Facing declining membership and steadily rising deficits, the American Medical Association (AMA), like most medical societies, is struggling to keep up with the wants and needs of physicians in the 21st century. At last month’s Interim Meeting of the AMA’s House of Delegates in Orlando, Fla., the AMA took preliminary steps that could transform the entire face of organized medicine, not only for itself, but for all county, state, and specialty medical societies—including APA.
The AMA’s Commission on Unity (COU) presented a report detailing a new design for the organization of the House of Medicine at last month’s meeting. The key to the new design and the crux of the controversy is in the way that the newly defined participating and core organizations would interact (see box below).
According to the COU report, in order to eliminate rivalry for membership between the core and participating organizations, any member of a participating organization would automatically become a member of the core organization. And, as such, a portion of the dues each member paid to the participating organization would be forwarded to the core organization.
In return, the core organization "would serve its participating organizations; it would not be a rival of those organizations," said the report. Based on actions of the core’s Congress (the presumed replacement for the current AMA House of Delegates), official policy positions would be established for the profession of medicine as a whole.
The idea of "automatic membership" in the AMA for all members of participating organizations is an enticing one, at least from the core organization’s point of view. The current AMA has about 293,000 members, with about 80,000 of those being either students or retired, leaving roughly 210,000 physicians who are in active practice as members. That is a relatively small percentage of the roughly 775,000 physicians currently licensed in the U.S.
The impact of the COU plan becomes clear when looking at psychiatry as an example. The most recent AMA figures show that nearly 11,000 psychiatists belong to the AMA. However, about 40,000 psychiatrists belong to APA, a substantial difference of nearly 30,000 potential dues-paying members. If all APA members were to be automatically folded into the AMA under the COU proposed system, the AMA would stand to gain revenue from each of those 30,000 members.
According to Walter J. McDonald, M.D., chair of the COU, the impetus behind the idea of unity was to avoid duplication of efforts and the continued exhaustion of revenue sources sorely needed for advocating both for patients and for organized medicine.
"Today," McDonald said, "one of the major problems is that we, the House of Medicine, have no single unified voice to advocate for patients on issues which affect the whole of medicine—over 750,000 physicians who want and need the same things: a patients’ bill of rights; universal prescription drug coverage, indeed, universal health care coverage; and managed care control. When these goals are addressed appropriately and effectively by organized medicine, we will get more members."
Reference Committee testimony was considerable, including broad-based support for the COU’s conclusion that if medicine is to meet the challenges of the future, it must change fundamentally.
Many delegates expressed frustration with the report, noting that it asked more questions than it answered. APA joined this front, adding significant questions to the growing list.
Jeffrey Akaka, M.D.: "We would like the momentum toward constructive change to continue, and we stand fully behind efforts to increase AMA membership."
"The Section Council on Psychiatry applauds the commission and its tremendous efforts in meeting its charge of putting forth a document recommending ways to improve organized medicine," said Jeffrey Akaka, M.D., who is an alternate delegate from APA and testified on behalf of the Section Council on Psychiatry. "We would like the momentum toward constructive change to continue, and we stand fully behind efforts to increase AMA membership. However, there are a number of areas that we believe need to be further addressed."
Akaka, an associate clinical professor of psychiatry at the University of Hawaii, outlined for the Reference Committee four areas of concern. First, that members of the new organization may be represented by viewpoints diametrically opposed to their own; second, the question of who would control the new system of organized medicine; third, concern among the Section Council members about AMA membership being "required" in order to be a member of a state or national specialty society; and "fourth, most importantly," Akaka said, "we are concerned about the potential dilution of our organization by nonphysician members; which could under the new plan be up to 49 percent. This could mean the end of the governance not only of our house, but also of our home, for physicians, by physicians, with physicians."
Akaka was referring to a recommendation buried within the COU report that called for opening membership to interested, nonphysician, health care providers as a means of increasing membership numbers. Akaka recommended on behalf of the Section Council on Psychiatry that the COU continue to work at "clarifying and fleshing out potential ways of addressing these concerns."
A minority of delegates opposed the report and the concepts it contained, putting forth Resolution 608, which thanked the COU for its work by disbanding it without further consideration of its recommendations.
After debate on the floor of the House of Delegates, the COU report was adopted with a few clarifying amendments in lieu of Resolution 608. The amendments clarified that the concept in the COU report was only one possibility, not the only one; designated the AMA Board of Trustees to assume a leadership role in working with other organizations; created a Special Advisory Group to be made up of representatives of members of the COU and other organizations; and produced a priority list to help the AMA’s Board of Trustees quickly move forward on the issue.
The Commission on Unity’s Report is available online at www.ama-assn.org by clicking on the Interim Meeting 2000 icon and then on "Reports and Resolutions." ▪