The AMA Doesn’t Represent Me
Internet community reflects growing discontent with AMA among doctors
Sermo.com, a 3-year-old physician-only online community, has recently become a hotbed of discussion against the AMA. Its founder, Dr. Daniel Palestrant, posted that he was “joining ranks with physicians who believe the AMA no longer speaks for them.”
The results of a survey of 4,156 physicians were recently posted on the site. Of the respondents, 75% are not AMA members, and 89% claim that, “The AMA does not speak for me,” while 91% do not believe the AMA accurately reflects their opinions as physicians.
Over the past three years, there have been over 2,000 AMA discussions on Sermo.com among physicians, with the majority highlighting frustration with AMA policy stances.
Naturally, physicians responding to Dr.Palestrant were not in absolute agreement. It’s long been said that trying to organize physicians is like herding cats, and that if you get 10 doctors in a room, you’ll end up with at least 11 opinions. We wouldn’t have ended up in medicine if we weren’t passionate and opinionated. Most of us end up doing what we do because we care about people, about science and about making the world a better place.
The majority of doctors responding to the survey believe medicine needs to be changed to enable them to take better care of their patients, and they felt the AMA hadn’t been dealing with the issues adequately. Here’s what they want to see happen:
- Limit insurance companies' ability to deny care
- Restrict the encroachment of nonqualified healthcare workers into patient care
- Provide caps on settlements
- Work toward malpractice insurance reform and adjudication by qualified boards
- Abolish CPT codes
- Allow physicians to negotiate collectively for an equal footing with insurers
- Give cost of living increases in insurance reimbursements
In the Sermo discussions, most physicians expressed strong feelings about being hampered in daily practice by insurance demands and drowning in paperwork. They’re burdened by the minutiae of the current system, falsely blamed for rising costs, and misrepresented. (For example, only 10.6% of the 2010 Medicare budget is slated for physician compensation.)
Physicians were particularly concerned that President Obama, by meeting with the AMA, had not met with physicians working “in the trenches.” That could lead the public to believe the AMA reflects the opinions of all physicians. In fact, the AMA was called “the nation’s doctors” by NBC News White House Correspondent Savannah Guthrie, when she discussed the President’s impending speech to the AMA on MSNBC’s Morning Joe.
The AMA only reflects, at best, one-fourth of all doctors practicing in the United States. (921,000 physicians: 236,000 AMA members). As such, can the AMA really be considered the voice of America’s physicians.
In early July, doctors who defend the AMA suggested critics become involved and work within the organization to change thinking, which generated heated discussion. One of the more quotable comments is this: “There’s a misperception that those involved in the process are favorably disposed to the AMA, and that those who hate the AMA must have never been involved. It somehow never occurs to the defenders of AMA that others might have been involved and found it to be a ‘Heart of Darkness’ experience.”
Many physicians expressed dismay that a fraction of AMA revenues come from dues, and so much of the revenues ($70 to $100 million per year) stems from license fees on CPT codes. This struck them as a conflict of interest for an organization whose vision statement includes this: “The American Medical Association helps doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues.”
It’s time to take healthcare back to the basics and put the patient in the driver’s seat because it’s clear that the AMA and the nation’s physicians are not on the same page.
Dr. Christina Peterson is a neurologist in private practice at The Oregon Headache Clinic. She is a former member of the AMA.
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Comments
Dr. Peterson, an excellent clinician with long experience, speaks the truth. I remain a member of the AMA, but not because I believe it speaks well for me on health policy. I've been quite deeply involved in the past, representing Alaska in the Young Physicians Section (when a lot younger!), and as president of the Alaska State Medical Association in the 1980s. Even that far back, it was clear the AMA House of Delegates disproportionately represented wealthier physicians from wealthier subspecialties, who had the time and money to participate much more than others, and defended their self interest much more than it worked for health policy changes needed to improve care or access. Certainly others attended and participated, but "going along to get along" meant sacrificing some important values, or muting one's expression of them, for sure. Now that serious health reform puts the incomes of those same subspecialties in tension with universal coverage and access, and with reform of the delivery system to properly support needed primary care changes, the contrast between the AMA's statements and its deeds, and society's needs, is much more stark.
Don Thieman, M.D.
Not to be overly inflammatory, arn't the AMA, AHA, and the likes, trade organizations with missions to first and foremost protect and advance self interest? How would we expect such organizations to lead or even cooperate with overt strategies to reduce or inhibit the cash flows of its members? I realize all "professional" organizations take a strong swipe at altruism which is good and should be fostered, but I would think that should only be presumed as going so far. About like asking insurance companies to ignore risk selection.
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