Credibility Crisis at the AMA

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 American Medical Association, though generally well-meaning and occasionally useful, is no longer a genuine national physician association, if it ever was. Indeed, last year’s reform debate exposed, and aggravated, the AMA’s 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 alternative if it pays better than Medicare. But yes, possibly, on even a Medicare-indexed public option, if Medicare’s formula for calculating payments is reformed. Confused? Oh well. 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. 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 achieve? 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 recent years, the AMA’s member rolls dropped 3.5 percent? 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 are evident in the AMA’s budget. With only 16 percent of revenue coming from members’ dues, it’s heavily dependent on other financial sources - licensing information about individual physicians, and reaping profits from the very CPT coding system that doctors loathe.

As it becomes more reliant on such revenue streams, the AMA 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 American 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.

Bob Keaveney is editorial director for Physicians Practice. He can be contacted via e-mail at bob.keaveney@cmpmedica.com.
This article originally appeared in the July/August 2010 issue of Physicians Practice.