Organized medicine needs a powerful, unified voice in dealing with a host of issues facing physicians, and the American Medical Association is the only group capable of providing that voice. Yet we watch in dismay as the AMA continues to stumble along, led by the same generation of older men pursuing an agenda of self-interest, while membership declines and specialty societies increasingly follow their own path.
The AMA actually hasn't had a bad year on the lobbying front, winning some Medicare payment relief and getting closer than ever before to achieving limits on patients' right to sue for malpractice, though the measure stalled in the Senate. Now the AMA wants to punish Democrats seeking re-election for opposing tort reform, which only underscores its conservative reputation.
Despite the steep decline in dues revenue, the group also is doing OK fiscally, after cutting workers and benefits in the past few years. It has some viable business properties, particularly in publishing and information technology.
But the Chicago-based group continues to hemorrhage members-it now represents just 27% of America's doctors- and lacks focus on issues with appeal to younger practitioners.
It was interesting to see that although delegates to the AMA's recent annual meeting endorsed a policy proclaiming that improving public health "is our highest goal," the leadership said its No. 1 "legislative priority" remains tort reform. On issues of medicine it makes all the right noises, but does little to push those agendas with the same fervor as issues of self-interest.
Now, after dropping its plan to become an umbrella organization for all medical societies, the AMA is rehiring a consulting firm to fix its woes. An internal memo obtained by reporter Michael Romano found that the group plans on paying more than $3 million to the same consulting firm, McKinsey & Co., to which it paid $1 million to last year study organizational changes. At a time when other institutions are doubting the value of the advice given them by generalist management consulting firms, the AMA is asking McKinsey to tell it what its own constituency cares about.
Two weekends ago, AMA leaders held a membership summit in Chicago at which leaders vowed to come up with answers to its membership problems. If we were at such a meeting, we would tell them they need to think young, bringing in a new generation of leadership. They may need to cut dues from the current $420 to $100 as some have suggested; the loss of revenue would be made up by having more doctors involved in all of its activities.
They also need to be realistic about tort reform. The group has thrown all of its marbles into the campaign, which hasn't yet succeeded. The $250,000 limit on noneconomic damages that the AMA steadfastly clings to is based on a landmark California law, but the cap in that law dates back to 1975. Adjusting for inflation, it would be $855,000 in today's dollars. AMA officials refused to budge even when a modest alternative of $500,000 was proposed in the Senate, costing them a chance to win the day. That intransigence is why a coalition of specialty groups is trying its own, less restrictive approach to tort reform (See story, p. 12).
Finally, the AMA needs to become a passionate advocate on health policy, overriding the notion that it is simply out for its members' economic interests. It should use its lobbying muscle in Washington to work on behalf of doctors and patients on the full range of health concerns.
There must be one voice speaking for medicine on the important issues. We know it should be the AMA's, just not the one we hear today.
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