AMA reassesses priorities amid membership woes: report on services rankles some delegates

Internal Medicine News, July 1, 2003 by Jennifer Silverman

CHICAGO -- With a reorganization plan on the cutting room floor, the American Medical Association may need to refocus on its priorities in order to boost ailing membership rolls.

A special committee charged with reviewing the AMA's structure spent the last year in part ranking the AMA's products and services on the basis of their level of importance to the organization. At the annual meeting of the House of Delegates, AMA leadership was asked to use this list to create a plan for a more focused and strategic organization.

The Committee on Organization of Organizations included leaders of 137 of the 171 societies represented in the House of Delegates. Legislative / regulatory, advocacy, and AMA unity issues were ranked higher in the review than science, public health, education, and community service.

During committee deliberations, many delegates took issue with the results, claiming that the AMA might eventually reduce allocations for these lower-ranking issues. "It is our obligation to support science and public health," one delegate said. Those who don't support that are "rejecting their professional obligation."

The AMA has no such plans, countered Dr. William Plested, the new chair of the Board of Trustees and a facilitator for the review process. The bottom line is that the AMA must prioritize its focus. "Physicians are leaving the practice of medicine due to malpractice and Medicare. There are terrible problems with the uninsured. We've got to solve the problems of the health care delivery system first," he told this newspaper.

What's unlikely to change is AMA's style of membership. Abandoning a year-long project to transition to an "organization of organizations," the House of Delegates took up the recommendation of the committee and voted to keep the organization individually funded but governed by the House of Delegates.

In its review, the committee considered a model in which only organizations could be AMA members and would pay dues on a per-member basis. Medical specialty societies objected to the fee--$20-525 per member--that they would have to pay the AMA under this proposed model. "Not all members of state and specialty societies are members of the AMA. If you had a pure model, the societies would have to pay for all of their members to join the AMA, something that would cost a fair amount of money," Dr. Rowan Zetterman, delegate to the American College of Physicians, said in an interview.

The organization-based model also posed a problem for nonprofit educational organizations that would become ineligible for Internal Revenue Service tax exemptions if they started paying for their members to join the AMA.

The year-long examination of AMA's membership structure was "a serious coming to grips with reality," said AMA Vice President and Chief Executive Officer Dr. Michael Maves. Contrary to popular myth, the AMA remains a strong force on Capitol Hill and is not in dire financial straits, he told delegates at the meeting's opening session. The AMA's operating profit in 2002 was $11.7 million, an improvement of nearly 7% from the previous year.

Despite the public perception that the AMA represents all physicians, only one-third belong to the organization. Membership has declined from 300,000 in the mid-1990s to 260,000 in 2003, Dr. Maves said, voicing a plea for delegates to help boost those numbers. "It's up to us to convince physicians to join forces with us."

But the committee's report "completely failed" to address the issue of declining membership, said Dr. Michael 0. Fleming, president-elect of the American Academy of Family Physicians. "It's going to continue to be a major problem for the AMA."

Delegates rejected the committee's recommendations to reduce the total size of the AMA House of Delegates, opting to explore the idea of proxy or weighted voting, so organizations could send fewer delegates without losing representation.

Malpractice reform and low Medicare reimbursement rates--usual hot topics at the AMA meetings--had a lower-than-usual profile this year as delegates grappled with the membership problem. Addressing Medicare issues, the delegates approved a resolution calling on the AMA to work to simplify the newly proposed Medicare enrollment policy for providers.

Physicians have serious concerns about the potential burdens of this regulation, Georgia delegate Dr. Michael Greene noted during committee debate. The rule would require physicians to submit to the Centers for Medicare and Medicaid Services any changes in staff within 90 days, and impose onsite investigations in physician's offices to ensure that their applications are accurate. "This would create a mountain of information that no one would ever look at," he said.

To protect the rights of patients, delegates also approved language opposing the presence of pharmaceutical representatives in clinical situations, and said that the AMA should work with industry to promulgate guidelines that protect patient privacy and confidentiality.