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May 2001
Volume 65 |
Number 5
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WHAT'S NEW IN...
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Medicine: Do We Need AMA?
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Richard R. Johnston,
M.D., Chair
Committee on Representation to the American Medical Association
As Chair of the Committee on Representation to the American
Medical Association (AMA), I am writing to inform ASA membership
of evolving changes in AMA. This article attempts to explain changes
that may occur with organized medicine and how these changes could
affect ASA and you as an individual physician.
Twenty-five years ago, AMA represented a substantial percentage
of American physicians. Today, only 25 percent of active, practicing
physicians belong to AMA. Previously, when AMA lobbyists and leadership
advocated for physicians, they could claim they represented all
American physicians. Today this is not the case.
During the past 25 years, the changes that affect each of your
practices have affected AMA as well. With more federal and state
governmental hassles, increased paperwork, increased work for
less pay and the continued demeaning of American physicians, today's
physicians have come to believe that some of their problems have
been created by a weak AMA that is not looking out for their interests.
As a result, more and more physicians sought solutions to their
problems through their specialty societies and/or their local,
state and county medical associations.
AMA was slow to respond to many of these changes because they
had been firmly committed to maintaining geographic state medical
associations, without acknowledging the significant potential
input of specialty societies, other practice arrangements and
changing physician demographics. Physicians saw few benefits in
belonging to AMA, and membership began falling. In an attempt
to maintain revenues and membership, AMA leadership became involved
in several ill-advised programs, including AMAP (an expensive
quasi-credentialing process) and the Sunbeam fiasco, which damaged
AMA's reputation and further contributed to loss of membership.
The continued drain on membership has awakened the AMA to the
realization that if it is to remain viable, significant changes
are necessary. AMA is finally attempting a major restructuring
that will reorganize the changing involvements of physicians,
as mentioned above. Significant for us is the increased recognition
of specialties such as ASA.
One could question, do we really need AMA? If it has membership
problems, what if we just ignore AMA and let it dissolve? The
answer to that question is: Fine, if you do not want anyone representing
you as a physician at the national level and in Washington, D.C.
It should be clear, then, that we definitely need AMA. It has
had tremendous involvement with medical education, medical standards,
ethics and publications, in addition to participation as an advocate
with our national legislators. Furthermore, AMA has assisted individual
states with legislative efforts and on numerous occasions has
filed lawsuits on behalf of physicians. Recently, AMA has won
several major lawsuits that supported physicians against the government
and egregious insurance companies. Closer to home, AMA has been
very supportive of our efforts concerning nurse anesthetists and
the supervision issue.
Although ASA is vital to anesthesiologists in particular, there
are many issues we have in common with all of medicine. It is
shortsighted to think that we, the ASA, can individually promote
the medical interests of anesthesiologists and the patients we
care for without the help of AMA. It is estimated that AMA yearly
provides ASA with more than $1 million in direct and indirect
lobbying efforts. The reports made through the AMA House of Delegates
are invaluable in providing the research and information necessary
for our staff and leadership to work on our behalf.
We need AMA. However, AMA needs ASA as well. Amid the current
restructuring at AMA, one important question is, what type of
organization should AMA be? Should we have a voluntary or mandatory
organization? Should ASA participate in an organization-of-organizations,
or should we maintain the status-quo, leading to the inevitable
decline in AMA's power and resources? ASA could function as one
organization along with other specialties, states, counties, large
group practices, etc., that participates as a member of a larger
organization whose name might be different than AMA. The parent
organization would then be funded by the participating organizations
on the basis of each organization's membership numbers.
In my opinion, what is necessary for building a stronger voice
for medicine is better trust between the AMA Board of Trustees
and AMA House of Delegates. There also needs to be better trust
among the various components of the Federation (i.e., specialty
societies, AMA and the state medical associations). The new AMA
should be slimmer. Perhaps AMA needs to eliminate many of their
traditional tasks and allow those responsibilities to be carried
out by specialty societies and/or state associations education
is an area where this could occur. A slimmer AMA is necessary
for the creation of an efficient umbrella organization that is
cheaper and more efficient than what they offer now. Additionally,
there needs to be a better and more representative governance
of the parent organization.
Currently, the Advisory Committee for Commission on Unity is
working to make some of the changes. It contains two anesthesiologists
out of 25 members (one is a representative of a state organization).
John B. Neeld, Jr., M.D., represents ASA.
Would you be willing to pay $50 to $100 extra above your ASA
dues to participate in an organization that would be an advocate
on your behalf ? Currently, AMA dues are $420, and ASA dues are
$450. Mandating that all physicians participate through their
organization, if their organization participates, is a question
each of you needs to consider. It may be less expensive for some,
but current nonparticipants who benefit from AMA activities would
now contribute something.
For the strong voice of medicine to be heard, and for continued
representation of our profession in the future, AMA's issues must
be addressed by ASA and its members. We need a strong and more
focused AMA in which all physicians participate. How the change
occurs and how ASA participates will be a major issue for your
current delegation to AMA and ultimately the ASA House of Delegates.
We welcome your input and hope that we can represent you well
in this transition.
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Richard
R. Johnston, M.D., is Staff Anesthesiologist, Sacred Heart
Medical Center, Eugene, Oregon |
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