American Medical Association

The American Medical Association (AMA), founded in 1847 and incorporated in 1897,^[2] is the largest association of medical doctors (M.D. and D.O.) and medical students in the United States.

Scope and operations

The AMA's stated mission is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education. The Association also publishes the Journal of the American Medical Association (JAMA), which has the largest circulation of any weekly medical journal in the world.^[3] The AMA also publishes a list of Physician Specialty Codes which are the standard method in the U.S. for identifying physician and practice specialties.

While its membership has declined in recent years, the AMA claims approximately 22% of US physicians and medical students as members.^[1]

The AMA's political positions through its history have often been controversial. In the 1930s, the AMA attempted to prohibit its members from working for the then-primitive health maintenance organizations that sprung up during the Great Depression, which violated the Sherman Antitrust Act and resulted in a conviction ultimately affirmed by the US Supreme Court.^[4] The AMA's vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan. Since the enactment of Medicare, the AMA reversed its position and now opposes any "cut to Medicare funding or shift [of] increased costs to beneficiaries at the expense of the quality or accessibility of care" — and it also "strongly supports subsidization of prescription drugs for Medicare patients based on means testing". However, the AMA remains opposed to any single-payer health care plan that might enact a National Health Service in the United States, such as the United States National Health Care Act. In the 1990s, the organization was part of the coalition that defeated the health care reform advanced by Hillary and Bill Clinton.

Also, the AMA has given high priority to supporting changes in medical malpractice law to limit damage awards, which, it contends, makes it difficult for patients to find appropriate medical care. In many states, high risk specialists have moved to other states that have enacted reform. For example, in 2004, all neurosurgeons had relocated out of the entire southern half of Illinois. The main legislative emphasis in multiple states has been to effect caps on the amount that patients can receive for pain and suffering. These costs for pain and suffering are only those that exceed the actual costs of healthcare and lost income. Multiple states have found that limiting pain and suffering costs has dramatically slowed increases in the cost of medical malpractice insurance. Texas, having recently enacted such reforms, reported that all major malpractice insurers in 2005 were able to offer either no increase or a decrease in premiums to physicians. At the same time however, states without caps also experienced similar results; suggesting that other market factors may have contributed to the decreases. Some economic studies have found that caps have historically had an uncertain effect on premium rates.^[5] Nevertheless, the AMA believes the caps may alleviate what is often perceived as an excessively litigious environment for many doctors. A recent report by the AMA found that in a 12 month period, five percent of physicians had claims filed against them.^[6]

Claims that the AMA generates $70 million in revenue through its stewardship of Current Procedural Terminology (CPT) codes appear to be a mischaracterization. The estimate is based on a distortion of the transparent financial information the AMA voluntarily offers in its Annual Report. The AMA has publicly reported this figure represents income from its complete line of books and products, which include more than 100 items, not just CPT.^[7]

The AMA sponsors the Specialty Society Relative Value Scale Update Committee which is influential group of 29 physicians, mostly specialists, who help determine the value of different physician's labor in Medicare prices.

Charitable activities

• The AMA Foundation provides approximately $1,000,000 annually in tuition assistance to financially needy students. This has to be seen on the background that in 2007, graduating medical students carried a mean debt load of $140,000 which rose to $220,000 after 4 yrs of negative amortization during residency^[8] medical student debt has increased by 7% each successive year.^[9]
• Funds awareness projects about health literacy
• Funds community service, community health, and healthcare education events held by local medical societies and student chapters
• Supports research funding for students and fellows around the U.S.
• Provides grants to community projects designed to encourage healthy lifestyles (of diet and exercise, good sleep habits, etc.).
• The Worldscopes project is a collaboration with the medical community to collect stethoscopes and the funds to buy them. The stethoscopes are then distributed to those in the global medical community who normally lack the resources to obtain the instruments. Thousands of stethoscopes have been sent to physicians and others in the medical community around the world who lack access to this medical instrument.^[10]

Politics

Throughout its history, the AMA has been actively involved in a variety of medical policy issues, from Medicare and HMOs to public health, and climate change.

• In the 1930s, the AMA attempted to prohibit its members from working for the primitive health maintenance organizations that sprung up during the Great Depression. The AMA's subsequent conviction for violating the Sherman Antitrust Act was affirmed by the U.S. Supreme Court. American Medical Ass'n. v. United States, 317 U.S. 519 (1943).
• The AMA's vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan. Before Medicare passed, according to Steven Schroeder, Wilbur Cohen inserted "usual, customary and reasonable" charges into the Social Security Act of 1965 "in an unsuccessful attempt to placate" the AMA.^[11] Since the enactment of Medicare, the AMA stated that it "continues to oppose attempts to cut Medicare funding or shift increased costs to beneficiaries at the expense of the quality or accessibility of care" and "strongly supports subsidization of prescription drugs for Medicare patients based on means testing". The AMA also campaigns to raise Medicare payments to physicians, arguing that increases will protect seniors' access to health care. In the 1990s, it was part of the coalition that defeated the health care reform proposed by President Bill Clinton.
• The AMA has given high priority to supporting changes in medical malpractice law to limit damage awards, which, it contends, makes it difficult for patients to find appropriate medical care. In many states, high-risk specialists have moved to other states with such limits. For example, in 2004, not a single neurosurgeon remained in the entire southern half of Illinois. The main legislative emphasis in multiple states has been to effect caps on the amount that patients can receive for pain and suffering. These costs for pain and suffering are only those that exceed the actual costs of health care and lost income. Multiple states found that limiting pain and suffering costs has actually dramatically slowed increases in the cost of medical malpractice insurance. Texas, having recently enacted such reforms, reported that all major malpractice insurers in 2005 were able to offer either no increase or a decrease in premiums to physicians. At the same time however, states without caps also experienced similar results; this suggests the cyclical nature of insurance markets may have actually been responsible. Some economic studies have found that caps have historically had a dubious effect on premium rates.^[5] Nevertheless, the AMA believes the caps may alleviate what is often perceived as an excessively litigious environment for many doctors.
• Another top priority of the AMA is to lobby for change to the federal tax codes to allow the current health insurance system (based on employment) to be purchased by individuals. Such changes could possibly allow millions of currently uninsured Americans to be able to afford insurance through a series of refundable tax credits based on income (for example, the lower one's income, the greater your credit).
• The AMA has made efforts to respond to health care disparities.
  • As such, the AMA created an advisory committee to assess the nature of disparities within different racial and ethnic groups.^[12] One such committee focuses on the health of the Gay, Lesbian Bisexual and Transgender community. In 2005, the AMA president Edward Hill gave a keynote address to the Gay and Lesbian Medical Association at its annual conference.^[13] Since that time, the AMA has worked closely with GLMA to develop AMA policy towards better health care access for LGBT patients and better working environments for LGBT physicians and medical students.^[14]
  • The AMA responded to the government estimate that more than 35 million Americans live in underserved areas by stating it would take 16,000 doctors to immediately fill that need, and the gap is expected to widen due to rising population and aging work force. "And that will mostly be felt in rural America," said Sen. Kent Conrad, D-N.D., adding, "We're facing a real crisis." Fueling the shortage are the restrictions on allowing foreign physicians to work in the U.S. after the September 11, 2001 attack, and may become more restrictive after the attempted terrorist bombings June 2007 in Britain, still under investigation, linked to foreign doctors.^[15][16]
• In June 2007, at its annual meeting, the AMA discussed its opposition to a fast-spreading nationwide trend for medical clinics to open up in supermarkets and drugstores. The AMA identified at least two problems with in-store clinics: potential conflict of interest, and potential jeopardized quality of care. The AMA went on to rally state and federal agencies to investigate the relationship between the operating clinics and the pharmacy chains to decide if this practice should be prohibited or regulated. Dr. Peter Carmel, neurosurgeon and AMA board member asked, "If you own both sides of the operation, shouldn't people look at that?" The AMA also noted some employers reduce or waive the co-payment if an employee goes to the retail clinic instead of the doctor's office, inferring that this practice might negatively affect quality of care.^[17]
• In 2008, the AMA issued a policy statement on global climate change declaring that they "support the findings of the latest Intergovernmental Panel on Climate Change report, which states that the Earth is undergoing adverse global climate change and that these changes will negatively affect public health." They also "support educating the medical community on the potential adverse public health effects of global climate change, including topics such as population displacement, flooding, infectious and vector-borne diseases, and healthy water supplies."^[18]
• In July 2008, the AMA focused its energy on blocking cuts to Medicare. Through advocacy efforts and communications campaigns, the AMA and all the specialty societies and state medical societies it comprises came out with a temporary victory. Despite a presidential veto, H.R. 6331, the “Medicare Improvements for Patients and Providers Act of 2008”, passed with wide, bi-partisan majorities in both the U.S. House of Representatives and the U.S. Senate.
• The AMA has affirmed, through continual policy statement (policies H-460.957, H-460.974, H-460.964, and H-460.991 for example), its support for appropriate and compassionate use of animals in biomedical research programs, and its opposition to the actions of other groups that impede such research, such as some actions from animal rights groups, and its opposition to legislation that unduly restricts such research.
• The AMA's Office of Alcohol and Other Drug Abuse promotes temperance and lobbies for a reduction of alcoholic beverage advertising and an increase in alcoholic beverage taxes, among other activities.
• The AMA supported the Patient Protection and Affordable Care Act as a step toward providing coverage to all Americans and improving the nation’s health system.^[19] See AMA news release at: http://www.ama-assn.org/ama/pub/health-system-reform/ama-supports-reform-passage.shtml
• The AMA is completely against the death penalty and does not allow any of its members to partake in part of an execution process.

Criticisms

• Critics of the American Medical Association, including economist Milton Friedman, have asserted that the organization acts as a guild and has attempted to increase physicians' wages and fees by influencing limitations on the supply of physicians and non-physician competition. In Free to Choose, Friedman said "the AMA has engaged in extensive litigation charging chiropractors and osteopathic physicians with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible."^[20]
• Profession and Monopoly, a book published in 1975, is critical of the AMA for limiting the supply of physicians and inflating the cost of medical care in the United States. The book claims that physician supply is kept low by the AMA to ensure high pay for practicing physicians. It states that in the United States the number, curriculum, and size of medical schools are restricted by state licensing boards controlled by representatives of state medical societies associated with the AMA. The book is also critical of the ethical rules adopted by the AMA which restrict advertisement and other types of competition between professionals. It points out that advertising and bargaining can result in expulsion from the AMA and legal revocation of licenses. Restrictions against advertising that is not false or deceptive were dropped from the AMA Code of Medical Ethics in 1980 (AMA Ethical Policy E-5.02). The book also states that before 1912 the AMA included uniform fees for specific medical procedures in its official code of ethics. The AMA's influence on hospital regulation was also criticized in the book.^[21]
• The AMA and other industry groups predicted an over-supply of doctors, and worked to limit the number of new doctors. But recently, the AMA has changed its position, predicting a doctor shortage instead.^[22]
• It has been argued that the AMA's CPT monopoly has been created by the government and makes the organization subject to government influence; further, the restricted access to CPT codes may not be in the interest of its constituents.^[23]

Membership

Physician membership in the group is thought to have decreased to less than 20% of practicing physicians.^[23] In 2004, the AMA reported membership totals of 244,569, which included retired and practicing physicians along with medical students, residents, and fellows. The medical school section (MSS) reported totals of 48,868 members, while the resident and fellow section (RFS) reported 24,069 members. Combined they account for almost 30% of AMA members. There are currently approximately 661,400 practicing physicians in America.^[24] However, MedPage Today estimates that the AMA only represents 135,300 "real, practicing physicians" as of 2005 (15.0% of the United States practicing physicians).^[25] When asked about this, Jeremy Lazarus, a speaker in the AMA House of Delegates, stated that membership was stable, avoiding commenting on the low overall numbers (2005 AMSA annual meeting, AMA vs. PNHP healthcare debate, Arlington, Virginia).

See also

• AMA Foundation Leadership Award
• AMA Manual of Style
• AMA Scientific Achievement Award
• American Association of Physicians and Surgeons
• American College of Physicians
• American Dental Association
• American Medical Student Association
• American Osteopathic Association
• List of journals published by the American Medical Association
• National Physicians Alliance
• Physicians for a National Health Program

References

Further reading

• Burrow, James G. AMA: Voice of American Medicine. Baltimore: Johns Hopkins University Press, 1963.
• Campion, Frank. The AMA and U.S. Health Policy Since 1940. Chicago: Chicago Review Press, 1984.
• Fishbein, Morris. History of the American Medical Association, 1847–1947. Philadelphia: W. B. Saunders, 1947.
• Numbers, Ronald. Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912–1920. Baltimore: Johns Hopkins University Press, 1978.
• Poen, Monte. Harry S. Truman versus the Medical Lobby: The Genesis of Medicare. Columbia, MO: The University of Missouri Press, 1979.
• Starr, Paul. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. New York: Basic Books, 1982.

External links

• Official website
• AMA Archives
• AMA Foundation
• AMA Health System Reform
• AMA Political Contributions (Opensecrets.org)
• AMA Resources for Continuing Medical Education and Careers in Health Care
• AMA Resources for Physicians