Last fall, the only state medical association left standing beside the American Medical Association (AMA) voted to de-unify. The move signaled possible unrest among the nation’s physicians, many of whom believe the AMA isn’t lobbying in their best interest concerning sweeping healthcare reform under the Obama Administration.

 

But AMA leaders say it’s not true.

 

“I was in the House of Delegates at AMA last June when the vote was 70-30 to support healthcare reform,” said Edward Hill, MD, past president of AMA, who hasn’t missed an AMA House session since 1975. “True, every House of Delegates has its own personality, but after a while you learn the ebb and flow … and pick up on members’ feelings of public interest.

 

“I know the AMA did not want a repeat of what happened in 1965, when the AMA decided not to favor Medicare, and it turned out to be the biggest boon for physicians financially—at least for a while. The AMA should’ve been more supportive and tried to improve Medicare to make it a sustainable program.”

 

The AMA was founded in 1847 when the medical profession was weak and insecure, said Curtis E. Margo, MD, a professor at the University of South Florida College of Medicine and Tulane Medical School.

 

In his 2009 book, Glass Half Full: an Informal History of American Medicine, Margo said in its early days of formation, AMA members distinguished themselves from sectarian practitioners in their commitment to a code of ethics and dedication to high educational standards.

 

“The AMA used its code of ethics to gain an advantage over other healers, but in so doing stirred up more controversy than it anticipated,” said Margo.

 

Nathan Smith Davis, MD, a 27-year-old physician from New York, took to task signing up America’s doctors for the AMA.

 

“He reportedly took the train from town to town, met with every physician one by one, and explained to them that the AMA could represent patients through their membership,” said Hill, “and that’s how he grew the AMA.” 

 

Because recruiting members was such a daunting task, only 8,400 of the nation’s practicing 100,000 physicians were AMA members by 1900. Black physicians were excluded and formed their own organization—the National Medical Association.

 

“At the end of the (nineteenth) century, the AMA risked being known more for what it stood against than what it stood for,” said Margo.

 

Early on, the AMA established a burdensome “and painfully” democratic process, Hill described, that remains in place today.

 

“The AMA has eight reference committees that debate at length, sometimes heatedly, before their recommendations are submitted to the House,” said Hill. “After debating healthcare reform at length last summer, the majority of physicians sent a message in their vote, that physicians also have a humanitarian, altruistic element through their commitment to public health, and the medical and healthcare needs of all citizens.

 

“People should observe the AMA democratic process. Congress could learn a lesson about open and transparent negotiations.”

 

But some doctors believe the complex mix of components that constitutes the AMA—separating the scientific-educational mission from the AMA’s economic and commercial interests, for example—makes it difficult and somewhat dangerous to fairly critique the organization.

 

One suggested, “the ambiguous position the AMA now finds itself in with the Obama health initiative is because the AMA cannot decide what its primary moral imperative is: economic self interest or providing optimal healthcare to the public. Unfortunately, the choice of one mutually excludes the other. It’s the pivotal problem facing the AMA.”

 

Hill said the AMA is simply going through a cycle, and will emerge even stronger.

 

“American physicians have only one ally. It’s not insurance companies, not government, not hospitals and not even other physicians—but patients,” he said. “The AMA should get back to its roots, personally interact with patients throughout the country. AMA leaders should spend less time, effort and expertise lobbying legislative changes through Congress that don’t improve healthcare for patients.”

 

Even criticism of AMA’s business interests—having a corner on the Current Procedural Terminology (CPT) publishing market, for example—doesn’t faze AMA leaders.

 

“Many people don’t realize that AMA is the largest publisher of scientific medical books in the world,” said Hill. “Sure, we own the CPT, but we also spend a great deal of money updating it and maintaining it first-class. We’ve been attacked about it, but probably mostly out of political anger to the AMA.”

 

Even though the growing sentiment of doctors in America toward sweeping healthcare reform is disfavor, the AMA membership is 20 percent—at best— of practicing physicians.

 

“We didn’t go to medical school to be in the business of business,” said Hill. “We went to medical school to learn the skills to heal patients. It’s so easy to get caught up in the practice of medicine and let others handle the political process. But physicians should be more responsible and step up to the plate.”

 

If the AMA didn’t stand behind the House version of healthcare reform, the organization would be politically ostracized as it was when association leaders drew a line in the sand about Medicare.