National Journal Examines American Medical Association’s ‘Identity Crisis’

The current issue of National Journal examines the "identity crisis" at the American Medical Association, which is considering restructuring as its membership base declines and its political power wanes. The group currently represents 29% of physicians nationwide, down from 75% three decades ago. It has been unsuccessful recently in lobbying for a federal patients' bill of rights and in attempts to "roll back" a 5.4% cut in Medicare reimbursements to physicians that took effect Jan. 1. The once "rock-solid" ally of Republicans is developing increasingly "caustic relations" with the congressional GOP, which it has opposed on such issues as patients' rights and Medicare payments. In addition, the group is facing a growing rift with state and specialist medical societies on several issues, including patients' rights. The AMA must "find some unity among these divisions" if it wants to survive, National Journal reports.

The AMA is considering a number of "once-unthinkable changes," including transforming from a membership group to an "organization of organizations" that receives funding from state and specialty societies. The organization is also targeting younger doctors, according to Dr. Michael Maves, the AMA's executive vice president. Currently, 16.6% of the group's members are medical students, 11.6% are residents and 10.4% are physicians under the age of 40. Some critics say such changes would be "unworkable." Nancy McCann, director of government affairs for the American Society of Cataract and Refractive Surgery, said, "I just don't see a scenario where the AMA controls what goes on legislatively, and we [specialty and state groups] give them money." Jack Lewin, head of the California Medical Association -- the largest state medical society -- said, "The AMA is the only organization that can be the voice for, the convener of, medicine in this country. Specialties, state societies and group practices have their place, but they cannot by themselves achieve that 800-pound gorilla status. That can only be the AMA" (Zeller, National Journal, 4/27).