Winds of change are sweeping through the executive offices of the AMA. A recent article provided some details about what's happening in this major medical organization (see: Dissent roils the AMA, the nation’s largest doctor’s group). Below is an excerpt from it. You may also want to read: Trump’s Health Secretary Pick Leaves Nation’s Doctors Divided.
...[M]edicine is a house more divided than ever. The AMA still has more clout....than the scores of medical specialty societies and splinter groups that sort doctors by political leanings. But it counts fewer than 25 percent of practicing physicians as members, down from 75 percent in the 1950s. And the association infuriated many doctors recently with its quick endorsement of President-elect Donald Trump’s choice for secretary of health and human services — Representative Tom Price, an orthopedic surgeon-turned-congressman who’s led the charge to overturn Obamacare. Just two weeks earlier, the AMA’s House of Delegates had reaffirmed the association’s support for coverage expansions under Obamacare....Just hours after Trump named Price as his pick to head HHS, the AMA’s board of trustees put out a strong statement of support. Controversy erupted immediately. Within days, more than 700 AMA members had signed a letter protesting that endorsement as “divisive.” A separate petition accusing the AMA of disregarding patients’ needs drew 5,500 physician signatures. Dr. Patrice Harris, board chair of the AMA, found herself in the hot seat. In a recent phone interview, Harris said the organization’s endorsement of Price doesn’t signal that the AMA has backed off its support for Obamacare....The association has spent $347 million lobbying since 1998 — more than any other company or group except the US Chamber of Commerce and the National Association of Realtors, according to the Center for Responsive Politics. Still, scholars agree that the association’s clout has declined over the last 30 years as specialty societies rose in prominence, health care costs soared, managed care became more prevalent, and physicians’ allegiance to the organization diminished.
One of the major problems for the AMA is that physicians are increasingly leaving private practice to work for hospitals. Private practitioners are the core supporters of the organization. Here are some of the reasons cited by physicians for the declining popularity of private practice from a 2012 study (see: More Data on Physicians Leaving Private Practice; Discussion of Findings):
- The majority (87 percent) of physicians surveyed cited the cost and expense of running a business as a chief concern.
- Most doctors (65 percent) joining health systems said they expect to make the same or less compensation than in private practice.
- Sixty-one percent cited business operations as a main reason for seeking hospital employment rather than remaining independent.
- More than half of doctors (53 percent) cited electronic medical record requirements as a main reason for leaving private practice.
Accenture reported in July 2015 that the number of independent physicians in the U.S. has declined over the past several years from 57% in 2000 to 49% in 2005. The firm predicted that in 2016 this number will drop to 33% and represents a 10% decline from Accenture's 2012 report (see: Many U.S. Doctors Will Leave Private Practice for Hospital Employment). The majority of physicians are now health system employees. As such, they will undoubted turn to their speciality medical societies for professional and scientific information but must cede most financial and economic decisions to the executives of their hospital employers.
I believe that the membership and political influence of the AMA will inexorably decline. Like labor unions, these organization are roadkill for major structural and economic forces that are outside of their control. It seems to me that that there are two strategies that the AMA could pursue in order to retain some of its former influence and prestige. One would be to align its strategy and interests with those of large health systems but they already have their own lobbying organizations. The second would be to develop professional societies or merge with existing ones that appeal to physicians. This latter approach would probably not be attractive to current speciality societies who would see little gain in such an approach and who also relish being independent.