The Bigger Picture: Wither Organized Medicine?

Jim Claflin is a gentlemanly allergist from Oklahoma. He's not easily ruffled, but he's worried about the future of organized medicine.

"Organizational membership attitudes have definitely changed in the past 30 years, since I started medicine," he says. "As a young physician, I remember attendance of at least 80 percent at county medical society meetings. We now have less than 10 percent of membership at the meetings and almost all those present have gray hair like me. ... The mindset of young physicians has definitely changed. ... The lack of involvement in organized medicine results in a weakened ability to negotiate the business of medicine."

From pay for performance to malpractice reforms, there seems to be more need than ever for physician voices to be heard by the public and politicians. Traditionally, medical associations served as megaphones.

But if organized medicine is getting weaker - and many physicians share Claflin's intuitive sense that it is - what happens to physicians? Trial lawyers and health plans will continue lobbying. Will physicians get lost in the shuffle, victimized by their own packed schedules?

Those inside medical associations insist their demise is far from imminent, though their roles may be changing.

Observers have speculated that the ranks of the AMA - the largest physician lobbying group - have been dwindling for 20 years. AMA spokesman Robert Mills, while refusing to disclose changes in membership figures, argues that the group is as powerful as ever. It need not have a majority of physicians as members to remain potent, he suggests.

In fact, according to data from the American Society of Association Executives (ASAE), membership in professional associations, and the number of such groups, has been on the rise over the past five years, albeit slightly.

So why is everyone so worried about organized medicine? Partly - as Claflin intimates - it's a generational difference in what people expect of their association. Older members embrace what William Jessee, MD, president and CEO of the Medical Group Management Association, calls "the pageantry of the past" - the fellows' dinners, the ornate, ceremonial meetings. The newer generation wants tangible benefits.

Still, busy people in their 30s and 40s - those with crowded practices and young families - will volunteer if it's clear how doing so will affect them, says ASAE president John Graham IV. (Curiously, people in their 20s act more like an even older generation. "They are more the joiners. It could be something that's cyclical," Graham suggests.)

Willarda Edwards, immediate past president of the Maryland State Medical Society and an internist in Baltimore, also marvels at the energy of the new generation. "I see more energy among the young people all the time," she says. "Young people have a lot more at stake in terms of what could be their future ... [and] they are more aware of what's going on" in terms of reimbursement and malpractice rates, for example, than previous generations of physicians just entering practice. Medical associations will be viable "as long as we keep our pulse on what's relevant to practicing physicians," Edwards asserts.

This article originally appeared in the March 2006 issue of Physicians Practice.