Can the AMA be fixed?

There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.

In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.

Then, in the 1970s, 80s, 90s, it came apart and now has the least representation of actual members of a widely diverse base than ever and shows few signs of recuperation. Recently, I advocated that all American physicians should become members of the AMA for their entire time in medicine.

Responses, both published and unpublished, were vigorous.

The divide between physicians who think that the AMA should fight for them and those who think that the AMA should fight for the health of the people seems too large to bridge in 2012.

When you add to that the often expressed belief that the AMA fails on both fronts, it really becomes unsalvageable.

Perhaps it is as simple as a reflection of the gridlock in the American government, red states vs blue states and within states, red counties vs blue counties. Too-far-right Republicans and too-far-left Democrats, and few in the middle, with few willing to compromise.

Perhaps it is as simple as generational gaps between the key motivations of medical students entering medical school during different decades as the landscape, environment, and ecology of American medicine has changed so abruptly, in fact in midstream of many medical careers.

I see only three ways to rescue the AMA. Membership in the AMA, state, and county medical association could be made a legal condition for state medical licensure, or a national medical license.

Or, the AMA could change its key objective. It could either become a lobbying organization representing all physicians with group bargaining, to the fullest extent of the law, or a new law that allows collective bargaining.

Or, it could follow its current key objective and truly “promote the art and science of medicine and the betterment of public health” and stop also trying to represent the financial interests of its members.

Depending upon how these played out, this “new” AMA could spin off the eternally successful journal publishing effort as a separate publishing business. It could close the Washington office. Physicians could go mostly to salaries from not-for-profit multispecialty managed care organizations like Kaiser Permanente or Geisinger, or various ACOs.

Without a strong AMA speaking for all American physicians, Medicare for All is just around the corner. And this Medicare will not be fee-for–service, since that failed to control costs. It will be physicians on salary from ACOs, HMOs, government run clinics, and the like. No private insurance companies, thus no need for billing, so no need for coding.

Goodbye AMA lucrative CPT, no more hated RUC. Physicians who refuse to take Medicare patients (my estimate less than 5%) will still be allowed to care for private, pay-as-you-go, out-of-pocket patients, concierge level or less.

And, if you think physicians are angry now, wait 5, 10, 15 years, and there will be another effort to rebirth an AMA, probably like the old one. Oh my.

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

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  • familydoc

    Let the AMA give up the pretense of representing physicians and simply go sell journals and licenses to their CPT code monopoly.

    Docs4PatientCare http://docs4patientcare.org/ speaks for me.

  • buzzkillersmith

    The AMA has sucked family medicine and the US health care system dry by directing all the money to proceduralists. Drive a stake through its heart.

    • southerndoc1

      Agree, and it was done with the enthusiastic participation of the AAFP and ACP.

  • glandsone

    The AMA should long ago have been consigned to the dung-heap of history. They were segregated for most of their existence, had to be shamed into divesting their tobacco stock investments and various and sundry other disgraces. Most of us have long seen through the veneer of distinction.

  • DavidBehar

    I am a member of the AMA. I have an intense hatred of these left wing extremist traitors to clinical care. Begin by purging the entire home office staff of all highly paid Ivy indoctrinated, big government Commie traitors and collaborators. They are the mortal enemies to our patients, but good pals to the Chicago Obama mob. They refuse to fight for clinical care. Highly paid cowards and collaborators with the enemy.

    There should be a legal wing, that just attacks our enemies into ruination in court, including the federal government. You can decimate an entire agency by repeatedly suing it, all its employees will be fired even if the case is thrown out. They have no money. They cannot defend even the most frivolous claim without spending $millions. Sue government officials as individuals, and make life unbearable as they are doing to doctors. Always attack the prosecutor of doctors personally. Start with total e-discovery of all personal and work computers. Refer any child porn to the FBI. (The federal government thugs are the biggest downloaders and subscribers to child porn and actually subsidize and keep it going by their subscriptions.)

    In conjunction with patient groups, a direct action branch should physically intimidate insurance companies, regulators, and eventually assassinate some. To deter.

    Lobby for statutes that crush overly entitled family members, the lawyer profession, and other officious intermeddlers interfering with the decision made with patients. End all legal immunities, especially of HMO’s and file hundreds of class action suits. Repeal the Eleventh Amendment so that states can be sued into ruin.

    Judges and plaintiff attorneys should come to fear the doctor, rather than the other way around. A list of enemies should be made, and all service and product providers should boycott them, including the dying judge having a heart attack. These heartless little tyrants should know they are risking their lives when attacking clinical care to plunder it. Doctors should not be forced to service their mortal enemies, and others seeking their destruction.

    Doctors collaborating with the enemy should be expelled from the AMA, and demonized in their local communities.

    I do not want to be around when docs get angry.

  • kjindal

    there is such a sharp divide between us clinical “in the trenches” doctors, and the growing army of overpaid ivory-tower elitist non-practicing “MDs” at the AMA, ACP, ABIM, AAP, AAFP, etc. (take your pick – they’re all a bunch of hypocrites). I have heard over and over again from the likes of Lundberg, and even us docs who are self-employed still have various overseers of our work, all of whom see fewer patients than us (or none at all), or are far lesser trained “professionals” (various visiting nurses, hospice social workers- don’t get me started on them, NPs, DNPs, insurance company execs, etc)
    Now this year studying for the first ABIM recertification it is even more angering. These jokers at the ABIM:
    1- write an esoteric exam, then except themselves & their contemporaries from it (grandfathering)
    2- mandate the bullshit “MOC” program where we must compile patient data & submit it for their expertise to advise us what a shitty job we’re doing, and that they must save us from mistreating our poor ignorant patients
    3- target us, a demographic of MDs fighting for every penny from medicare & insurers while raising small children (typical 1st recertifiers are in their late 30s/early 40s), for loss of income, essentially forcing us to lose otherwise productive time & money on review courses, review materials, the test day itself; then again they exempt themselves; and finally
    4- pay themselves insane 6- and 7-figure salaries off our backs.
    these guys are not interested in the future of the medical profession AT ALL, but rather only on continuing to “eat their young”. Sorry Mr. Lundberg, but your last post was such a disappointment, and to me, rings truer than this one…

  • kjindal

    not to mention the growing (false) mentality that “board certification” means “licensed”. I recently had a NURSE administrator at the NYS education dept disallow the use of “pediatrics” in a professional corporation title for my wife because her board-cert status lapsed while she was raising our kids & stopped working. Even the MSSNY (and my $800 in dues they have) could not fix that. So by their logic, an NP who took an online course in pediatrics for 6 months could use “pediatrics” but not an MD who completed a 3-year residency! That our organized representatives are so powerless, continues to disappoint me.

  • lauramitchellrn

    Nursing went through similar moments of angst in the 1990s. It started when the California Nurses Association voted to disaffiliate from the American Nurses Association. Why? The leadership of ANA was primarily administrators and academics who were intent on throwing the bedside nurse under the bus and shilling for the hospital associations. Several other state nurses associations have also disaffiliated from ANA for similar reasons. I think that both the AMA and the ANA are still operating in the world in which they were founded.

    Since medical and nursing curricula are standardized, and in the case of nurses, we ALL take the SAME NCLEX exam, I would love to see a national license that would allow us to practice from sea to shining sea in the US, Puerto Rico, Guam, the Virgin Islands, etc.

  • cerissa

    Their time has long gone…this is a phony status for has been, never were much, doctors. Along with ending this blowhard bunch, take the FDA (Fraud and Death Assoc) with it and all the other pompous less than average, bottom of the class graduates as well. They are all in bed together to give themselves undeserved status to feed their voracious ego. Their main goal is to promote Pharmacy dictates and destroy anyone with a true advocacy for a better way to deliver the best in medical care…and, of course, attend expensive banquets and seminars gratis from the very Pharmacy co’s., and various industries that tout cures & care, ie: American Cancer, etc., yet actually do very little for the sufferer of the disease and continue to build their empire and garner more power over the life pattern we all must follow thru their dictates.

  • Bhavin Jani

    Lundbergh,you have sold us and our profession to the non physician bureaucrats who control us now. Made it so difficult earning bread through your nonsensical CPT billing. I am done with AMA. You better not tie my license to my react icing medicine. At least fight a little bit for our noble profession from total takeover by bureaucrats