Address the primary care shortage and make the AMA more relevant

It saddens me to proclaim that the American Medical Association (AMA), the once-venerable organization that has advocated for the interests of physicians and patients alike since its founding in 1847, is on the precipice of irrelevancy.  Membership has dwindled such that only 1/4 of physicians now belong to its ranks.

The attendant decrease in social and political influence that accompanies this decrease in membership arguably compromises the ability of the AMA to execute its mission statement: “To promote the art and science of medicine and the betterment of public health.”

Now more than ever, as we witness the transformation of healthcare delivery in the United States, there exists a need for a strong voice to represent the collective wisdom and experience of physicians in this country.  Sadly, this is lacking at this pivotal time.

Regardless of one’s political leanings, there appears to have developed a broad consensus among stakeholders that:

  • the cost of healthcare in the United States is too high
  • there are not enough primary care physicians in the United States
  • relatively low compensation is one factor motivating medical students to choose more lucrative specialties as careers

If our goal, as a society, is to increase the number of medical students who choose primary care then we must commit to paying these physicians fairly.

The AMA’s Specialty Society Relative Value Scale Update Committee (RUC) is advertised as representing the entire medical profession.  It consists of 31 members, with 21 of these appointed by medical specialty societies.  At any one time, no more than 5 of its members (at most) represent primary care.  It is this committee that is tasked with allocating a work relative value unit to every professional activity performed by physicians.  These recommendations, which are made annually, are then forwarded  to the Center for Medicare and Medicaid Services (CMS) and also serve as the template for Physician reimbursement by commercial payers.

Since every committee is a reflection of its membership, the recommendations of the RUC (not surprisingly) allocate a higher value to the activities performed by specialists and subspecialists compared to those performed by their primary care counterparts.  The downstream effect is reduced reimbursement to primary care physicians by both CMS as well as private insurers.  To begin to address this significant differential in compensation between specialists and primary care physicians, the composition of the RUC must change.  Otherwise the AMA risks being indelibly tarnished as an organization that serves as a lobby for specialists and subspecialists to the exclusion of our primary care brethren in the trenches.

Revamping the membership of the RUC so that half of its voting members represent primary care would represent a bold attempt at acknowledging that primary care physicians have been under appreciated (and under compensated) for far too long in our current healthcare system.  So as not to silence the voice of any specialty society that is currently privileged to serve on the RUC, the committee can instead be enlarged via the addition of positions that would be reserved exclusively for primary care physicians.  The consequences of such a restructuring of the RUC would be clear: as greater value is placed on activities performed by primary care physicians compensation would increase, followed by an increase in the number of medical students who choose to enter primary care.  In time, the shortage of primary care physicians in the United States would be alleviated.

Such a change would demonstrate that the AMA (both its leadership as well as membership) is serious about addressing the dearth of primary care physicians in the United States for “the betterment of public health” (as per its mission statement).

Such a change would also secure the AMA a continued place at the table of stakeholders as our healthcare delivery system undergoes dramatic transformation in the 21st century.

James M. Pritsiolas is a nephrologist and can be reached on Twitter @Nephro_Doc.

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