The AMA and You

By Rodney L. Trytko, MD, MBA

Changes in health care are occurring at an unprecedented rate and the path forward is a dismal one. Medical homes and acute care will be controlled by large corporations. The corporate practice of medicine will likely fail to achieve the two primary stated objectives of healthcare reform legislation – access to care and reduced costs. Those that support single payer approach will claim that now is the time for true reform.

More than ever before, all physicians need an organization that will protect our interest and those of our patients.

The ability of any entity to effectively advocate is based on its organizational strength, scope, and primary constituents. All three attributes are necessary. Let’s consider each attribute as it pertains to the AMA.

Organizational strength requires effective management and non-dues financing. The AMA clearly has the largest and most experienced staff of any physician society. AMA products and database supply vast revenue. Its lobbying staff, history, name recognition, marketing, and relationships cannot be rivaled by any other medical society. Coordination efforts with national specialty and state medical associations leverage the strength of all medical organizations. If an issue is at the national level, the AMA needs to be involved.

Scope is the second factor. The AMA has been providing effective advocacy for physicians on a national level for decades. Never has that been more important than now. National legislative efforts, regulatory issues, and a host of legal actions necessitate an AMA response and anticipatory actions.

The final attribute is primary constituents. The AMA House of Delegates had many spirited debates on health care reform. Support for Obama Care was clearly led by primary care, and was hotly opposed by southern states and surgical specialists.

After controversially supporting the original House Bill which included an SGR fix (worth about $300b), the AMA House decided upon seven guiding principles that the association would base further support of a health care reform bill. They were:
1. Cover all Americans
2. Expand choice, eliminate denials
3. Protect the patient-physician relationship
4. Repeal Medicare SGR
5. Reduce defensive medicine
6. Streamline administration
7. Promote quality, prevention, wellness
By my count, only two or three of these guiding principles were included in the final bill. Despite this and with no notice to the AMA House of Delegates, the AMA Board decided to endorse that bill. This created a real and possibly insurmountable division in the AMA.

So the AMA has an outstanding organization and a national scope. With so many important issues at the national level, what other entity can effectively replace the AMA? At the present time, the answer is none.

Who are the AMA’s primary constituents? Many of us are not real sure. I sincerely hope that the AMA will be able to resolve the current divisions for the benefit of all physicians.