Lately I have been discussing American Medical Association (AMA) membership with various people, and the responses I get are very interesting. There is a flood of feelings that exude from normally calm individuals when the AMA is mentioned. It has become a sociology experiment to see what responses I will receive when the AMA is mentioned. As a researcher of sorts, I started to ponder the issue further: Why are so many people upset with the AMA? Does the AMA represent physicians? Does it represent me? If I’m forced to acknowledge the importance of the AMA, what can be done to improve it?
Why Are Physicians Upset?
Some of the overwhelming responses I’ve received from physicians focus on the AMA’s stance on hot-button issues. For example, there seems to be a lot of angst about the AMA’s position on healthcare reform—and in many cases the anxiety started way before the Affordable Care Act discussion began. The physician community, much like the rest of the United States, is divided on healthcare reform. Other rheumatologists comment that the AMA is too concerned about surgical specialties or, conversely, too concerned about primary care. This is interesting because it would be virtually impossible for the AMA to be pro–primary care and pro–surgical specialties at the same time.
After 27 years in practice, it has become common nature for me to see a problem and want to fix it. So, what can be done to “fix” the AMA? First, let’s dig deeper, look at the “problems” that need fixing. Why was the decision made to support aspects of the Affordable Care Act? It wasn’t just a few physicians sitting around in a room making these decisions. The decisions were made by physicians in various practice settings across the United States voting in a democratic fashion. If the AMA isn’t representing you or me, one possible explanation is that so many of us have left the AMA; therefore our voices are no longer heard and the only voice left is that of “one type of physician.”
Is the AMA perfect? Far from it, but, until or unless another larger or more recognized group arises, the change needs to happen from within the existing structure of the AMA. We need people to join the AMA to make the change….I am now asking you to join.
Another reason for declining AMA membership is the various requests for physicians to be members of specialties, subspecialties, state societies, counties, etc. While belonging to such societies (particularly the ACR, of course) is beneficial, such societies fragment physicians into interest groups. This is when physicians are often criticized as “circling the wagons and shooting inward.” The AMA counters these trends, whether we like to admit it or not, by serving as a highly regarded, unified voice for physicians. The AMA brings together varying interests and hammers out compromise. It is time to take back the AMA. Rheumatologists need to join the AMA in droves so that our voice can be heard and the AMA will be tilted in our direction.
What Have You Done for Me Lately?
I have something to confess: I rejoined the AMA during the last big ACR push for members in 2007. I was asked to join so the ACR could reach the magical number of 1,000 members needed to remain part of the AMA Federation. The AMA delegates told me to let the AMA prove their worth to me. I have now been a member for five years. I don’t approve of everything the AMA does, but I know that by being a member, I have a voice. Furthermore, the businessman in me sees the folly of abandoning an established and publicly respected brand. I am, instead, attracted to turning the significant resources of the AMA to my advantage, which is precisely why the association exists.
The AMA has worked hard for physicians this year by:
- Advocating relentlessly to fix the Sustainable Growth Rate formula that determines Medicare reimbursement;
- Developing legislation allowing physicians to privately contract with Medicare patients; and
- Commenting to the Centers for Medicare and Medicaid Services (CMS) during federal comment periods and encouraging changes to the Accountable Care Organization rules so more physicians could participate.
Additionally, a report was provided to the AMA Delegates at the AMA annual meeting in June 2011 outlining the “AMA Performance, Activities, and Status in 2010.” This report included improvements to access to care that were part of health care reform, such as eliminating disqualifications due to preexisting conditions and lifetime limits on benefits. Another highlight of the report was that the AMA, along with the American Association of Medical Colleges, helped advocate for a $168-million distribution of Title VII funding to support residency training, which created more than 900 new primary care residency positions.
I’m not surprised by the negative reactions I get when I discuss the AMA, because I used to be one of those people, and occasionally I still am. However, just as the ACR has recognized the need to have a political action committee, we also need to acknowledge that, on a national level, the AMA is the organization that is most recognized as speaking for us. This is true whether we like it or not.
Learn More about AMA Activities
You can read more about AMA performance, activities, and status in 2010 by downloading the June 2011 Reports of the Board of Trustees at http://www.ama-assn.org/assets/meeting/2011a/a11-bot-reports.pdf and viewing pages 122–131.
Why Does the ACR Care about AMA Membership?
Many ACR members are wondering why I am even discussing the AMA in TR, the newsletter for rheumatology about rheumatology issues. Well, just as I rejoined five years ago, it is again time to be counted; the ACR must show the AMA that we have 1,000 ACR members in 2012 that also belong to the AMA so we can remain part of the AMA Federation.
Why you care (or should care) about the AMA Federation:
Rheumatology Represented in CPT Discussions
Gerald Eisenberg, MD, is the Current Procedural Terminology (CPT) advisor for the ACR. Having a rheumatologist as a CPT advisor gives the ACR a voice as CPT codes are being developed and modified. No seat, no voice in CPT discussions.
Rheumatology Represented in Reimbursement Discussions
Timothy Laing, MD, is on the Relative Value Update Committee (RUC), Eileen Moynihan, MD, is the alternative RUC representative for the ACR, and Alfonso Bello, MD, is the ACR advisor. The RUC makes recommendations to CMS regarding reimbursement for CPT codes. There are many important codes that will be presented to the RUC for evaluation this year, including infusions, large joint injections, and musculoskeletal guidance. Having a rheumatologist sitting at the table gives the ACR a vote. Having an RUC advisor gives the ACR an opportunity to present information on codes relevant to rheumatologists. No seat, no voice in physician reimbursement discussions.
A Seat in the House of Delegates (HOD) Means a Voice on Policy
The HOD is the policy making body of the AMA. Gary Bryant, MD, Dr. Moynihan, and Colin Edgerton, MD, serve as the ACR’s delegate, alternate delegate, and young physician section delegate, respectively. The AMA HOD reviews hundreds of resolutions twice a year to determine which resolutions will become policies of the AMA. Policies that have recently been discussed include balance billing, drug shortage, maintenance of licensure, and many others. No seat, no voice in some of the most influential policies affecting medicine.
Voice in Advocacy
The AMA has one of the strongest lobbies for organized medicine, and the ACR is privileged to sign on to letters developed by the AMA. The AMA provides updates and strategy allowing the ACR to assist in federal legislative efforts, which include stopping the anticipated Medicare physician fee schedule cuts each year, educating Congress regarding medical liability, patient safety, and more. No seat, no voice in influencing medicine’s legislative and regulatory agenda.
Don’t Silence Rheumatologists
Rheumatology needs to have a voice in these groups. Is the AMA perfect? Far from it, but, until or unless another larger or more recognized group arises, the change needs to happen from within the existing structure of the AMA. We need people to join the AMA to make the change. I am asking all the people in my department to join. I am asking the ACR board of directors and committee chairs to join. I am now asking you to join.
Join the AMA. Don’t join because you agree with everything the AMA does. Join so we, as rheumatologists, will continue to have a voice and make a difference. Join to make an impact in the unified, national “voice of medicine” heard by members of Congress and the president. Join so rheumatology can continue to influence CPT and RUC discussions.
If you are not a member of the AMA, please join.
Dr. O’Dell is director of the Internal Medicine Residency Program and division chief of rheumatology at the University of Nebraska, Omaha and the Omaha VA medical centers. Contact him via e-mail at [email protected].
