My Trip to New Orleans…OR…Why You Still Need the AMA

In November, I spent a gastronomically excessive four days in New Orleans. The occasion was, of course, the Interim Meeting of the American Medical Association. New Orleans is an amazing place, partially depopulated though it may be. The food is wonderful, music plays everywhere, the weather is balmy, and did I mention the food? Ah, yes. New Orleans, the Big Easy. Supposedly, there is a medical society in the southeastern states whose (unofficial) title is The Society for Meeting in New Orleans Each Year. Truly, it is a unique spot, duplicated nowhere else on Earth.

But I have to say that the AMA meeting itself was an unsettling experience. There is a lot going on in American medicine. The number of issues facing our profession is almost overwhelming. We have a physician shortage which is getting worse, yet Congress and the President want to cut funding for resident training. Some 90% of medical students accrue debt, owing an average of $160,000 on graduation. We face a 30% cut in Medicare reimbursement. Congress continues its love affair with the Sustainable Growth Rate formula. Tort reform seems an impossible dream. More than half of doctors are employed by hospitals, and are steadily losing autonomy and freedom of action. Drug shortages plague us. So… what can we do about all of these problems?

As individuals, very little. As members of MSMA, perhaps a little more. But neither local nor state organizations can address these issues very well. There is no substitute for activity at the national level. But, who speaks for us? Some specialty organizations make a valiant try, although they have less influence than most of them think. One lobbyist does not get you very far in Washington. No matter how slow, dysfunctional, and politically correct it may be, the AMA is our major national voice. And if you find that unsettling, welcome to the club.

It’s true that AMA was badly fooled during the passage of the Patient Protection and Affordable Care Act. The AMA gave qualified support for PPACA in return for getting rid of the SGR. But Congressional leaders announced loudly that the AMA was firmly behind PPACA, welshed on the deal, and kept the SGR. So the AMA lost a great deal of credibility in Washington, especially with the Republicans. And with doctors. Many physicians dropped their memberships, and more remain seriously annoyed. Some societies (like MSMA) have separated their dues billing from that of the AMA.

Well, so be it. The AMA Board made a decision that turned out badly. Worse, the senior leadership shows little public remorse about it. A bit of mea culpa might be in order, but we aren’t seeing it. Still, and as the current cliché goes, decisions do have consequences. Showing the AMA what you think of that particular decision is fine. And the Republicans can be excused for more than a bit of testiness. But the Republicans will no doubt eventually excuse the AMA. In politics, as in diplomacy, there are no friends, only more or less temporary allies. And for much the same reason, we physicians should excuse the AMA, as well. We need that national voice too badly, and it is to our collective interest as physicians that the AMA speaks strongly.

Let’s get personal. Do you need the AMA? Should you join, or remain in, the AMA? Are your dues supporting an organization which is worth your support? Well, let’s look at the reasons. In the first place, the AMA does represent you, in the view of the public, Congress, and, most of all, the media. If you don’t believe it, just google “AMA national.” You’ll get 40 million hits. The AMA has direct membership of 150,000 practicing physicians, give or take. There are about 660,000 practicing physicians.² The total membership of the AMA is unclear, and includes students, residents, and retired physicians besides practicing physicians.¹ It represents 180 organizations through the House of Delegates-including state medical associations, but also such groups as the American College of Physicians. Not everyone agrees with everything the AMA does. How could they? We all disagree with this or that. But – and I say this again – there is no other national voice which speaks for all physicians.

In the second place, and unlike nearly all of the specialty societies, it is a representative democracy. That’s important. Most organizations have self-perpetuating governance groups. Such organizations may assume strong public positions with which many of their members do not agree. In fact, a major reason with frustration with the AMA is precisely that it is a democracy. The democratic process in the House of Delegates shows the same sort of divisions that we see in the rest of the American democracy. The New England delegation comes down hard in favor of pretty much any and all Federal mandates and taxes, while the Southern Caucus is more inclined to agree with the Tea Party. I know, that’s an historical paradox, the original tea party being held in Boston and all. The majority rules in the House of Delegates, which of course means about as much as it does in Congress. The HOD is messy, rambunctious, raucous, quarrelsome, nit-picking, and inefficient. In short, it represents us as we really are.

In the third place, the AMA commands a lot of resources. The AMA Political Action Committee is highly influential, and it is effective. Over 90% of the candidates it supports win their elections.³ The recent advertising campaign – you know, the one with the old guy and the balloons – costs millions, and could have been mounted by no other organization. The last few years have shown clearly that we agree on a lot of important things – Medicare reform, tort reform, and support for medical education, to name a few. The AMA is our best shot to convince the public to get these things done. And on projects which benefit us all – the CPT books are an example – the AMA allows us to maintain at least a degree of physician control over the course of events. Now, I know what you’re going to say. ICD-10. Hey, the AMA held it off for five years. Sometimes the dragon wins, no matter how hard we fight.

Convinced you yet? Okay, then, try this. As MSMA members, we are all justifiably dismissive of nonmembers as “freeloaders.” We pay the dues, we hire the lobbyists, and we visit Jeff City, and nag the legislators and bureaucrats. All Missouri physicians get the benefits. Well…suppose you’re an MSMA member, and not an AMA member. Aren’t you doing the same? (Listen, this is a Worthy Cause. If I can’t win with logic, I’ll go with guilt.) If the AMA manages to get the SGR fixed, would you turn down your piece of the benefits? I thought not.

Lastly, can you afford $400? Let me ask you this. Everyone with an Apple iPad, raise your hands. Ah, yes. I thought so. Everyone who buys your spouse a nice dinner three or four times a year, raise your hands. Okay. Everyone who pays more than $400 every month to your golf, tennis, swimming, fitness, and/or country club? Right. And none of the above is deductible. Is anybody still poor-mouthing on this point? Finally, how much would that 30% cut in Medicare reimbursement cost you starting in January? Who do you think is hounding Congress with letters, emails, testimony, and visits on your behalf? And you aren’t helping to pay for it? “Freeloader” isn’t half how you should be described.

Ahem. I do get carried away, don’t I? But you know I’m right. So go out and do your part. Pay your dues, and if you’re not a member, then join up. Nag your friends. And get involved. Go to www.ama-assn.org, and learn how to send messages and calls to Congress. Make yourself obnoxious to your senators and representatives. The AMA has a motto, and it’s actually true. Together, we really ARE stronger.

And try to visit New Orleans in the next year or so. True, it’ll cost you more than $400. But it will be worth it.

Biography

Charles W. Van Way, III, MD, MSMA member since 1989 and Missouri Delegate to the American Medical Association, is a Professor of Surgery and the Sosland/Missouri Endowed Chair of Trauma Services at the University of Missouri - Kansas City.

Contact: vanwayc@umkc.edu