Despite its members' fervent plea for rapid and radical change, the American Medical Association's plan to transform its business structure is moving ahead at a decidedly slow pace-too slow for some big specialty societies eager to lend their voices to the debate.
Indeed, little has been done publicly on the complex issue since the AMA's annual meeting three months ago, when the 550-member House of Delegates overwhelmingly called on the board of trustees to study the repercussions of a new structure that would eliminate individual memberships and transform the AMA into an umbrella group for national specialty societies.
The call for change by the AMA's members has triggered only limited activity so far. In early August, the AMA's board appointed an internal subcommittee to conduct a complete financial audit of the organization's products, services and resources. The AMA hired an outside firm, McKinsey & Co., to assist in the exhaustive inventory at an undisclosed cost.
Last week, the AMA made the first public announcement of its embryonic plans to study the feasibility of its rebirth into an "organization of organizations." In a five-paragraph open letter published on its Web site, the AMA explained that it is "actively soliciting input" through a survey that will be distributed to its members in the next month or so.
That effort will be followed by the creation of a committee on organizations of organizations, comprised of representatives from specialty societies and state medical associations, which is expected to meet for the first time in early 2003, the letter said.
Under the proposed change in its structure, the Chicago-based AMA, struggling for years with declining membership and the ensuing decrease in dues revenue, would cease to be an organization of individual members. Instead, as an umbrella group, it would rely on a certain percentage of annual membership fees from all national specialty societies, a formula that is already generating some opposition and controversy about potential costs.
The slow pace has puzzled some officials from specialty societies who said they wondered why it took the AMA so long.
"Maybe they're working hard behind the scenes; if they are, I'm not seeing it," said Glenn Johnson, executive director of the 37,000-member American Society of Anesthesiologists. "But I haven't heard anything that leads me to believe that's true."
Though he welcomed news that the AMA plans to survey its members, Richard Roberts, M.D., chairman of the 93,500-member American Academy of Family Physicians, said he was disappointed by the lack of public progress on such a complicated issue. Considering the stakes-the survival of the AMA, according to some observers-Roberts said he expected a far more aggressive approach.
"It would be my fear for the AMA that it will be like a death from a thousand nicks," he said. "It would be hard to argue with the statement that the House of Delegates did express a strong desire to at least look at the implications (of changing the AMA structure). And if that process plays out too long, all those nicks continue to bleed."
The AMA declined to make any top official available to comment on the process.
John Tooker, M.D., executive vice president of the 115,000-member American College of Physicians-American Society of Internal Medicine, said the summer doldrums might have contributed to the unhurried pace of activity at the AMA. He also noted that any change in the AMA's structure represents an exceedingly complex task that is bound to take careful planning.
"The summer is always a hard time to do anything like this," Tooker said. "And considering the complexity of the issue, they're trying hard to think this through so that, once a committee is established, they can be clear about how to proceed."
"If we're going to switch to an organization of organizations," said Johnson, "then those of us in those organizations need to know where we stand."
With the change in structure, the AMA, which now has about 278,300 dues-paying members, would present itself as the voice of almost all of the U.S. medical community, with the aim of providing the organization with far more political clout in the nation's capital.
In the message on its Web site, the AMA said the survey it will be conducting next month is intended to solicit input from members on the "structural, governance, and, most importantly, financial commitment issues" associated with the reorganization.
A "business plan" for the new structure is expected to be presented to the House of Delegates at its annual meeting next June in Chicago.
Under the scenario, specialty societies and geographic societies would provide the AMA with a certain proportion of its annual dues-from $50 to $99 per member, according to figures floated during the last annual meeting. At the same time, the AMA would be expected to reduce staff and services, focusing on core missions such as national advocacy and professional issues.
"It's hard to tell what the price tag for each organization will be," Tooker said. "The model is not yet clear."
The most critical responsibility of the new committee will be to create a financing formula acceptable to the vast majority of the AMA's diverse and often contentious members, a federation that includes about 165 specialty societies and state associations. The AMA said the committee will include "state medical societies, national medical specialty societies and other appropriate components of the federation," which could result in a large, unwieldy collection of voices.
"When you put all that together," Tooker said, "you're talking about a lot of people, a large group dynamic with lots of individual interests."