AMA Doesn't Speak for Most Doctors

The American Medical Association officially endorsed the Democrats’ health reform bill.  An eager Barack Obama, of course, used this endorsement to claim that “doctors” support his healthcare takeover.  This misleading statement plays on the common misperception that the AMA represents some huge block of American  physicians.  Not true.  In fact, excepting membership given to students and residents in training, the AMA represents only 17-19% of physicians actually in practice.

During the last twenty plus years, the AMA has progressively lost members, and this slide continues.  Like many doctors, as a medical student I belonged to the AMA.  But once in practice, I recognized the disconnect between the highly paid AMA directors, the AMA policy makers, and me. Rather than stand on principle, the AMA has sold out for short term financial benefits for its members and, most egregiously, for its own organizational self-preservation.   

In the 1960s, the AMA protested appropriately against the institution of government run Medicare.  But, sadly, when the politicians assured AMA leadership that physicians reimbursement would continue as “usual and customary” fees — in other words that the doctors could continue to charge their usual rates and this would be paid by the Medicare budgeteers, the AMA rolled over like a salivating puppy.  This proved to be a bad bargain since the government — surprise surprise — did not keep its financial word.  

The AMA, if we can say nothing else about it, fails to learn.  History repeated itself recently as the AMA traded its endorsement for a promise by the politicians to improve physician pay scales.  To know the truth, the AMA needed only to look around. Car dealers are even now discovering government perfidy by expecting to be promptly paid in the “cash for clunkers” scam.  It seems no one can avoid the lure of money — even when promised by politicians.

Worse yet, the AMA has become an arm — sometimes a strongarm — of the government.   Under the balanced budget act, there is a fixed pot of money for physician reimbursement — in 2008 approximately $76 billion.  So, in this fixed pot scenario, if internists, for example, are to be paid more for their patient care, someone else — general surgeons for example — must be paid less.  

Needless to say, everyone wants a seat at the table when the money is doled out, and the AMA is in charge. Theoretically, all specialty areas of medicine have representation in this process, however that is not always the reality.  According to the AMA rules, if a specialty society doesn’t maintain a certain level of AMA membership among its members it loses its seat on the bargaining committee.  In other words, the AMA says, “Belong to us or you won’t get paid.” The Gambino family union bosses must be consultants for AMA contracting.

In spite of this strong arm membership tactic, physicians have left the AMA in droves. Some are joining other organizations such as the Association of American Physicians Surgeons, a free market conservative medical society that has opposed government health care since 1943.  40 Medical societies representing over half a million doctors have recently opposed the AMA’s position on health care reform.  Most recently, the New Jersey Medical Society has written a letter of opposition to the AMA’s position, very clearly stating that the AMA does not represent the views of its members.  

Given the dropping membership, how does the AMA stay in business?  In a brilliant business move, the AMA created a coding system that all doctors and hospitals must use to bill the government: the CPT code book. And, as the codification of medicine required more and more paperwork the AMA was more than happy to step in and supply electronic systems to help both the government and the doctors — all at a price of course.  

The AMA’s yearly report for 2008 shows a dismal financial picture from 1984 to 2000 — many flat line and deficit years, until 2000 when its profits from the CPT monopoly really took off.  Although it is illegal, according to the Supreme Court, to copyright information required for others to be in compliance with federal law, the AMA continues to hog exclusive rights to the CPT codes and bring in millions of dollars ($111 million in 2008 — the AMA’s only growth area). Thanks to this monopoly, the AMA doesn’t need members to survive, so why should it care what we really think.

To be fair, many other medical societies have similarly been reduced to lobbyists for the government’s dime. But the tragedy of the AMA is one of lost opportunity.  Had it chosen a different path, today it could have been the strongest voice for the noble tenets of medicine, a bulwark against government takeover, and advocate for the patient.  Instead it has become a self absorbed, self preserving jobs program organization which has sold out the Hippocratic ideal for the promise of shekels from government toadies.