New Advocacy Group Aims to Give 'Every Physician' a Voice

Kerry Dooley Young

April 28, 2020

A new advocacy organization is launching today to give "every physician" a voice in decisions that affect their professional lives. But this group doesn't intend to use the top-down approach to decision making seen in many medical societies.

Dr Paul S. Tearstein

Paul Teirstein, MD, chief of cardiology for Scripps Clinic in La Jolla, California, and founder of the new organization United Physicians, told Medscape Medical News it is a nonprofit group that will operate through online participation.

He said the intention is to use online voting and discussions among physicians across specialties to advocate for more and better legislation on pressing issues for their profession and, as noted on the group's website, "protect the physician-patient relationship."

Projects would need the support of a two-thirds majority of United Physicians' members to proceed with any proposals. Meetings will be held publicly online, Teirstein explained.

There is a need for a broad-based organization that will respond to the voice of practicing physicians rather than dictate legislative priorities from management ranks, he said.

Teirstein said he learned how challenging it is to bring physicians together on issues in his battles in 2014  against changes in maintenance of certification (MOC) rules. The result of his efforts was the National Board of Physicians and Surgeons (NBPAS), set up to provide a means of certification different from the one offered by the American Board of Internal Medicine (ABIM).

Teirstein has argued that the approach of ABIM unfairly burdened physicians with a stepped-up schedule of testing and relied on an outdated approach to the practice of medicine.

Physicians busy with their practices feel they lack a unified voice in contesting the growing administrative burden and unproductive federal and state policies, Teirstein said.

He cites the limited enrollment in the largest physician groups as evidence of how disenfranchised many clinicians feel. There are about 1 million professional active physicians in the United States, according to the nonprofit Kaiser Family Foundation. Yet, even the largest physician group, the American Medical Association (AMA), has about 250,000 members, according to its 2018 annual report

"Clearly, most physicians believe they have little voice when it comes to healthcare decisions," Teirstein said. "Our physician associations are governed from the top down. The leaders set the agenda. There may be delegates, but does leadership really listen to the delegates? Do the delegates really listen to the physician community?"

On its website, AMA describes itself as "physicians' powerful ally in patient care" that works with more than 190 state and specialty medical societies. In recent months, James L. Madara, MD, the group's chief executive officer, has urged governors to remove obstacles for physicians who want to fill workforce gaps in COVID-19 hot spots, among other actions.

In its annual report, the AMA ― which declined to comment for this article ― said its membership rose by 3.4% in 2018, double the growth rate of the previous year, thanks to a membership drive.

"The campaign celebrates the powerful work of our physician members and showcases how their individual efforts — along with the AMA — are moving medicine forward," wrote Madara and other organization leaders in the report.

What Teirstein proposes is an inversion of the structure used by other medical societies, in which he says leaders and delegates dictate priorities.

United Physicians will use meetings and votes held by members online to decide which projects to pursue. Fees would be kept nominal, likely about $10 a year, depending on the number of members. Fees would be subject to change on the basis of expenses. The AMA has a sliding fee schedule that tops out with annual dues for physicians in regular practice of $420.

"There are no delegates, no representatives, and no board of directors. We want every physician to join and every physician to vote on every issue," Teirstein said.

He stresses that he sees United Physicians as being complementary to the AMA.

"We do not compete with other organizations. Ideally, other organizations will use the platform," Teirstein said. "If the AMA is considering a new policy, it can use the United Physicians platform to measure physician support. For example, through online discussions, petitions, and voting, it might learn a proposed policy needs a few tweaks to be accepted by most physicians."

No Compensation

Teirstein is among physician leaders who in recent years have sought to rally their colleagues to fight back against growing administrative burdens.

In a 2015 article in JAMA that was written with Medscape's editor-in-chief, Eric Topol, MD, Teirstein criticized the ABIM's drive to have physicians complete tests every 2 years and participate in continuous certification instead of recertifying once a decade, as had been the practice.

Teirstein formed the NBPAS as an alternative path for certification, with Topol serving on the board for that organization. Topol also will serve as a member of the advisory board for Teirstein's United Physicians.

Topol wrote an article that appeared in the New Yorker last August, as reported by Medscape Medical News. In it, he argued for physicians to move beyond the confines of medical societies and seek a path for broad-based activism. He said he intended to challenge medical societies, which, for all the good they do, can sometimes lose focus on that core relationship in favor of the bottom line.

Topol told Medscape Medical News that his colleague's new project is a "good idea for a democratized platform at a time when physician solidarity is needed more than ever."

Teirstein plans to run United Physicians on a volunteer basis. This builds on the approach he has used for NBPAS, where there is no compensation for him or the directors.

In contrast, AMA's Madara made about $2.5 million in total compensation for 2018, according to the organization's Internal Revenue Service filing. Physicians who served as trustees and officials for the AMA that year received annual compensation that ranged from around $60,000 to $291,980, depending on their duties.

"Having volunteer leadership mitigates conflict of interest. It also ensures leadership has a 'day job' that keeps them in touch with issues impacting practicing physicians," Teirstein said.

Start-up costs for United Physicians will be supported by NBPAS, but it will function as a completely independent organization, he said.

In introducing the group, Teirstein outlined suggestions for proposals it might pursue. These include making hospitals secure adequate supplies of personal protective equipment ahead of health crises such as the COVID-19 pandemic.

His outline also includes suggestions for issues that likely will persist beyond the response to the pandemic.

Teirstein proposed a project for persuading insurance companies to provide online calendar appointments for peer-to-peer patient preauthorization. Failure of the insurer's representative to attend would trigger approval of authorization under this proposal. He also suggested a lobbying effort for specific reimbursement for peer-to-peer, patient preauthorization phone calls.

Teirstein said he hopes most of the proposals will come from physicians who join United Physicians.

Still, he said it is unclear whether United Physicians will succeed. An initial challenge could be in sorting through a barrage of competing ideas submitted to United Physicians.

But Teirstein appears hopeful about the changes for this experiment in online advocacy. He intends for United Physicians to be a pathway for clinicians to translate their complaints about policies into calls for action, with only a short investment of their time.

"Most of us have wonderful, engrossing jobs. It's hard to beat helping a patient, and most of us get to do it every day," Teirstein said. "Will we take the 30 seconds required to sign up and become a United Physicians member? Will we spend a little time each week reviewing the issues and voting? I think it's an experiment worth watching."

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