Why Physicians Won't Unite to 'Rescue' Medicine

Leigh Page

Disclosures

September 04, 2014

In This Article

AMA Has Seen Membership Decline

One of the biggest threats to physician unity is the decline of the AMA. This 167-year-old organization is the only traditional membership organization that represents all US doctors. At this point, no other group could fill its shoes.

The AMA reported[21] that it lost 10.5% of its membership from 2009 to 2010, ostensibly in reaction to its support of the ACA, but the group's membership decline -- and its concomitant loss of power -- started decades earlier. The causes of that decline run much deeper than anything that's happened recently, and this makes the AMA's problems very hard to fix.

The chief cause of the AMA's long-term decline is physicians' growing allegiance to their specialty groups. As these groups grew, AMA membership fell from a high of 75% of all practicing physicians in the 1950s to about 20% in 2012, according to AMA leadership,[22] but many critics say it is much lower.

AMA membership has recovered modestly in the past few years, but the organization still has other problems.

For example, it has not been able to erase concerns about potential bias due to its profitable ownership of the Current Procedural Terminology (CPT) coding system and other commercial ventures. In a 2011 survey[23] of physicians, more than one half of them said one reason for quitting the AMA would be that the AMA's CPT business is "a conflict of interest." Dr. Lindes said that if the AMA wanted to win back physicians, it "needs to demonstrate that it works for all of us, and not for its own special interest."

In 2010, Cecil Wilson, MD, then the AMA president, defended[24] its agreement with the federal government to run the CPT system, saying the arrangement is "not exclusive (CMS could sanction other code sets) and not binding on private insurance companies. And the AMA derives no income from the federal government on the agreement."

It's unlikely that the AMA would spin off its CPT business because it has become a key source of income. AMA officials say[25] that earnings from CPT and other commercial ventures make it possible to keep dues low, and if these ventures were ended, the AMA would have to substantially raise dues. This could turn into a death spiral for the organization, because higher dues would mean that even fewer physicians would join.

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