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Second opinions

When it comes to healthcare policy, the AMA doesn't have the only

June 30, 2009|Rahul Rajkumar and Harold Pollack | Rahul Rajkumar is a physician at Brigham and Women's Hospital in Boston. Harold Pollack teaches social service administration at the University of Chicago, where he chairs the Center for Health Administration Studies.

When President Obama visited Chicago recently to discuss healthcare reform with the American Medical Assn., his reception was polite but not entirely friendly. After weeks of behind-the-scenes courting by the White House, the AMA had just come out against a public health insurance plan -- something the administration hopes will be included in healthcare reform.

It's easy to understand why elected officials court the AMA. For decades, the powerful group has opposed, and sometimes helped to kill, important healthcare reform efforts. Although less powerful than it used to be, it remains America's largest and best-known physician organization. If you're trying to win over doctors and want to be seen by voters as genuinely reaching out, the AMA's convention remains a required visit.

But lawmakers should take note: The AMA does not speak for all physicians. In the battle for the soul of American medicine, the AMA is often on the wrong side. At least, it's not clearly on the right side of key contested issues in this year's healthcare reform debate. If lawmakers really want to reach out to the medical profession, if the media really want to understand what doctors believe, we have some advice: Stop treating the AMA as if it's the only game in town.

At last count, the AMA claimed about 245,000 members, a number that has declined in recent years. Of these, 195,000 are practicing physicians. That's only about 20% of all practicing physicians in the U.S. The same day that Obama spoke to the AMA, seven national organizations representing physicians, medical students, residents and interns held a news conference to support a public health insurance plan. Membership in these organizations totals 215,000, a significant number even though the groups probably have some overlapping membership. As AMA membership declines, these growing organizations arguably represent the future of the medical profession. Their views are more in touch with the American public, which polls indicate overwhelmingly supports providing citizens with the option to purchase public coverage.

In our view, the AMA is stuck in an old model of special-interest politics -- one that represents an increasingly narrow segment of the medical profession. The doctors we know express many worries. Sure, they care about their incomes, but they care about other things too that strongly affect the well-being of their patients.

The group with which we are affiliated, Doctors for America, along with others, is working to support healthcare reform that works. We support the need for reform that eliminates unnecessary testing and rewards high-quality care. Doctors for America and other organizations are trying to educate their thousands of physician-members and urge them to engage in the political debate.

Politicians in Washington have yet to recognize the growing power and the grass-roots legitimacy of these new voices in medical care. By and large, these organizations aren't given a seat at the table. They are only just beginning to receive invitations to meetings in Washington. The media don't generally write about them.

We don't know precisely how many doctors support a public-plan option. Polls indicate broad support among doctors for universal coverage and for other progressive measures, and even the AMA has pulled back slightly from its outright rejection of a public plan. A sizable minority of physicians actually supports a single-payer plan.

From their vantage point on the front lines of American medical care, doctors see firsthand the need for reform. They see patients facing financial hardship because of medical bills. They see others who forgo needed treatments they can't afford. Doctors work within a fragmented system that makes it increasingly hard to provide the high-quality, attentive and compassionate care they were trained to give. They see their profession facing increasing public skepticism, fueled by accounts of wasteful practice patterns and by their profession's frequent and frank stance as a special-interest group.

Of course lawmakers should consult the AMA. But they should stop putting the group on a pedestal above other doctor organizations. Perhaps if politicians did so, the AMA might make greater efforts to move beyond its narrow stance as a special-interest group.

Doctors are right to worry about the economic impact that reform will have on their profession. They have every right to lobby lawmakers in the same spirit Archer Daniels Midland lobbies on ethanol. Some such lobbying is natural and justified. Over the years, though, the AMA has sometimes forgotten that other values matter too. As thousands of doctors are starting to realize, that's a poor long-term strategy for a great profession that so greatly benefits from the public's trust.

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