Are they?

    The perception is that the AMA has been divided and turned by outside interests, mainly the government, against some of its erstwhile members, partly in favor of other members and in the end, serving all of its members poorly.
    There is also the perception that they have become “advocates” for patients and less so doctors, forgetting that they have a charter to represent their members. They aren’t the “American Patient Association.” Now there isn’t necessarily anything wrong with patient advocacy, but that is not what the paying membership is expecting as their primary mission. To read their publications, I get the feeling they think it is unseemly to represent doctors’ interests.

    And then there is the questionable business alliances they have made. Sunbeam, the U.,S. government and large insurers, by writing and publishing the CPT coding guidelines, directory management, devised not just for public reference, but for use by the government to call up health care professionals in a draft. There is good reason to wonder, with their funding sources so varied, whether they even can be an effective organ representing U.S. physicians.

    Specialty societies seem more responsive to their memberships and have less outside business activities to distract and deflect their actions.

  • Matthew Bowdish MD

    Dr Lundberg- You did not directly mention the AMA’s support of the PPACA…With polls showing large percentages of physicians remaining skeptical of the PPACA, what affect has the AMA’s support of the law had on its already declining membership?

  • paul

    as long as we continue to snipe at one another, as we are taught to do in our training process as not only acceptable but expected behavior, we will continue to have no voice.

    also, i don’t see how it is possible to be united in both the best interest of patients as individuals AND and the financial health of the nation, as those two things will frequently be at odds with each other. especially when the “best interest of patients” is usually not being directly paid for by the patients themselves.

  • PAULMD

    All of the members of my group have, from my lead, dropped our AMA memberships and direct more of our financial resources toward our specialty society and PAC.

    I fear the AMA has gone the route of other “advocacy” organizations and has joined the ranks of AARP. In their quest to advocate for everyone (of every age), AARP now seems to only advocate for their own interests.

    Nothing will change (with the AMA) unless individual members say “NO.”

  • American Medical Association

    The American Medical Association is the largest physician organization in the nation, striving to represent physicians from all states and specialties through a representative democratic process. Since 1901, the AMA House of Delegates has been the democratic forum for all of medicine, gathering physicians from all fields to shape the future of medicine.

    All physicians should step up and join the AMA to enter the conversation and participate in their profession. To become a member of the AMA, please visit http://www.ama-assn.org/ama/pub/membership.page. To find out which AMA delegates represent you, please contact your state society or specialty society. To read more about the AMA House of Delegates, please visit http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates.page .

  • Marc Gorayeb, MD

    “Scott, you just don’t get it, do ya? You don’t.” Let’s see; I pay cold hard cash for the privilege of entering the conversation? I’d rather pay money to support an entity that already speaks my language.

  • DocB

    the AMA has done 3 things really well….

    1. allow physician’s status as THE medical authorities of the country be worn down to “just another opinion.”
    (the recent healthcare bill made it very clear who is the REAL healthcare leaders of the country…. Pharma and Ins Companies.)

    2. allow physicians to be given more and more responsibility of unfunded mandates and liability while at the same time making it clear we are not worth being paid for it.

    3. make sure nothing happens to their cash cow (the CPT) even at the expensive of physicians themselves. (im sure the government and Ins comp are very happy with this one.)

    oh… well I guess they did do one other thing….

    thank god they got that pesky plastic surgery tax out of the health reform bill.

    • pj

      Here here!

  • http://www.epmonthly.com/whitecoat WhiteCoat

    I have to commend Dr. Lundberg for at least asking the right question.

    Many doctors are dropping/have dropped their AMA memberships because they perceive that the AMA is not representing their interests. I am one of those physicians.

    Once the AMA gets the answer to Dr. Lundberg’s question, it needs to act and it needs to act definitively. Many of the issues facing physicians do not involve easy answers. Look at health care reform, JCAHO directives, effect of patient satisfaction on medical care, payment reform, and insurance reform as a handful of examples. Acting in the physicians’ interests in these issues might put the AMA at odds with the federal government, with insurance companies, with federal agencies, or even with patient interests.

    Unless the AMA better represents the physicians’ interests in these issues – or whatever other issues are important to physicians – even if those interests are at odds with other industries, it will continue to see its membership diminish in its march toward obscurity.

    Also, as Dr. Gorayeb noted above, charging a $500+ admission fee every year to enter a “conversation” on the subject won’t cut it. If the AMA wants new members, perhaps offering a free membership for a year and free admission to the annual meeting for a year or two would get more people involved and help shape the conversations.

  • Sideways Shrink

    Vox Rusticus’ idea perception that the AMA is or is viewed as a patient advocacy organization is news. This would not account for the way the AMA laid down when managed care and HMO’s came around and essentially sold out primary care. The AMA is viewed as representing the interests of academic/research physicians, and highly paid specialist physicians. If the AMA were advocating for patients and physicians, they would have, for example, held a major lobbying campaign to prevent Medicare from discontinuing E&M codes. But that is a rank and file issue….

  • ninguem

    What Dr. Lundberg should be asking, and does not……….is why the vast majority of American physicians view the AMA with disdain and contempt.

  • http://drpauldorio.com Paul Dorio

    Put simply, as with many entities like the AMA, which purport to “speak” for a disparate group of individuals, they have become political pawns in the larger game of government. I realize that sounds cynical, but when the insurers and government officials run healthcare that is delivered by physicians and whose customers are the American people (and non-American visitors of course), what role can the AMA truly have in that scenario? Healthcare should be run by physicians for the betterment of their patients. Appropriate oversight is essential to eliminate or reduce abuses. But the middle-man that is the insurance company doesn’t make much sense the way it is currently being handled, with continuing cuts to physician reimbursement being the main focus for “cost cutting.” The fact that the AMA doesn’t come up with solutions for the group it purports to serve is testament to the fact that the organization has lost its true focus: mouthpiece for physicians with the goal of excellent patient care.

    • Molly Ciliberti, RN

      Never thought of the AMA as political pawns but instead as those who try to buy “democracy” that they want. They have contributed to many Republicans over the years to try to get the legislation that profits the AMA. The AMA represents itself.

      • http://Www.twitter.com/alicearobertson Alice

        Then why are they supporting liberal causes?

        • http://Www.twitter.com/alicearobertson Alice

          In the last election a few doctors were voted into office. I think that is great! I would love to see more doctors run for political office. A different type of front line…but I think their training as a physician brings a great balance to deciphering the law that benefits constituents. Maybe they can help heal the ills of society, and their colleagues?

  • PatientX

    This is a really interesting commentart from the vantage point of a patient and a long-time pharma industry veteran with HCP interests as a primary professional focus.

    As a patient, which is the perspective I’m currently speaking from, I don’t want my physicians to all have one voice. I want them to have different voices and to be encouraged to express them differently.

    I want my Oncologist to have a different voice from my OB/GYN, my FP, my orthopedic surgeon. They see me differently as a patient, and I want their voices to reflect those differences. My Oncologist should fight for me in a way that’s different from how I want my kids’ Pediatrician to fight for them.

    I would, however, like to see a united front returning to basics of treating the patient in the best manner for how their condition presents. Too many of my physician friends aren’t allowed to practice medicine with autonomy because a third party is telling them how to do it without assuming any of the liability or vested interest in me…….as a patient.

    • DrB

      “Too many of my physician friends aren’t allowed to practice medicine with autonomy because a third party is telling them how to do it without assuming any of the liability or vested interest in me…….as a patient.”

      well put….
      Doctors have lost their authority but have retained their liability. an evil combination. thanks AMA.

  • jim jaffe

    as an outsider, my guess is that all physicians would agree they should be allowed to practice medicine as they see fit and be compensated in an adequate fashion. obviously physicians would define both parameters of practice and adequacy of reimbursement. you make a plausible case for an alliance between physicians and patients lobbying together to optimize care, but that’s a shifting alliance because patients are also, however indirectly payors, who tend to be unconvinced that primary care physicians pulling down $150,000/year are underpaid.

  • Primary Care Internist

    When hundreds of thousands of physicians watch AMA delegates passively listen to Obama as he says that caps on malpractice awards are wrong, and imply that there isn´t really a malpractice crisis, and that pediatricians are ripping out kids´ tonsils because it´s more lucrative than giving an allergy pill, and that surgeons are amputating legs because they make money on it, rather than treating someone´s diabetes etc, is it really any wonder why nobody wants to PAY THEM to do the same crap???

    All the while our politicians are being bought with big dollars from insurers and pharma, and nonphysicians like Michelle Obama pull down $300k as a hospital administrator. But people think family docs are not underpaid at half that!

    disbelief has turned to anger, which has turned to apathy. kind of like the stages of grieving, when you realize that NOBODY has your back, professionally. Not the AMA. Not hospitals. Not insurers. Not patients. Not even other docs who are too busy figuring out ways to get out. Absolutely nobody. There is a tremendous growing apathy among physicians now, even those in the prime of their earning years. Sadly, patient care has become secondary to getting thru the daily schlog and putting away enough money to look realistically at retiring or pursuing another career.

    • http://drpauldorio.com/ Paul Dorio

      Brilliant and absolutely right on (except the first comment: whose listening silently?! We’re all screaming but no one’s listening to our perspective!)

      The absolutely spot on truth of the matter is that doctors are fighting for their survival. We put in fifteen or more years of schooling plus training (and that is AFTER high school!). In return we get to scramble and fight for every dollar, arguing politely that our time is worth at least what the politicians, insurers and citizens think it is. Meanwhile, we look forward to a possible retirement where we get no pension, no health insurance, and the only funds we can use to live on are those we save diligently for ourselves throughout our careers.

      I admit that we get paid a decent wage – today, at this moment. I also point out that wage is 20-30% less than when I started my career for harder work and longer hours (and I’ve only been out of training for ten years!). And in ten years we will be working harder, longer hours and for less pay and still under the constant threat of a lawsuit which at any moment could wipe out any possible financial gain we might have been able to eke out over the preceding years. (if you don’t believe me look up the tragic, and public, case of the doctor in Florida who lost an $8Million judgment recently for a surgery gone terribly bad. Email me for the link.) only lawyers and obtuse individuals think that our collective concern over being sued is unfounded.

      So, yes, as the internist stated: sadly we are inexorably driven to care not for our patients, but for our own sorry little doctor hides. Would you feel otherwise if you lived with the constant travails that we do?

  • PAULMD

    @ Paul and PCI

    Your opinions are shared and echoed by me. Other than spreading the word and informing others I feel powerless and I want out.