Why the AMA is in decline, and should doctors care?

The American Medical Association recently released its membership numbers, and they’re declining.

According to MedPage Today, the AMA “saw another steep drop in its membership in 2010 — this time losing about 12,000 members or 5% of its total membership.”

It’s been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it’s between 20 and 30%.  But it seems many physicians have little positive to say about the organization.

In a provocative opinion piece, former JAMA editor George Lundberg asks, “Why do so many physicians hate the AMA?

He lists a myriad of possible reasons, including previously opposing Medicare, lack of progress on malpractice reform, and support for the Affordable Care Act.  Although that may all be true, he concludes it’s because doctors are unhappy and the AMA is a convenient punching bag:

It could be as simple as that every unhappy person needs a whipping boy, and the AMA has been an attractive target for so long.

Perhaps, but let’s dig deeper.

The AMA traditionally has been a politically conservative organization, opposing national health insurance in 1948, and, as mentioned previously, resisting Medicare in 1966.

But, in a turn, it supported the Affordable Care Act, angering a core segment of supporters.  According to MedPage Today, “membership declines were most acute in Southern states — the same region in which state medical societies have been championing opposition to the Affordable Care Act (ACA).”

However, the AMA had no choice but to become more politically moderate, or risk extinction.  More doctors are becoming salaried employees, and salaried doctors tend to be more progressive.  The New York Times recently wrote how the political leanings of doctors are shifting left:

Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.

Even the issue of liability, while still important to the AMA and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.

But will a pivot to the center save the AMA? It’s an uphill climb.  Like most centrist groups, the AMA angers both sides of the political spectrum. Conservatives are quitting because of the Affordable Care Act’s support, and progressive physicians are loathe to back an entity that had historically opposed Liberal values.

In the end, however, it’s in the medical profession’s best interest to keep the AMA politically relevant.  Despite having a minority of physicians in its membership, what other choice do doctors have?  Fragmenting physicians into smaller political niche and specialty groups will only guarantee that they be further ignored by policy makers.

The AMA may not be every doctor’s cup of tea, but it’s the best voice we have.  And that is better than no voice at all.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitter, and LinkedIn.

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