A doctor quits the AMA and his state medical society

Everywhere in the news these days, you read of stories where physicians are being cancelled from insurance plans, and groups like the American Medical Association, and state based medical societies fighting to reverse these decisions. Does anyone think these actions will really make a difference? I certainly don’t.

Since this is the start of December, this is the time of year where I look at certain expenses and wonder if they are worth continuing for next year. There are some elements which are essential, like my state medical license and DEA license (so I can prescribe certain medications). One cannot practice medicine without these.

What I struggle with every year is justifying the expense for continued membership in physician professional organizations like the American Medical Association, state based medical societies, and my specialty organization.

It is no secret and it has been well documented that the American Medical Association has not had the membership numbers it once had, and less than 30 percent of American physicians are AMA members now. Every year, it has come down to this question for me: “Does this organization represent me and support my professional interests?”

At one point that answer was “yes,” but now, it’s “no.” I’m issuing my cancellation letter to the AMA and my state based medical society. With shrinking payment, increasing expenses, and not feeling like I have a voice there anymore, it is time to part ways.

I know there are some physicians out there saying, “What took you so long?”

One could always hope that my family physician activist friends could help to turn the tide at the speciality driven AMA, but I don’t have the dollars to wait any longer. My heart and soul and voice remains with my specialty organization (American Academy of Family Physicians), and I think that other physicians feel the same way in that their niche group or their specialty group brings their health policy message to the local, state, and federal levels for advocacy.

I went to medical school to be an independently owned, primary care physician, who sees patients in the hospital and in my office. Unfortunately, we are facing extinction in the face of the current trends of hospital owned, employed physicians, who are either hospital based or office based. Physician membership organizations are doing a lot of soul searching these days trying to figure out who there membership is these days. Fragmentation is not only in patient care. It is also in physician advocacy. My dollars and support will go to organizations who support me and hear my voice.

Mike Sevilla is a family physician who blogs at his self-titled site, Dr. Mike Sevilla.

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  • Skeptical Scalpel

    Excellent post.

    What took you so long?

    Be prepared for a never-ending barrage of notices asking you to rejoin which I describe here http://bit.ly/1blmVLF.

    • May Wright

      In your post:

      “According to recent figures, only about 17% (217,000) of all
      US doctors and medical students are AMA members, 25% of them are over 65 years old and enrollment is flat.”

      And yet the average member of the public still thinks that the AMA speaks for all physicians. Which is not helpful when the AMA comes out in support of policies or statements with which the majority of the average public disagree.

      How can physicians get it across to the general public that “the AMA does not speak for me, nor for 83+ percent of my colleagues”?

    • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

      oh yes… the “not to subtle” PAYMENT DUE notices that AMA sends out…. like we owe then something….. scoff.

  • southerndoc1

    “I went to medical school to be an independently owned, primary care physician, who sees patients in the hospital and in my office.”

    Actually, of all the medical societies, the AAFP is the most openly hostile to that style of practice.

  • Dr. Drake Ramoray

    Excellent post. Welcome to the club.

  • NewMexicoRam

    Yep.
    I still belong to the AAFP and NMAFP, but only because they help keep my CME organized.
    But who knows for how much longer?

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I have a question: If you are employed by a hospital system, does the employer pay (or reimburses the expense) for your dues to professional associations, as a benefit or courtesy?

    • Dr. Drake Ramoray

      Generally speaking yes. There is a certain CME stipend, vacation time, and professional dues. Hospital employed are employed and like any employee paid in such a way that the CEO and administration make some money. Hospital employ is generally stable but less income than private practice. It is sold as less hassles but that is not always the case.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Well, if the “employer” pays the dues, shouldn’t the associations be more than tempted to cater to the employer?

        • Dr. Drake Ramoray

          At this time a plurality of physicians are not employed by hospitals so this hasn’t happened yet. I think it was last year for the first time most new docs fresh from residency were working for hospitals or mega-groups.

          Much like the AMA gets a large part of it’s revenue from CPT codes and the like, and little from actual physicians, the current physician groups can get corrupted. Many argue something similar happened with AARP in supporting Obamacare given that the AARP has an arm that sells insurance.

          As for why the AFP is working against it’s members I do not know. My group (AACE) is pretty good we are just too small.

        • LeoHolmMD

          A great point that I have been making for a long time. Hospitals subsidize the dues, and the medical societies serve their master. This explains much of their behavior and priorities.

          • May Wright

            “He who pays the piper calls the tune.”

        • Dr. Drake Ramoray

          Yes Leo is probably closest to the mark. My specialty association still represents us well but we are very small and most of us are working for ourselves. So my experience has a positive bias for now.

    • buzzkillerjsmith

      In the old days No. CA Kaiser did not because it thought the AMA was anti-Kaiser. But I last worked there in 1995.

      Kaiserdoc out there care to give us an update?

    • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

      Margalit, are you aware that the AMA owns the rights to the asinine ICD/CPT coding system that has burdened physicians for years?

      a system that CLEARLY benefits insurance companies and the government as they look for bureaucratic excuses to dismiss or deny claims.

      A system that the AMA is licking it’s chops over as they stand to make a tremendous amount of money next year conveniently “rolling out” ICD 10. as practices around the country will have to pay thousands of dollars to try and implement this monstrosity….. for what reason!!!!???

      no…. AMA does NOT speak for doctors. Insurance companies and government happily are feeding this bloated cow to prevent real physicians from having a voice as they claim “doctors” via the AMA are on “their side.”

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Dr. Stephens, the AMA does indeed own the CPT codes, but the ICD codes are owned by the WHO. There is no fee to use them http://www.cdc.gov/nchs/icd/icd10cm.htm
        This, of course is not meant to dispute the point you are making… just to clarify :-)

  • buzzkillerjsmith

    The nice thing about belonging to the AMA is how good it feels when it stops.

  • Dave Mittman, PA, DFAAPA

    What is most interesting is the new thinking in association management where they are willing to write off sizable numbers of members who they know they will not make happy and do not want to expend the energy or funds to do so. I was shocked that is the current thinking in some associations.
    “Can’t be all things to all people”. Especially multispecialty orgs.
    Dave

  • querywoman

    I wouldn’t pay to be in these societies. Medical societies used to disseminate info to their members. Now the internet does that better.
    The only ones of my own doctors who are in the AMA are ones who have an “agenda,” like activism for a certain disease.

  • Gaspere (Gus) Geraci

    The public believes the AMA and state medical societies represent us. If we want to convince the public that they do not, then who shall we tell them does? If you believe the AMA and the state societies (or the AAFP) do not represent us, why is that? Both are composed of members who must speak out and vote within the organization creating the agenda. Why then, do they seem to not support the independent? I, too, want to be independent and see patients in the office and hospital. But healthcare must be efficient and high value to be delivered to all. Cars made one at a time by craftsman exist, if you can afford them. (Concierge practice calling you?) Healthcare must be affordable and deliverable to entire communities, not just to those who have discretionary cash. If healthcare is to be delivered to the community, and improve the health of all in the community, the community is demanding a newer model. I condemn hostility to any style of practice, but to deliver care efficiently to the community requires newer models than independent docs who do it all themselves. A sad truth. Henry Ford made cars affordable. Not by building them carefully one at a time. We have to make high quality healthcare affordable for all. Let me know if you think all physicians can be independent and see patients in the office and hospital and do that, if that is the goal. Or tell me what your goal is, and enjoy what you do, but don’t expect the majority to always agree with you, nor society to support your goals.

    • Jess

      Automobiles were not made affordable through government fiat, they were not made affordable by the government dictating that every American must buy a car, then dictating how every car is to be made, what features it must have, and how much each manufacturer is allowed to charge for it.

      Automobiles were made affordable through the genius of the free market.

      Yet the AMA is wholly on-side with the Big Government dictates of Obama’s PPACA, and openly antagonistic to anything even slightly resembling the free market.

      A sad truth. Henry Ford</strong and free citizens with free choice in the free market made cars affordable. Not some centrally-planned and taxpayer-funded trillion-dollar Affordable Car Act.

      • Robert Luedecke

        The US is the only developed country in the world to not have medical insurance for all citizens and our country is suffering because of it. The people who cook our food, mow our lawns, and cut our hair will never be able to afford health insurance if we do not use tax dollars to help. Because each uninsured person who has a major accident or illness leaves a huge hospital bill which they cannot possibly pay, all the rest of us pay for their care through increased health insurance premiums and local hospital district taxes. All taxpayers would get a tax break if Medicaid was expanded throughout the US. Medicaid also allows a small problem to be treated in a doctor’s office before it becomes a big expensive problem treated in an expensive emergency room.

    • Robert Luedecke

      There is absolutely no reason physicians can’t continue to own their practices. Changes are needed in term of doctors working better together, but we do not need to be employed by the hospital to work together, only to want to work better together and be more efficient.

  • Alex Hunt

    I also quit the AMA years ago. Much of their politics is contrary to mine. I was told that most of the membership they have is in academics.

  • Sara Stein MD

    Not a member. Nowadays I spend my dues at the societies with the best education.

  • Michael Wasserman

    Kudos to you. Unfortunately, organizations like AAFP encourage their doctors to belong to the AMA so that they can have a seat at the table. We shouldn’t care about having a seat in an organization that doesn’t truly have the interests of the patients in mind. I addressed some of this in a recent article http://altarum.org/health-policy-blog/medicares-10-billion-secret