AMA: And The Verdict Is…

Following up Mike Radienza’s post, I wished to register some comments of my own.

While I interpreted the Tennessee reference a bit differently, Mike and I agree on the impact of the address, mainly, it fell a bit flat.

Yes, it was an AMA stump speech, and lacked the personal touches our SHM audience desired.  SGR and medical malpractice are issues important to all of us, but given the opportunity to address a younger, “unacquainted audience,” emphasis on broader themes of data transparency, measurement, and recognition of transitions of care would have shown a situationally aware AMA, ready for the next phase of health care transformation.  It was a missed opportunity.

Mike also points out that in our HM11 session of approximately 250 people, when asked how many attendees were AMA members (remember, this sitting was related to policy and reform—an engaged crowd), I counted six hands.

However, given SHM’s recently obtained status as a full House of Delegate member, I thought a brief overview of AMA “purpose” was in order.

Keep in mind, the AMA is a political organization, and while it provides an array of beneficial services to both the public and our profession, it corrals every notable state society, professional organization, and special interest group under one roof to amalgamate policy.  As medicine has splintered, it is becoming more difficult to maintain that roof.

By no means is this a comprehensive overview, only a primer, but here are the AMA vicissitudes, or at least my brief take:

Five Ups:

1. Like it or not, the AMA is the voice of medicine.  When Congress wants to hear from physicians on the Hill, whom do they call?  The AMA.  When the White House wants to establish a health policy position and needs doctor input, whom do they call? The AMA.  When the public wants to know what providers think?  They call the AMA.  SHM is important, but to ignore the AMA is unwise (see #2).

2. Sometimes words, or in this case a chart, says it all:


While I have not researched the source of contributions, let us benevolently say, the AMA has a seat at the table (keep in mind, this post is not about campaign finance reform), and I do not need to comment further.  Res Ipsa Loquitur.

3.  Similar to the United Nations, the world sees a unidimensional AMA, failing to note the vast number of services (and very hard working people) the organization offers.  This was a revelation to me also, especially as I became more involved with the association. They provide a great service to patients, and are committed to the public health of our country.  I see this firsthand at every meeting, and it is impressive.

4. It is a melting pot, and if SHM wishes to caucus with society x, y, or z, we have that option.  Not that we cannot, or have not, done this through other venues, but it is a unique forum.  Dialogs can open and we can accomplish meaningful things, if we choose.

5.  Whether other organizations confess it, the AMA is the 800-pound gorilla on major healthcare concerns, i.e., a countervalence to unwieldy regulatory practices, physician pay, unrealistic implementation timelines, etc.  We all free ride, and when other medical societies discuss policy strategy, it is a given often, that “the AMA will take care of that one.”

Five Downs:

1. The lumbering giant in the room is physician pay.  It is often unspoken, sometimes not, but a conflict regarding physician resources ($$)  is looming.  Right now, there is much distraction with the logistics of reform solidifying; the focus is not doctor salaries and “fairness.” However, once the SGR transition is in place—and the transition will be an illusory “bond,” and some of the bigger issues get settled (ACO’s, exchanges), there will be disarray.  The AMA will not have adequate potency to keep our house of medicine composed.

Think of the television show Survivor.  You start with 16 people, and when 3-4 souls are left, it is every man for him/herself.  Using that dimension, there are still  14 people remaining on the 2011 game board, and the positioning has not yet begun.

2. The difference between the AMA and SHM is stark.  See the AMA demographic report:  Tables 1 & 2, on pages 6-8.  It is interesting to review, and you will observe the average age of their delegates, members, practice setting, etc.  I am generalizing, but if you are a 50-something, white male in a mid size private practice, your interests are well represented.  Many organizations, particularly a younger, more progressive one like ours, will only see variance.

I do offer these photographs of our plenary front row at HM 11 however (h/t : Eric Siegal).  Maybe we are like the AMA (LOL):





 

3. SHM and the AMA have divergent interests, as does the ACC, ACEP, ATS, and many other organizations.  The matter of whether each organization can accomplish more independently, or in small assemblages, advancing niche interests, is one I can answer easily and in one word.  Yes.  For example, on care transitions, SHM is the expert in the room, and that is a policy position we need to own and steer in DC.  I do mean that with respect.  Regardless, multiply that example a thousand times with dozens of professional groups, and there looms a difficult problem to disentangle.  Which of course leads to the big question–why do others or we need the AMA for a majority of our interests?

4. We all pay dues to SHM, and the AAP, or the ACP, or the AAFP.  For others, add SGIM, ACPE, ACCP, or IDS, etc.  Throw in CME, and most of us have hit our limit—given the perceived lack of AMA utility–real or not.

5. The AMA is a political organization with a past.  Many view it as a conservative, right of center guild that has advanced the interests of physicians to the detriment of others.  On principle, many will not affiliate with them.

As the SHM HOD delegate, I have discussed with many folks within our organization how we should proceed.  The answer is still unclear.  We are still monitoring AMA policy carefully, discussing mutual issues adroitly, and always considering next steps.  As our affiliation matures, look to our advocacy web page for updates.  Of course, feel free to comment below or offline, as your opinion does matter—we are only in the inaugural stages of this relationship.  It is complicated.

Brad Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.

Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.

Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.

He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

2 Comments

  1. Kelly Caverzagie on May 24, 2011 at 9:55 am

    Great comments from Brad and I completely agree with the ups and downs that he provides. I want to add a brief historical perspective regarding the AMA.

    I’ve been very engaged and active with the AMA for the past 10 years and have held several leadership positions with the organization dating back to residency. While the primary AMA delegate/member is still the 50-year old white male from a mid-sized private practice, this has dramatically changed since my involvement. In my opinion, there has been a transformational change in the culture, structure and leadership within the organization (current and president-elect excluded). There is an extremely strong presence of students and residents who are now starting to “grow-up” and become the leaders of the organization – they have been the primary drive to have AMA engage access to care, quality, public health, etc… The current Treasurer of the BOT is a very progressive emergency physician … there are numerous others. Furthermore, most (not all) state and specialty society delegations are recognizing the need to transform their representation to a younger generation. This wasn’t the case 10 years ago.

    I believe that SHM is in a very strong position to greatly influence the future direction of the AMA. I recently read where over half of docs in the country are now employed physicians – the AMA has already begun looking at providing resources and education for these physicians on how to best navigate the employed relationship. No one has a better perspective on this than SHM. This also goes for issues such as transitions of care, quality, measures development and application … with many more. There will always be the bread and butter issues (i.e. payment reform, SGR, liability) which I believe that AMA should always advocate for and be the primary leader. I can say firsthand, however, that the AMA is a changing organization and SHM engagement with AMA on certain key issues would benefit both organizations in the long run.

  2. […] The Hospitalist Leader, Bradley Flansbaum begins by grading the speech of a representative of the American Medical Association to the Society of Hospital Medicine. He then proceeds to grade the AMA itself, offering 5 “Ups” […]

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