The AMA's Credibility Crisis

July 21, 2010

When President Obama wanted to address American physicians directly during last year’s health reform debate, he pointed Air Force One toward Chicago and spoke at the AMA’s annual convention.Next time, he might do well to find another venue.Because let’s face it: The AMA, though generally well-meaning and occasionally useful, has not been a genuine physician association for many years, if it ever was. Indeed, last year’s reform debate exposed, and aggravated, the AMA’s large and growing credibility problem with American physicians.

Readers, the following column appears in our current issue of Physicians Practice. I've started receiving some direct feedback, so I thought now would be a good time to posit it here, in hopes of starting a conversation about the role of the AMA in the lives of modern physicians.

When President Obama wanted to address American physicians directly during last year’s health reform debate, he pointed Air Force One toward Chicago and spoke at the AMA’s annual convention.
Next time, he might do well to find another venue.

Because let’s face it: The AMA, though generally well-meaning and occasionally useful, has not been a genuine physician association for many years, if it ever was. Indeed, last year’s reform debate exposed, and aggravated, the AMA’s large and growing credibility problem with American physicians.

A survey of 5,000 doctors published in the New England Journal of Medicine found that only 13 percent agreed with the stance taken by the AMA. The group argues that the surveyors mischaracterized its position.

Not familiar with that position? Let’s review: Yes on reform generally. No on the public option. But maybe yes on some kind of public option-esque alternative if it’s not too public option-y and pays better than Medicare. But yes, possibly, on even a Medicare-indexed public option, if Medicare’s formula for calculating payments is reformed. Got all that? Whatever. You’ll just have to take the AMA’s word for it when it claims major victory on reform.

Or consider its feckless public advocacy campaigns this year on the so-called “doc fix.” A number of Senate Republicans were blocking attempts to delay for 18 months the scheduled 21 percent Medicare pay cut. So did the AMA name those senators and threaten to spend money in their states to defeat them at the ballot box? Heavens, no. It ran a bland ad blaming Congress generally for the problem. And what did its milquetoast efforts get for its members? A six-month patch, after which we will start again, no closer to a permanent solution.

It’s not ineptitude: the AMA knows that such half-baked efforts don’t work; it’s just that opting for a more viable campaign might have caused hard feelings with certain members of Congress whom the group doesn’t wish to offend, period.

Is it any wonder, then, that last year, like most years, the AMA’s member rolls dropped 3.5 percent from the year before? Of America’s roughly 950,000 MDs, only about 228,000 called themselves AMA members in 2009, and of these almost half are students, residents, or retirees, whose dues are deeply discounted. There was a time when 70 percent of doctors were members. Now it’s one in four, or less. That’s tragic.

The causes of the AMA’s ever-downward spiral are evident in its budget. With only 16 percent of revenue coming from members’ dues, it’s heavily dependent on other financial sources - some of them borderline creepy, like its licensing of information about individual physicians, others just frustrating, like the profits it reaps from the very CPT coding system that doctors loathe.
As it becomes more reliant on such revenue streams, it grows more distant from the real lives of working doctors, which enlarges its credibility problem, which feeds further membership drops, which, yes, makes it still more dependent on nonmember revenue.

Scores of new, bootstrap doctors’ groups have sprouted up in the last four or five years - Libertarian-minded groups like the Association of Physicians and Surgeons, lefty groups like Physicians for National Health Reform. And everything in between. Today’s physicians are more determined than ever to have a role in shaping the forces that are affecting their world. They have things to say, and are opting to join groups that are giving voice to their views. All of this is excellent news for doctors.

But not for the AMA.

What’s your opinion of the effectiveness of the AMA’s representation of physicians? Tell us in the comment field below.