Is Our AMA in Trouble?

s our American Medical Association in trouble? Well, an article by Nicholas Kristoff published in the New York Times on June 25th provided some food for thought.
Yes, we know now that our AMA's position regarding a public insurance option is a maybe but not an outright no. Nevertheless, the heated debate within our organization and the ideological rigidity displayed by some has created the impression that the AMA is AGAIN opposed to a meaningful reform of our healthcare system. Right or wrong, the impression counts and its out there.
Furthermore, our membership is indeed dwindling and as an outreach recruiter I can attest to the fact that its getting harder and harder to convince doctors to join or rejoin. For some we are too soft and for others not tough enough. For some we are too much on the right, for others too much on the left. The media reports regarding our recent Annual meeting does not help in that effort either.
In Florida alone our membership decreased by 14%! Having listened and spoken to hundreds of doctors in South Florida I can list a few reasons that our leadership must consider:
1)Doctors in private practice want to have their problems addressed and resolved today, rather than tomorrow. They are afraid that they are being forced to close shop and merge with larger groups , or to end up as hospital employees. I visit private offices every week and many are on the verge of financial insolvency!
2)Far too much time is being wasted on ideologically-motivated debate, and too little on the development and deployment of practical practice solutions. Talk the Talk, or Walk the Walk?
3)Our AMA delegation is comprised of individuals representing their own political interest and are detached from the constituents they supposedly should represent.
Therefore, I have resigned from the AMA delegation and return to where I came from: union style grass-root organizing, listening to our members and to find alternative modalities of membership representation. The Web 2.0 technology demonstrates what a few can do using these tools, and they can successfully bypass the encrusted and inflexible structures of organized medicine.
The time for change has come even for our AMA. The questions remains: will our AMA embrace or resist change? Thats an existential question for our organization and circling the wagons will only hasten our demise.
Looking forward to your comments.

Bern Wollschlaeger,MD,FAAFP,FASAM
AMA Member


June 25, 2009
OP-ED COLUMNIST
The Prescription From Obama’s Own Doctor
By NICHOLAS D. KRISTOF
As a society, we trust doctors to be more concerned with the pulse of their patients than the pulse of commerce. Yet the American Medical Association is using that trust to try to block a robust public insurance option as part of health reform.
In fact the A.M.A. now represents only 19 percent of practicing physicians (that’s my calculation, which the A.M.A. neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman’s plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton’s health reform plan.
So I hope President Obama tunes out the A.M.A. and reaches out instead to somebody to whom he’s turned often for medical advice. That’s Dr. David Scheiner, a Chicago internist who was Mr. Obama’s doctor for more than two decades, until he moved into the White House this year.
“They’ve always been on the wrong side of things,” Dr. Scheiner told me, speaking of the A.M.A. “They may be protecting their interests, but they’re not protecting the interests of the American public.
“In the past, physicians have risked their lives to take care of patients. The patient’s health was the bottom line, not the checkbook. Today, it’s just immoral what’s going on. It’s abominable, all these people without health care.”
Dr. Scheiner, 70, favors the public insurance option and would love to go further and see Medicare for all. He greatly admires Mr. Obama but worries that his health reforms won’t go far enough.
Dr. J. James Rohack, the president of the A.M.A., insisted to me that his group is committed to making health insurance accessible for all Americans, and that its paramount concern is patient health.
“When you don’t have health insurance, you live sicker and you die younger,” he said. “And that’s not something we’re proud of as Americans.”
He added that the A.M.A. is not necessarily opposed to a public option, and I have the impression that it might accept a pallid one built on co-ops. Dr. Rohack wouldn’t repudiate his association’s letter to the Senate Finance Committee warning against a new public plan. That letter declared: “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”
I don’t mind the A.M.A. lobbying on behalf of doctors in the many areas where physicians and patients have common interests. The association is dead right, for example, in calling for curbs on lawsuits, which raise medical costs for everyone.
An excellent study published in 2006 in The New England Journal of Medicine found that for every dollar paid in compensation as a result of lawsuits against doctors, 54 cents goes to legal and administrative costs.
That’s an absurd waste of money. Moreover, aggressive law leads to defensive medicine, in the form of extra medical tests that waste everybody’s money. Tort reform should be a part of health reform.
Yet when the A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal. Doctors work hard to keep us healthy when we’re in their offices, and that’s why they win our trust and admiration — yet the A.M.A.’s lobbying has sometimes undermined the health of the very patients whom the doctors have sworn to uphold.
I might expect the American Association of Used Car Dealers to focus exclusively on wallet-fattening, but we expect better of physicians.
In fairness, most physicians expect better as well, which is why the A.M.A. is on the decline.
“It’s what has led to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. “At this point only one in five practicing doctors are in the A.M.A., and even among its members about half disagree with its policies.” To back that last point, Dr. Himmelstein pointed to surveys showing a surprising number of A.M.A. members who support a single-payer system.
For his part, Dr. Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public insurance option. It also quite rightly calls for emphasizing primary care.
The American Medical Student Association has issued a sharp statement disagreeing with the A.M.A.
The student association declared that it "not only supports but insists upon a public health insurance option."
Look, a public option is no panacea, and it won’t automatically set right the many shortcomings in our health system. But if that option is killed in gestation, then we’re back to Square 1 and there’s little hope of progress in solving the vast challenges confronting us.
So, President Obama, don’t listen to the A.M.A. on this issue. Instead, for starters, call your doctor!