Two weeks ago, the AMA met for its 160th annual meeting in Chicago; this year with 12,000 fewer members than during the 159th annual one year ago. At the meeting, I heard many physicians express a growing concern: the membership of this national professional organization has dwindled recently, and now represents less than 10% of the physician voice in America.
Speculation has suggested two reasons for the loss of membership. First is the controversial position of “support” that the AMA gave two years ago to the PPACA. Second is the inconsistency between AMA policy voted upon by its House of Delegates (HOD) and the actions taken by AMA’s Board of Trustees on the organization’s behalf. Rather than leveraging the election and legislative processes to reign in these problems, 12,000 doctors have chosen not to renew membership in their national professional organization.
What would happen if our national legislators decided not to participate in the democratic process because they disagreed with an election or policy vote? Arguably, it would be quite counter to effective democracy. Having observed the policy creation process in the AMA’s HOD, it is clear that the process makes great efforts to entertain the minority opinion prior to a vote. Perhaps for dissenters, the more effective approach to strengthening representation would be to recruit like-minded physicians to pledge membership and run for elected office, rather than leaving the table all together.
Medical politics, like those of our federal government, continue to grapple with unwavering and polarized points of view. Many AMA southern delegates proclaim freedom from government regulation of any kind, while northern delegates are generally more comfortable complying with some terms of the PPACA in order to achieve greater access to healthcare. During debate on more benign policies, like the one requiring physician excuses from physical education in grade school, southern doctors dogmatically proclaim freedom from exercise mandates, while northern states judged such colleagues as holdouts to fighting our nation’s obesity epidemic.
One of the most contentious votes during the last four national meetings of the AMA has been on the healthcare mandate prescribed by PPACA. Prior to the A-11 meeting, the vote in the HOD has been evenly split 50/50 along state and ideological lines. In this meeting, however, almost 60% of the House passed a resolution with language endorsing current AMA policy D-165.966 (find it on AMA policy finder). This policy will provide state governments the freedom to decide how to best cover the uninsured. A state-by-state implementation is already enacted by PPACA, but will not take effect until 2017. The Wyden-Brown Senate bill, currently under debate, would move this deadline to 2014 if adopted by the US Congress.
There are many medical associations representing specialty medicine, regional interests, and national politics within medicine; but only one association - the AMA - purports to represent ALL physicians. Arguably, based solely on membership numbers, the AMA is already a long way from that claim. What’s undeniable, however, is that for this professional organization to continue, new ways to connect new members are required. What are the best strategies for doing this? And how can the AMA empower physicians such that they feel like their concerns are addressed? Is our nation so polarized and the practice of medicine so regionally variable that no one organization can truly represent all US doctors?
We look forward to exploring these questions more in coming weeks. In the meantime, we look forward to reading your input and ideas.
David-Thanks for your inside view. The Wyden-Scott bill is interesting and an area where the AMA's political activity is beneficial.
ReplyDeleteHowever, the whole process sounds overly politicized. Does the average doctor receive any benefit of professional development through AMA services? There's a long running reputation that doctors have a lack of business sensibility. Has a lack of professional services offered by the AMA (and an over abundance of political play) driven away members?
Society is hinged on the idea of strength in numbers. The assumption is that power requires sameness, and hence an organization is needed to assemble the masses.
ReplyDeleteBut this assumption is not universal. Some see opportunity in difference, and power in uniqueness, not number. Take Qliance, for example, which implements a radical, but highly successful, medical practice, independent of popular poll and in spite of the mighty Insuraglomerate.
Recruitment requires something attractive--a lure if you will--to draw participants. A suggestion ensues regarding one such lure for physicians seeking uniqueness. Could AMA provide an exclusive protected network (like a Facebook ripoff, Linked-in partnership, or Google+ mimic) that allowed members to observe colleagues, critique innovations, and develop collaborations?
Anonymous - I think your suggestion is great. Physicians in academic centers already use grand rounds as a departmental tool for reflecting on complicated cases, sharing innovative new approaches to common medical problems, and discussing current research on topics of interest. If this type of exchange could be broadened to a professional social network for physicians, I think doctors and patients would benefit.
ReplyDeleteOne of the drawbacks of the AMA and other professional sub-groups of physicians is that too often they only represent a small percentage of their profession, and much of their discussion and advocacy is focused on scope practice and reimbursements. A social network would likely engage more doctors and allow for informative discussions on care that would enhance the value provided by every physician that participates. This would require smart and established doctors to let down their guard, however, and admit at times that they've forgotten some things and have deficiencies to improve. My experience has taught me that this is something that's hard at times for proud physicians to do.