What does it mean to be part of organized medicine?

Even though AMA membership has declined in recent years, AAOS and other surgical specialties should continue to form coalitions that include AMA on mutual issues.

Issue: April 2004

ByDouglas W. Jackson, MD

Douglas W. Jackson, MD [photo] --- Douglas W. Jackson, Chief Medical Editor

One of the first things I wanted to do when I received my medical degree was to become a member of the American Medical Association. At that time in my career, the AMA represented organized medicine to me, and I was eager to be part of it.

As a young house staff physician, I attended two AMA national meetings and remember presenting a paper in the orthopedic section. When I first entered practice, one of the physicians in our community became president of the AMA. He strongly encouraged me to be an active member. So did the orthopedic group I joined. At that time, we all belonged to our city, county, state and national medical associations. That was in addition to our membership in the national and local orthopedic organizations that had not yet started increasing in number.

Over the subsequent years, I attended a few AMA meetings. Two years I was an AAOS representative at AMA leadership meetings in Chicago and Washington, DC, that discussed possible reorganization of the AMA and making changes that might keep more of us, specifically the surgical specialists, as AMA members.

Multiple dues

One of the frustrations I was experiencing with my AMA, state and local medical memberships was my feeling that there were too many layers of administration and the combined dues and requests were becoming too high for the city, county, state and national medical association memberships.

I wrote letters to the boards of directors at each level suggesting a $1000 membership to belong to all layers and suggested that some of the duplications of staff and programs be eliminated. I pointed out that other organizations were more effectively meeting the educational and health policy needs of orthopedic and other surgical specialists. Our county association responded that they felt that cutting the dues by almost one-half would not increase the number of members but that it would simply cut their financial base in half.

On each successive year after that when our orthopedic group received our dues statements and requests for donations to their political action and aid programs, we debated the value of continuing our AMA membership. Our discussions always boiled down to should we do it or not? For five years, we continued to join because we concluded each year that the AMA was “our union,” and we felt it was our major representation in Washington. When that even became a question to us as surgical specialists, we finally dropped our membership.

Surgical specialties not well represented

It had become our impression that primary care physicians and state societies controlled the AMA. Surgical specialties did not have enough meaningful representation to be able to influence programs to address our needs.

I know from previously stating this viewpoint that there are AAOS members who still belong, and many have served as delegates to the AMA and strongly disagree with my point of view. My views are not meant to demean their good work or the efforts they have put forward. The AMA has represented medicine for many years and accomplished many achievements. It is my impression that it was a much more inclusive organization prior to the 1980s.

Meeting the medical needs of our patients, profession and society is going to be an even larger challenge in the future whether we are part of an “organized medicine voice” or not.

My conclusion to drop my membership was made after having my AMA membership for more than 22 years because I came to believe my continued membership had less relevance to my practice and patient care needs than the other organizations in which I was active. My patients’ and my educational and political-action needs were being addressed specifically without membership in the AMA.

During that decision-making time, it was difficult to know exactly what other surgeons were doing. I was unable to find out the exact number of active physicians who were members of the AMA, separate from the student, resident and retired physician memberships. Modern Medicine recently published these numbers. It reported a 250,000 total membership, with about 140,000 active physician members. The remainder are students, residents and retired physicians.

A greater percentage of AMA members are actively practicing physicians vs. these special-category members (140,000 vs. 110,000). It is a real statement when only 17% of practicing physicians under age 40 currently belong to the AMA. For the past 15 years, AMA membership has been declining at an average rate of 1.3% per year. That decline has apparently slowed in the past year.

From working with orthopedic surgeons over the years, it becomes apparent that the house of medicine and the individual physicians who compose it are diverse, as are their interpretations and proposed solutions to many patient-care issues. “Organized medicine” that speaks with a unified voice would be more effective in our national health care debate and solutions. When it exists, it allows us to use our resources more efficiently and cost effectively.

However, in order for the house of orthopedics to participate in any organized medicine’s position, it requires us to do sophisticated analysis of the problems and have meaningful representation from our perspective on those issues impacting our practices and patients. Once we understand and formulate our position, we then can decide to interact with the AMA and other specialty societies wherever it is mutually advantageous. When the majority of our organizations come together on patient care and health policy issues, these mutual coalitions are truly “the voice of organized medicine.”

The AMA may take the lead on some of these issues and may be participants in others where they are not the leaders. Meeting the medical needs of our patients, profession and society is going to be an even larger challenge in the future whether we are part of an “organized medicine voice” or not. Let us strive to work together in meaningful issue-specific coalitions that will allow us to be more effective in the ongoing debate on health care delivery issues and policies.