Friday, December 7, 2007

Physician Leadership, The Physicians Foundation - Who Speaks for Doctors?

You’re a physician. Who, in your opinion, speaks for you?

The AMA? Theoretically, that’s the way it supposed to be. But AMA membership is slipping, and its cumbersome bureaucracy is slow to respond and hard to penetrate. Two-thirds of American doctors don’t belong, perhaps because the AMA has been relatively ineffective in matters of inadequate Medicare reimbursement, national tort reform, and rules and regulation battles with CMS and health plans.

State and local medical societies? These societies are closer to members than the AMA and are more focused on local and state issues. It was 19 state medical societies who succeeded in legal actions in 2003 against national health plans , which culminated in Aetna and Cigna providing over $150 million to form the Physician Foundation of Health System Excellence, dedicated to improving the overall health system and settling fee disputes between health plans and physicians.

Specialty medical societies? These societies represent the clinical, business, and political interests of their specialty members and hire lobbyists to work for them. But because there are some specialties (190 at last count), their overall impact tends to be diluted and drowned out in the cacophony of voices, each representing their own view of what’s best for their specialty and the nation as a whole. Probably the MGMA, a practice management organization said to represent 300,000 doctors should be included in this category.

Organizations employing physicians – large group practices, academic medical centers, and hospitals – These organizations are powerful and employ somewhere between 10 – 20 percent of physicians, but they do not, for the most part, speak for independent physicians, 70% of 80% of whom practice in groups of 10 or less. In the case of hospitals, they may be real or quasi-competitors of doctors.

Pharmaceutical companies - Relationships between Big Pharma and physicians have soured over the last ten years, because of direct consumer advertising, overly-aggressive sales reps, under the table payments to doctor consultants for drug or device promotion, rising drug costs, and a generally negative image in the media and among politicians. Physician-Pharma relationships may change as the fortunes of the Big Pharma decline politically and as the result of failing to produce new block-buster drugs (“Big Pharma Faces Grim Prognosis: Industry Fails to Find New Drugs to Replace Wonders Like Lipitor, “ WSJ, December 6. 2007).

I believe physicians will increasingly speak more for themselves through social networking websites such as, which will categorize and organize their points of view in such a way as to make them known to the wider public and to those who rely on physicians for their livelihoods. It’s becoming increasingly clear that for any practical reform to be achieved physicians will have to be at the bargaining table.

You physicians out there. Please let us know who you think speaks for you


DrWes said...

You left out "hospitals."

More and more hospitals are promoting the hospitalist as the wave of the future. It's so bad that now, some hospitalists who work at night are now designated "nocturnists" and they receive a pay premium for their efforts. Primary care and family practice groups are financially dying, so they join hospital systems, who are hungry for their diagnostic studies and referrals to specialists (they pay). In return, the hospitals provide financial incentives for reducing length-of-stay in hospitals.

And now, since doctors are becoming employees to big corporate hospital systems, their voice has withered in any real discussion of healthcare reform.

Sad, but true.

And this then, gets back to the point (I think) of your post. There is presently no collective voice of physicians (rather than the blog-o-sphere). Networking sites like Sermo, while warm and fuzzy, are really like sitting in a fishbowl where the pharmaceutical companies and hospital systems can monitor the thoughts of their worker bees. Remember the Sermo business model? Pharma and "industry" has to "pay" to listen in. Is this empowering for doctors? Will this really promote change to the corporate incentives rampant in medicine? No.

What will change is when the patient-doctor relationship is empowered again. And all the Sermos in the world ain't gonna make that happen.

Michael Rack, MD said...

The problem with state and local medical societies is that in many states, you have to be a member of the AMA to join.
I'd be happy to join my local medical society, but I'm not willing to pay the $1000 national dues to join the left wing AMA.