AMA Slides Into Irrelevancy

When I first heard about the American Medical Association (AMA)
opposing Obama's health care reform, I was troubled.  I almost
wrote a post about it, but by the time I got home, I found that others
had beaten me to it.   href="http://scienceblogs.com/effectmeasure/2009/06/revolutionary_medicine.php">Revere,
for example, appears to have written before work,
posting at 6:46AM.  That's dedication.



But it the interim, I've come up with a different angle.  Part
of it comes from an article on Medpage Today (free registration):

href="http://www.medpagetoday.com/MeetingCoverage/AMA/14691">AMA:
Obama Faces Tough Audience at the 'House of Medicine'

By Emily P. Walker, Washington Correspondent, MedPage
Today

Published: June 14, 2009

Obama's speech will end a 26-year long drought for presidential
speeches at the AMA -- Ronald Reagan addressed the delegates in 1983,
the same year he proposed to freeze Medicare payments to physicians
while his administration worked to cobble together a Medicare overhaul.



The freeze, and a short-lived Medicare option called part C which
covered catastrophic medical expenses, were both flops. When President
Barack Obama delivers a speech tomorrow in front of the American
Medical Association House of Delegates, it will be a poignant occasion
for the divisive doctors' group for a number of reasons.



The years since the Reagan speech have been tough ones for the AMA,
which has seen both its membership rolls and its revenues shrink.



While membership has shrunk since the 1980s, the group still
describes itself as the "house of medicine" with a membership of about
236,000 physicians from a wide swath of specialties-- but 30% of them
are students, who don't pay dues, and only about 50% are practicing
physicians. [emphasis added]

Unfortunately,  I can't tell you how many physicians are in
the USA.  But to put that membership number of 236,000 in
perspective:



The Bureau
of Labor Statistics says that there were about 633,000
physician jobs in the USA in 2006.  That includes MDs and DOs.
 It does not include medical students or retired physicians.
 I don't know if they include residents, but they probably do,
since residents get W2s.  I don't know if they include
physicians who do not see patients, such as those in research-only jobs.



American Family Physician reported that there
were 936,000 physicians in the USA in 2004.  That
includes MDs and DOs.  5.2% were DOs; the remaining 94.8% were
MDs.  

href="http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm">USA
Today reported that there were about 800,000 active
physicians in the USA in 2004, and that medical schools produce 25,000
per year.  



Let's say there are about 1 million physicians in the USA in 2009.
 The AMA has about 125,000 active physicians on its rolls.
 That's about 1/8th of the total .  That does not
sound right.  In an interview on href="http://www.democracynow.org/2009/6/16/dr_chris_mccoy_dear_ama_i">Democracy
Now!, Dr. Quentin Young -- an AMA member for over 50 years --
stated:

I’m a very severe critic of what AMA has
done. And it’s worth noting that AMA membership has dropped
from some 90 percent of doctors when I started out a half-century ago,
and now about a third of America’s doctors do belong.

Perhaps the discrepancies can be accounted for be the fact that not all
physicians are MDs, and some counts may or may not include medical
students, residents, retirees, and research-only MDs.  Perhaps
some counts merely total the numbers of licensed physicians in each
State, while many physicians are licensed in more than one
state. 



In any case, it is clear the the AMA is waning in influence.
 They are at risk of becoming marginalized.  In a
way, it is like what is happening to the RNC.  The membership
is declining.  The members who are left, are those who are
most extreme in their positions.  As they become relatively
more extreme, they become less relevant, easier to ignore.



I've not been a member of the AMA for a long time, maybe 15 years.
 I still get a lot of mailings and emails from them, exhorting
me to join again.  Sometimes they offer me a special deal,
half-price for a six-month membership.  Cripes, they think I'm
smart enough to be a doctor, but not smart enough to do arithmetic.
 But the most common pitch is that they would represent me in
Washington DC.  My suspicion is that it is the political
iinfluence that persuades many MDs to join.  Sometimes there
are other factors, such as local medical society than require
membership in the AMA in order to join the local group.  Some
hospitals or insurance groups require membership in the local medical
society, so this indirectly requires membership in the AMA.



I would venture to guess that many AMA members, gathered around the radical core, are fairly casual about
their membership.  It gives them something to put of their CV,
they are in the habit of renewing every year, and they take the expense
as a tax writeoff, or charge it to their employer, or something like
that.  The number who are truly active may be rather small.
 I can't prove nay of this, but I think it is true.



All this is a long-winded way of saying that the AMA probably does not
speak for the majority of doctors.  I would encourage
politicians to keep this in mind, lest they act out of disproportionate
fear of the organization's clout.  



One the the MDs that Amy Goodman interviewed on Democracy Now! has left
the AMA over their position on a public option for healthcare reform.
 I would do the same, if they'd let me quit twice.