The American Medical Association's 541-member House of Delegates gathers for its annual meeting in Chicago this week, reinvigorated by its national initiative to change tort laws but still struggling to deal with a free fall in membership during the past several years.
Despite concerns by some critics that the AMA has become too large and unwieldy, the Chicago-based doctors' group posted its third consecutive annual operating profit last year under the leadership of Michael Maves, an otolaryngologist who has won generally high marks during his tenure as executive vice president.
"We think Mike's been a very strong leader," said James Martin, president of the 93,500-member American Academy of Family Physicians. "He's tried to maintain a very balanced view. We think he really has a good understanding and vision of where the AMA needs to be going. He hasn't ignored the problems. He's dealing with them."
AMA delegates will consider more than 250 reports and resolutions during the five-day meeting, tackling a broad range of issues that includes everything from traditional topics such as tort reform and Medicare reimbursement to subjects such as a ban on fireworks and the regulation of packing plants that process deer meat.
The AMA reported an operating profit of $11.7 million in 2002, Maves' first full year at the helm, and achieved its highest national profile in years, leading the ongoing effort to cap noneconomic damages in medical malpractice cases at $250,000.
But the AMA, once the voice of the vast majority of America's physicians, continues to struggle with declining membership, which fell 18,000 last year to 260,455. About 27% of America's physicians are dues-paying members, a meager market share that triggered an effort during the past year to restructure the AMA as a smaller, more efficient voice for doctors.
Like similar initiatives since the 1980s, however, the latest recipe for change isn't likely to lead to a dramatic makeover of the organization. In fact, the AMA is expected to shelve the most controversial elements of a plan to transform itself into an "organization of organizations" that would shed its individual membership and receive a portion of the dues from each of the other 170-odd doctors' groups in the nation.
Underscoring the turf wars that have helped to scuttle the plan, many specialty societies and state medical associations were unwilling to turn over even a small portion of their membership dues as a tithe to the AMA. Several large specialty groups quickly rejected the initiative because they believed that joining an umbrella group would have legally required them to abandon their independent political-action committees, a vital source of lobbying muscle, said the AAFP's Martin.
"It would be very disappointing if nothing comes from this," Richard Roberts, an AMA delegate from Wisconsin, said of the initiative. "I think many of us believe that something needs to change; the AMA needs to transform itself into something that more physicians find attractive."
AMA delegates also will take up the issue of "retainer practices," a controversial but slow-growing trend in which physicians charge patients a premium for personalized services and amenities such as updated waiting rooms and guaranteed same-day appointments. A report by the AMA's Council on Ethical and Judicial Affairs concludes that such boutique practices do not pose an ethical problem as long as patients are not abandoned, a position the full House of Delegates is likely to endorse at the meeting.
While the organization-of-organizations initiative might not be "earth-shaking" to those outside the AMA, it represents a change in the way the organization functions, said Jack Lewin, a physician who is chief executive officer of the California Medical Association.
"I think the process is the beginning of a transformation of the AMA that will help it to better align itself with specialty societies and state medical societies," Lewin said. "I think it will give the board of trustees a clear view of where AMA members want this organization to be in 10 years."