Who Will Speak For Physicians and Their Patients?

Brian Klepper

Posted 8/29/12 on Medscape Connect’s Care and Cost Blog

Dr. George Lundberg has an important article on Medpage Today that deserves the thoughtful consideration of every American physician. He argues that the American Medical Association, a successful and representative organization for many decades, more recently “fails on both fronts” to fight for doctors and for the health of the American people. It has become, he says, “unsalvageable.”

In a companion piece earlier this month, he called on all physicians to become lifelong members of the AMA, as a way to gain professional impact and to make the AMA more reflective of American physicians’ concerns. “If you are an American physician and you don’t like what the AMA has done and is doing, if you are not a member, shut your mouth, you have no right to complain.”

Dr. Lundberg can lay claim to some authority on the topic. He served for 17 years as Editor of the Journal of the American Medical Association (JAMA). He came directly from that post to Medscape, and shaped the development of the solid publication that it has become. Throughout his career he has been a learned, reasoned, plainspoken and forward-thinking voice for mechanisms that can improve medicine and America.

The AMA has become anything but a representative organization for practicing doctors. Only about 15 percent belong, and the average age of its members has steadily climbed. Few young physicians believe the AMA speaks for them or offers value. For them, it is a body apart and unrelated to their professional lives.

The AMA has become a lobbying group, convening medical specialty societies through its House of Delegates, conveying economically preferential treatment on some physicians at the expense of others through its powerful Relative Value Scale Update Committee (RUC), and advocating mostly for doctors’ financial interests through policy. As many observers, including me, have detailed over the past two years, the RUC’s influence over payment and practice has extracted a huge toll on America, creating financial incentives for inappropriate care, putting patients unnecessarily at risk and driving up cost for health care purchasers: individuals, businesses and taxpayers. In other words, it has exploited its position, betraying the trust of patients and purchasers.

Organizationally, the AMA has become wealthy through its ownership and management of Current Procedural Terminology (CPT) codes, a lucrative government-bestowed monopoly over the language of health care. (Imagine giving the highway contractors’ association sole rights to manage and charge for use of highways.) Tying this medical services classification system to fee-for-service reimbursement is another mechanism fueling excessive care and cost in the US. In the absence of strong member support, the AMA’s CPT franchise also provides precious financing for its aggressive lobbying efforts. It is a key source of its power.

An important question for doctors in the middle and early stages of their careers is whether the AMA projects their values and interests as physicians and citizens. Certainly, the AMA’s financial resources have given it tremendous influence in DC, but whether it has advocated for  policies that rank-and-file physicians believe are important is open to debate.

American health care is at an inflection point. Change, however gradual, is becoming palpable. The health care economy as we’ve experienced it won’t continue indefinitely, in large measure because the people paying the bills are tapped out. The market vacuums associated with excess and egregious unit pricing have created opportunities for innovation. A health care market is finally emerging that will pay physicians to manage process rather than to deliver services and products. Increasingly, value will be tied to results.

Dr. Lundberg is right. American physicians deserve a unifying platform that expresses their best professional aspirations, and that seeks to protect the economic and health interests of their patients. This does not describe the AMA as it is currently constituted. The AMA may represent most American doctors again in the future, or another organization may displace it.

In his call to join, Dr. Lundberg noted:

“…the mission statement of the AMA is ‘to promote the art and science of medicine and the betterment of public health.’ That statement takes into account the unselfishness that is supposed to characterize a learned professional … that patient and public interest trump personal interest.”

That mission has been lost.

Americans who stand outside the House of Medicine need the American physician community to retake the stewardship of its influence.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s