How to Replace the AMA

There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.

In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.

Then, in the 1970s, 80s, 90s, it came apart and now has the least representation of actual members of a widely diverse base than ever and shows few signs of recuperation. Recently, I advocated that ALL American physicians should become members of the AMA for their entire time in medicine.

Responses, both published and unpublished, were vigorous.

The divide between physicians who think that the AMA should fight for them and those who think that the AMA should fight for the health of the people seems too large to bridge in 2012.

When you add to that the often expressed belief that the AMA fails on both fronts, it really becomes unsalvageable.

Perhaps it is as simple as a reflection of the gridlock in the American government, red states vs blue states and within states, red counties vs blue counties. Too-far-right Republicans and too-far-left Democrats, and few in the middle, with few willing to compromise.

Perhaps it is as simple as generational gaps between the key motivations of medical students entering medical school during different decades as the landscape, environment, and ecology of American medicine has changed so abruptly, in fact in midstream of many medical careers.

I see only three ways to rescue the AMA. Membership in the AMA, state, and county medical association could be made a legal condition for state medical licensure, or a national medical license.

Or, the AMA could change its key objective. It could either become a lobbying organization representing all physicians with group bargaining, to the fullest extent of the law, or a new law that allows collective bargaining.

Or, it could follow its current key objective and truly “promote the art and science of medicine and the betterment of public health” and stop also trying to represent the financial interests of its members.

Depending upon how these played out, this “new” AMA could spin off the eternally successful journal publishing effort as a separate publishing business. It could close the Washington office. Physicians could go mostly to salaries from not-for-profit multispecialty managed care organizations like Kaiser Permanente or Geisinger, or various ACOs.

Without a STRONG AMA speaking for ALL American physicians, Medicare for All is just around the corner. And this Medicare will NOT be fee-for–service, since that failed to control costs. It will be physicians on salary from ACOs, HMOs, government run clinics, and the like. No private insurance companies, thus no need for billing, so no need for coding.

Goodbye AMA lucrative CPT, no more hated RUC. Physicians who refuse to take Medicare patients (my estimate less than 5%) will still be allowed to care for private, pay-as-you-go, out-of-pocket patients, concierge level or less.

AND, if you think physicians are angry now, wait 5, 10, 15 years, and there will be another effort to rebirth an AMA, probably like the old one. Oh my.

George Lundberg, MD is the editor-at-Large for MedPage Today where this post first appeared. Lundberg served as editor-in-chief of the Journal of the American Medical Association and its Archives publications for 17 years.

14 replies »

  1. It is simple. The majority of us do not support the AMA. Where is the ACP? A mandate will end in court. Lundberg stays up too late at night.
    With respect.

  2. Organizations like the AMA are dinosaurs because first and foremost they are run by dinosaurs. Their sellout to PPACA was an affront that cannot be corrected nor forgiven.

    Lundberg wrote a good book a few years ago, but this post, WTF?!

    Mandating membership, what are you thinking, man!?

  3. The AMA (just like the RUC) does an excellent job of fighting for increased income of specialists at the expense of generalists. Why change something that works perfectly as intended?

  4. I agree they’re pains in the butt, but those costs aren’t the result of the ACA.

    (Yes, it’s a funny name, used in place of my real one after a harassment episode.)

  5. ” It is costing me a fortune and so many more buttons on those pesky EHRs that promise meaning for all of us.”

    Go off the grid and go cash pay. Docs are doing it.

  6. Oh B.S.. That is not the point. Let them grovel. CPT- ICD codes are available for free if you look. I have the ICD 10 codes. I do not need the AMA for that. Get on a computer. We are a decade behind Europe. Thank the AMA for that. Heard of google?

  7. I wouldn’t have so much contempt for the AMA if they didn’t have a such a death grip on CPT codes. In general, I find the AMA takes obstructionist stance on innovation and change. I observation is that the AMA represents the “keep things they way they are” camp.

    I’d like to see an “Open CPT” without AMA ownership.

    (For those who do not know “CPT” codes define/codify medical procedures and are the backbone of reimbursement in our pay-for-procedure system. These codes, and their meaning, are he intellectual property of the AMA.)

    This role belongs with the National Library of Medicine. These codes should be in the public domain.

    Due to dwindling membership, AMA is clinging hard to the revenue they make from selling CPT code books and related items.

  8. Hardware, software, licences, IT support, high speed, HIPPA, compliance, updates, insurance, society fees, LLCs, CPAs, RACKs, the ether of the internet, toilet paper, etcetera.

    $ promised if we do it right will not cover the cost of a medical practice. It will barely cover the initial investment. In the long run will not cover it at all.

    Breaking the oath. What is that cost?

    Time. My Time with patients, family, stolen. Stolen by efficient systems. Sold and exchanged by hospitals, HMOs, ACOs, AMAs, ACPs, Dems and Reps and so on.

    To answer your question. I started to implement the Quality c..p. I have 10 fingers. I knew this cat who had 12. But he cannot read. He lives in Wales, England. Cool cat. Real cat. I which I had 12 fingers. Slowed me down. New glasses did not help. Sorrow when I inform the world that so and so weighs so, drinks so, scratches his sos, has so and so, needs so and so, and god forbid told so and so to f… off.
    Does not go to church either.

    You have a funny name. southern doc. I can’t place it.

  9. What is the AMA? I get a lot of junk mail from them. Insurance offers and so forth. They want to represent me. I never asked them. They spend a lot of time in D.C. with politicians and interest groups. I know few colleagues who are members. I know one guy who feels important and yells a lot. He is part of the AMA. Oops, I must go and be eager about ACA. It is costing me a fortune and so many more buttons on those pesky EHRs that promise meaning for all of us.

  10. 1) Medicare for All is not just around the corner. It may be just around the abyss, though.

    2) Even if Medicare for All becomes a reality, F4F need not go away because there is no scientific evidence that this is the reason for escalating costs. It is just presumed so by those who prefer to keep shady deals in the shade.

    3) If the AMA was there to “promote the art and science of medicine and the betterment of public health”, it would be fighting tooth and nail to prevent its members from being devolvied into algorithm-controlled shift-workers, right about now.

    4) So basically if the AMA would like to survive (and thrive and be useful), all it needs to do is work hard at fulfilling its self-declared mission.