American Medical Association - In Defense of the AMA

I believe in civil discourse.

In my opinion, Daniel Palestrant, MD, founder and CEO of Sermo, crossed the line with the title of his message to Sermo’s 100,000 members. The title was “Why Physicians Always Get Screwed, Thanks AMA.”

I do not object to what Dr. Palestrant stands for. As a matter of fact, In my book, Obama, Doctors, and Health Reform, I devote two chapters to Palastrant and to Sermo’s open letter to the American public. I agree with his observations and insights – that the deck is stacked against doctors, that there is a disequilibrium between the supply and demand of physicians, that the quest for “perfect information” is unrealistic, and that is shift to consumerism is underway.

I do not object to what Palestrant is saying in his latest attack of the AMA – that the complexity of AMA dominated CPT coding burdens doctors with excessive paperwork and overhead, raises administrative costs, allows payers to aggregate and lower physician fees, keeps the general public and physicians themselves from comparing fees, competing on the basis of fees and services.

I do not even object to his bringing to light the fact that the AMA receives $70 million annually in “licensing fees,” thereby monopolizing the coding process.
What I object to is use of the word “screwed, “ and the implication that the AMA is engaged in some sort of secret cabal to simultaneously “screw” the public and AMA members alike.

Like any other large organization, the AMA needs margins to function. As the nun CEO of a Catholic health system observed, “The margin, no mission.” To say that the AMA is in collusion with Medicare and other payers to rip off the health care world seems to me to be verbal overkill. Palestrant is politizing and polarizing doctors, and I, for one, do not think this is a good idea. On the other hand, like Patrick Henry in the American Revolution, his words may have a useful function by moving the AMA to action.

Let’s get real. Being the AMA -- satisfying members representing 190 different specialties; overcoming the image of being a physician union dedicated to protecting doctors incomes and opposing Medicare, a widely popular public program; serving as a quasi-regulator of academic medicine and the number of doctors and residency slots; having a visible presence as the most powerful lobby in Washington, D.C, for physicians interests; and meanwhile, securing for physicians a legitimate presence at the health reform negotiating table – isn’t easy.

The public and CMS thinks of the AMA as representing doctors as a while. This has its good sides. For example, the AMA’s new president, J.James Rohack, MD, of Texas, has immediate access to the pages of the America’s national newspapers and other media. The AMA’s publications, particularly JAMA and The American Medical News, are balanced and give valuable insight into what doctors are doing, thinking, and reacting. And the AMA’s stance on health reform makessense

• Pluralism - Namely that we are a nation with multiple systems, public and private points of view.

• Freedom of choice - We ought to be free to choose among hospitals, doctors, and other caregivers, and among the various technologic options.

• Freedom of practice – Doctors ought be freedom to choose their mode of practice – solo, group, employment, concierge, cash only – even if that mode means not accepting patient in government programs such as Medicare and Medicaid.

• Universal access for patients - Universal access – being able to see a doctor when one pleases – in not the same as universal coverage – being covered by insurance whether one is able to find a doctor when one is sick. Universal coverage without universal access may be meaningless given the looming doctor shortage.

So let us not be too harsh or too uncivil towards the AMA. It may be too bureaucratic, too removed from its members on the ground, too slow to adjust to the new political realities . With a plunging membership and widespread physician discontent, the AMA cannot continue to function as it is. It is politically and financially vulnerable, and it needs to reassess its role. For now, however, it is our main representative in the public discourse on health reform.