Bravo!

Unfortunately the AMA is forced upon many physicians for some of the benefits that they do offer. I agree that the AMA is acting in its own self-preservation interests and not on the behalf of its constituents. It has become a member of the politico.

Local Medical societies are much more attuned to the local climate and physician needs. These local chapters meet together in state chapters which meet as the AMA. Somewhere in the translation from local to national level, the realities of the local community physician is lost. However it is not just the AMA. Many of our national based societies have fallen into the same trap. Take for example the self-serving publications of many university hospital that do research to prove that they are the only type of institution that should be doing x type of case. As more of these studies get published it makes it easier for people/lawyeres to point fingers should a complication arise. Yet I am sure if you look at the numbers there are many more community/private practice physicians then there are university physicians.

I for one am a board member of my local medical society and president our towns IPA. Both groups work toward making the working environment for the local physician better. I for one would relish an opportunity for the real voice of the majority of physicians to be heard; not just those from the AMA or academia.

I am impressed, I thought you were still partnered with the AMA?

OK - we've seen a few attempts on this site to develop the Anti-AMA (open letter, now a "million doc march" on Washington.) If there is little cohesion here, where will it develop? Do we need a charismatic leader? Have we succumbed to hopeless / helpless? Or to cynicism? ("Follow the money to success") Most of us are more than willing to help in some way, but in / on Sermo we're missing something, whether magical or practical that will galvanize us into action.

The AMA has about a century of entrenchment, an organization, and public perception that it speaks for all doctors in the country. That's tough to counter - takes time, commitment from a whole lotta people, plus money.

Don't want to sound hopeless / helpless, but there is the challenge.

While it may well be true that based on membership numbers and funding sources the AMA has a limited ability to claim to be the 'Voice' of physicians, but to claim that a poll on Sermo has any more voice is completely laughable!

Sermo has long been a radical, right wing, anti-universal care site. The poorly conceived , and utterly failed 'Open Letter" was strongly promoted by Sermo with countless spam emailing, and financial support ( at one point money for every new sermo member was donated to the campaign).

Only a small number of progressive physicians would bother to stick around here after post after post of agressive, insulting , and completely uncivil right wing, Ayn Rand quoting nutbags on here. The preponderence of that sentiment completely belies many non-Sermo based surveys on physician opinions in matters as heathcare reform.

This severe limitation and bias in the voting sample already makes interpretation of any polling data here practically irrelevant.
But at least the administartion behind Sermo has decided to be more honest about the site's administrative direction.... ( which is a change)...

This will not have any effect unless our point of view becomes available to the public. It is therefore important to make our point of view public.

All the while the AMA is profiting from the docs, and IMHO one of the immediate ways to stop that is to make sure that you opt out of demographics and prescription reporting by the AMA to pharmaceutical companies and anyone willing to pay for it. Even if you are not a member, you need to opt out.

Dan, thank you! I have e-mailed the president(Obama) several times to suggest exactly what you are saying and also that he needs to meet with some working physicians in America to get a true picture of the depth of the issues.

For those of you who are openly criticising Sermo...get real! This is a physician's discussion site and has been an excellent vehicle for the exchange of ideas. For almost 2 years I have read comments here that range from the extreme left, to the extreme right and occasionally to the extremely ridiculous and even extremely offensive. Isn't free speech wonderful!

This site has allowed an open exchange of ideas, education and communication among a large group of physicians unlike anything that I have seen in the past.

One theme that has run through many of the comments is that physicians feel undervalued and abused. They feel that the AMA and other organizations have become self serving corporations that no longer function as true advocates for America's physicians. They feel that the corporate and government push in America is to marginalize us and replace many of us with poorly trained substitutes, like NPs and PAs who have their place, but not as physician replacements.

There have been those who say that the AMA will respond and change, that the new president from Texas will bring the AMA back to it's roots and true purpose as an advocate for America's physicians. If so, I would applaud this move. But, realistically I don't see it occurring.

I think we are at a pivotal juncture in American medicine. We need physicians like Dan Palestrant to speak out and point these issues out with a clear voice. We need to restore the true physician-patient relationship and physician autonomy. There is much we can accomplish. But, nothing will occur if we remain silent.

Dan, you can use this and any other statements that I have made on Sermo in any public forum that you choose. You can attribute them to me and you are free to use my name. I am not afraid to stand up for what I believe and think.

Richard A. Armstrong MD FACS
Newberry, Michigan

Daniel, welcome to the party. Hopefully this means that the unfortunate misadventure of the Sermo-AMA partnership is in the past.

What a great rhetorical opportunity you now have. A large public announcement of the rejection of the impotent AMA by Sermo, both the business model as well as the community. This could be a powerful statement, "We partnered with the AMA in the hopes that such a partnership and free exchange of ideas may in some small way awaken and reinvigorate the slumbering beast. Sadly, this hibernation appears to be permanent, and it is now all too clear that the AMA has abjectly failed the very members it purports to represent -- America's physicians."

I was never prouder to be a member of Sermo than I am now.

Thanks, Dan.

Great post, Dan. I've always been proud to NOT be a member of the AMA -- and more so now than ever. Glad you feel the same way.

Twenty years ago, I figured out that the AMA had become a bastion of bureaucrats who had no desire to represent those docs actually out there doing the work. It has traded its birthright for some paltry trinkets of alleged influence that has actually worked in concert with those forces dead set on destroying physicians in this nation. It no longer represents the will of the American physician; and in fact, has grown into the means to be used by those outside medicine to indenture physicians and bring us to this anarchy that we must endure today.
Glad to have you on board Dan...................you will find that you will be in good company.

Agreed. proud to not be an AMA member.

Well stated. Thanks.

I, too, dropped my membership in the AMA this year. It is clear that they no longer represent mainstream medicine in general, and they certainly don't represent radiiology in particular.

What a load of self righteous crap

Change the AMA... nonsense

Change Health Care in its entirety

Get a grip Dan and put your energy into something meaningful

Agree wholeheartedly with the above. Dan, you really have said what I've been thinking and feeling for many years, and I thank you for actually saying what many of us have been thinking for quite a while. I have always been concerned about the AMA 's true agenda and I have never believed that it truly represented the "rank and file" - ever. When one finds out that they have been selling our personal information to pharma (to the tune of millions), allowing the insurance companies, attorneys and government ride roughshod over us and the many ridiculous "mandates" they want us to follow, such as taking our white coats away from us is too much to bear. I feel that it is time to truly move on and create an entity that really DOES represent us. I do think that Sermo now has enough members that we can really say that "I'm mad as hell and I 'm not going take it anymore!!"

I do not know if SERMO represents the voice of Physicians , but one thing I know is that the AMA does not represent us anymore. The public needs to be aware of this . it is our Moral responsibility to Our profession to let this be known. Here is an example of what the public perception of the AMA is feed by wrong information by the news media . This is an excerpt from Keith Obermans show on June 15 while talking to Bill Maher with regards to BO speech at the AMA:
OLBERMANN: Yes, he was speaking to the second most powerful union in America, behind the Baseball Players Association
You can read the entire transcript here: www.msnbc.msn.com/id/31387052
Union ? Powerful?
This is the type of perception the public has of our so called voice. I will post here the only known statistic with regards to the so called 250,000 strong membership the AMA has for the third time :

"Physician membership in the group has decreased to lower than 19% of practicing physicians. In 2004, 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"

Source :
REPORT OF THE BOARD OF TRUSTEES
B of T Report 20 - A-06
AMA
These numbers are a farce , mind you , these are 2004 numbers !! I am sick and tired of hearing that this self serving institution is our voice . I say let media into SERMO with limited access to see what we think with regards to health care reform.

Kz

There have been many attempts over the years to "replace" the AMA with more radical voices - and all have failed. Here's a thought - since the AMA is physician-run, why not GET INVOLVED at the local level, become a delegate to your state's House of Delegates, and then move upward to the AMA House of Delegates? It's a lot easier than it sounds, because most physicians are too busy or don't care to get involved. Show a little interest, commit to spending a little time, and bring the group around to YOUR point of view - if that point of view has any validity at all, you will be heard and, if your colleagues, who make up the membership and boards of trustees of local and state societies agree with you, it will be acted upon. Of course, if the majority disagree with your point of view, it won't - like the doctor who wanted to pass a resolution that AMA members stop treating lawyers several years ago. It's easy to whine about what an organization does if you don't bother to get involved - it's kind of like voting. Are you all registered to vote and do you all vote in every election? Or do you just complain about the outcome....?

I couldn't agree more. We need someone to speak for us who is not politically motivated and through Sermo we can speak for ourselves. The AMA should go the way of the unions------- It as well as the AMA has outlived their usefulness and their need.

this shows a complete lack of understanding of current AMA policy. I am The current president of the Massachusetts medical society, and we are fully in favor of health care reform. I could have forsworn the AMA, as this article implies that we should do, or.. get in the trenches and make the AMA a better organization. Please check the resolutions actually passed in the recent annual meeting. This is no longer your "fathers AMA". It is filled with many new delegates that want reform and want to make a better health care delivery system as you state you want. yes, there are disagreements of course, that is the nature of an open, democratic debate. But the majority of AMA delegates now want to move forward, be part of the process and make health care better.
Rather than call for more fractured voices, I contend those that wish to be critics of the AMA, check out the latest resolutions, become delegates, and help mold the AMA to be the organization that represents your view. be part of the process. All to easy to sit back and complain and not be active in the process.

Mario Motta, MD
President of the Massachusetts Medical society

AMA= Pale, Male and worse, STALE

I dropped out of the AMA when the AMA lobbyist who worked for the legal profession against tort reform was appointed. I have NEVER regretted not being an AMA member! I agree fully with the previous statements and the original letter.

I have been practicing Emergency Medicine for 30 years in urban Los Angeles area...the emergency safety net is broken and the ship has sunk...politicians sold us out, lawyers raped us and the public think we are all rich...ironic that an actor portraying an emergency physician makes more in one episode than we do in an entire year...it does not make any sense...for my sanity and health I have "retired" from the pit full-time...please let be know how I can get more involved to rebuild the safety net for our children and grandchildren...

I have absolutely no faith, whatsoever, in this process.

I have no doubt in my mind that NO MATTER WHAT WE DO, we (physicians) are going to get royally screwed by the government in this matter.

I just finished training one year ago and could wish NOTHING MORE than that I had chosen a different job. Sad thing is that I don't have a SINGLE SKILL now other than working as a physician..... weird.

I wholeheartedly agree with the basic premise.

Further, recognizing that there are many points of view represented by docs of the Sermo community, I propose the following:

1. Create a sort of physician advocacy "e-Republic". Allow for member creation and leadership of, for lack of a better word, "parties", each of which would presumably have a platform and a vision for the future of American physicians.

2. Each party would be open to membership by any docs in the Sermo community. Each party would have structure including elected party leadership and a spokesman for both internal and external communication.

3. This could be expanded, if effective, into real world advocacy by using this structure to raise actual money for public campaigns or lobbying efforts.

4. Though we have many viewpoints, we are all docs, and we should speak to the public with one voice. Thus, fostered by the party structure and Sermo e-Elections, we can construct a unified message, and the membership as a whole agrees to abide by the election results.

5. This would all be voluntary. Each Sermoan could choose to remain unaffiliated with any party or any advocacy whatever -- basically, those who choose to be advocacy agnostic would not join the e-Republic. When speaking to the outside world, we should only report to speak on behalf of the members who have chosen to be involved, not those who have elected to not be involved.

6. Further, I recommend that party affiliation for each Sermoan could be denoted by putting an icon by the user's name (voluntarily, of course), said icon to be chosen by the party leadership subject to reasonable review by Sermo itself to avoid offensive symbols or copyrighted ones.


I volunteer to help create this structure.

I believe that the voice of the American physician has been lost. And it cannot be regained through the AMA which is so deeply financially intertwined with insurers and others whose interests are antithetical to physicians themselves. A physician e-Republic would not only create a stronger, more unified, and transparent advocacy organizations for physicians, I believe it could be a model that other professional organizations would seek to emulate.

If not now, when?

If not us, who?

I have consistently seen that our best advocates have been through the specialty societies on both a national and state basis. I had not realized how entrenched the AMA was in The System. You cannot expect any reasonable level of representation in the face of those types of conflicts of interest.

That is enough to convince me to drop my AMA membership and redirect those funds to the organizations that are doing something.

Martin Ross, MD
Norwalk CT

It is interesting to see how we see through our own lenses. Some see Dan's statement as a pro-physician-power manifesto and yet, when I looked at it, I thought that perhaps he was advocating a pro-patient approach for the AMA.

They are not the same. I remember asking some organized medicine PAC people how they chose candidates to support, and the answer was that they support "pro-medicine" candidates.

It seems if you're a conservative, that means pro-caps on medical liability, pro-increased reimbursement for all, pro-status-quo (because it provides "choice" and "free-markets" to the benefit of our patients), and anti-Physician-extenders as primary goals.

As a liberal, "pro-medicine" means to me someobody supporting universal access to health care for all Americans, someone advocating what's best for our patients, rich and poor, and not just advocating for the blinkered self-interest of physicians as if we were a trade union and not a profession.

We as a physicians have no actual representation. It is not the AMA to be blamed.
We have a lot of so called specialties societies.We are divided in classes "certifieds, eligible, non certified, tri boarded, tetra boarded, etc. etc."
Like in government if you do not participate en elections and vote, do not complaint of the government you have,
Until the day we all unite under the name of "a one" medical profession were all are equal, do not expect one voice, nor strengh in our profession.
Dividing you conquer. WE ARE DIVIDED!!!

The second biggest threat to physicians with a government option is inability of individual physicians to negotiate fees and, probably, to reject participation. I expect ultimately that we will be forced to participate in Medi-Cal, Medicare, and the government option since fees will be low and not tied accurately to actual practice costs or geographic cost of living.

The biggest threat would be outlawing private practice in a single payor system, a la Canada.

Daniel:
What you say is not entirely without merit. I wonder, however, if part of the problem is not, in Pogo's words "We have met the enemy, and they are us!" How many of us (me included) have tried to take an active voice in AMA, etc. It makes us shudder. Representation, in most forms, makes us shudder, in part--as I know from ACEP-- that within any organization exists multiple trends and so multiple polarities.Your efforts are applaudable, but whether they will be doomed to the same demise as AMA's once committed and honest founders' ideas is quite another story. Would that we would change our natures, dive in, join AMA, swell the ranks from mediocrity, and reverse its behaviors. But will that happen, Daniel? I would venture to guess, not.

A more compelling poll would be taken from a random sample of physicians around the country. Even a small study would have more weight than any biased study such as this, no matter how large. The strongest defensible statement you could make is that the AMA does not speak for physicians on Sermo. Yawn. And even that would be a stretch, since those who answer this poll are likely self-selected. There's a lot more work to do if you want to claim that physicians on Sermo are representative of US physicians in general. Ironic, I know, given the subject of this poll.

OK, just WHAT is the AMA doing now that Sermoland doesn't agree with???

Opposing single payer?

Emphasizing that tort reform has to be a part of any health system change or it won't work?

Not endorsing or even being willing to use the words "public option" because no one knows what that is yet?

Opposing penalties for not having an EMR if you don't want one?

Saying that if there's a medical home model, that specialists ought to be allowed to be the medical home, not just primary care?

Were any of you actually AT the AMA House of Delegates meeting where these and many more issues were discussed? I was, and I didn't agree with everything that got passed, but I did with most of it.

AMA membership may be at an all time low, but your state society is there. And your specialty societies. And I'm glad that there are so many students and residents involved - they're our future. But they don't run the show. Practicing docs do.

The AMA is a painfully democratic organization, and if you don't think your voice is being heard, it's your own damn fault.

No, I don't think the AMA has spoken for physicians for some time and in the current healthcare debate, has assumed the role of yet another patient advocate. Decisions regarding healthcare reform are being made by politicians, pharmaceutical companies and insurance companies, which have clear leadership and know how to work the system. As doctors, we have no voice, which is scary. We are not a cohesive group and our own infighting is leaving us out in the cold, where once again, we will be told how to practice rather than being part of the transformation.

I am always amazed when I receive a request from the AMA PAC or one of the specialty society PAC's for a contribution. The recommended contribution often starts at $500 or $1000. Just another indication of how out of touch they are... .

The AMA needs to be a stronger physician advocate, but it can't be replaced tomorrow by Sermo. Sermo can be a vehicle for transmitting our voice (to Congress and to the AMA), but it cannot be alone. If we can speak more fully and freely to one another (via sites like Sermo), this will help AMA and the nation to understand what we need. But to abandon the primary physician advocate group at the very moment that Congress is considering the destruction of the American medical system... seems unwise.

Agree w Dan. I continue to be a member of the AMA and continue to hope that the AMA will stand up for me as a physician. What I see happening time and time again is the AMA trying to tweak whatever craziness the government is proposing rather than saying NO!!!! that is WRONG for patients AND for doctors. Way too politically correct, way too little original thinking, only responding/ reacting (usually impotently) rather than being proactive for us, patients and healthcare in general.

Very good letter, thanks. I hope we can actually get our act together and speak as a unified voice...

For me and the other physicians I know, the decision not to join AMA is easy. We can't afford the membership dues since medical school.

GREAT DISCUSSION !!

Now AMA has found ... yet another BED MATE !! to extract funds out of doctors .. the Microsoft and the Health Wault they have,
Folks that will be rammed down your throat just like they have done the CPT and ICD codes etc... watch it..
I vote for --- a complete boycott from AMA.

If the AMA were effective we wouldn't be in the the dire situation we are in now. Before coming to the US I was a member of the BMA - an entirely different story, with 90% membership, a registered Trades Union and extremely effective in negotiating with the British government, which of course is the employer of most physicians in the UK either directly or indirectly.
I am a member of the AAFP, which costs $550 or so per year, I cannot afford, as a PCP to also be a member of the AMA and our local medical society, which between them would cost $1200 per year - I see little of value that they deliver - my specialty organization, the AAFP has all the benefits I might need.
I have concerns about AMA's involvement with CPT and their role in keeping PCP's reimbursement low through specialty domination of the RVU committee.
Physicians will only have an effective voice in healthcare reform if a great majority of us can offer a sensible reform alternative, or say NO to a bad one. In 1948 when the British NHS was founded, the Labour minister responsible for making it happen, Aneurin Bevan haqd to negotiate with the BMA until he got a yes, since their opposition to the initial plan put it on hold for a year - unforunatelt US physicians are divided and will likely have the ultimate plan imposed on them. If it is uneconomic for physicians like me to stay in practice as a result then the US will face a dire physician shortage for those who cannot self pay.

I stopped my AMA member in the mid 1990's as I felt they weren't supporting and working toward the best interests of physicians and their patients. I'm appreciative of this forum which allows me to put my foot in the door and express my opinions even if it is just a drop of water in a vast ocean. By doing nothing, there is no hope.

The AMA has oposed virtually all legistration to reform health care. They stood strongly against Medicare & never supported the Primary Care Physicians in their pursuit of being adequately compensated for providing comprehensive care. They opposed Medicare & oppose Health Care Reform; especially single payer. American physicians who have relocated to Canada report a marked improvement in their quality of life in a land where physicians are still respected. The Obama Administration still believes that the AMA speaks for us - it does not! Physicians have been shut out of the process by this Administration. Who understands Health Care more-the practicing physicians or the Adminstrators of the AMA? It is important for this Admiinistration to hear our voice. 100,000 physicians absent from their practices for oone day, standing in front of the White House in their white coats!! What a powerful image!

"Truly we must hang together or most assuredly we will all hang separately" --Thomas Jefferson
Whether it is with the AMA or not, physicians have continued to in-fight about "who speaks for us best" while the practice of medicine has been increasingly turned over to the government and midlevels. I will keep my opinions on the AMA close to the vest, however, the brave new world of medicine is upon us and we are griping about what is being said by the only voice invited to the table. Perhaps a better approach is becoming one of the voices within the AMA and changing both policy and the elected folks who purport to represent us? Just a thought...

It is clear that medicine is under attack by the government. The annual scam of the AMA claiming credit for getting us a small Medicare increase which we then find is actually, on the whole, another cut has to end. I'm sure the scheduled Medicare cut of over 20% will be averted but we will in reality get a cut disguised as a raise again. If the government really wants to reduce costs, they could without hurting patients, reduce our costs by removing some of the unwieldy burdens they place on us such as CLIA, HIPPA, Stark, etc. Coding to the highest specifity is done for no beneift but adds costs and risks for denial (for example, if acute MI's are payable, why require coding the site of infarction except to add burden and potential for denial). So they squeeze us both ways, reduce our reimbursements while costs rise and then add unfunded mandates to further increase costs. This MUST stop. At some point, physicians must say "no." There will be accelerated retirements, restrictions of practices, etc. Already, in some communities, physicians are not available outside of the office and patients with emergencies are forced to see doctors who don't know them and thus perform duplicative studies, etc. This increases costs to the system. Ultimately, the best way to save medicine would be for us to unite to say "NO!" sooner.

Unfortunately, the AMA has the bully pulpit. I have yet to see anything the AMA has done to promote the maintainance or to further quality health care delivery under the terms of a free market. It is my belief that the AMA has actually endorsed the subjugation of physicians. The Texas Medical Association has been quite effective in representing Texas physicians in Austin, but we need effective represention in Washington. It does not come from the AMA. How can we establish an alternative effective organization to represent us?

I agree with your analysis. Can you create a poll from your membership asking questions that will help us create an e-medical voice for our representatives and president to hear?

i am a heavy participant in my state medical society. the ama delegates state it takes 20 years to become influential in the ama .ie stale, old, male. i believe the coding business keeps the ama powerful and wealthy. how can there only be five types of new or established office visits. in my experience there are hundreds. the coding books are internally inconsistant and the insurance companies use this to cheat doctors. the whole system needs to be rethought. billing like lawyers might work(by the minute-client present or not).

Sermo is definitely not a substitute for AMA. Dan's letter is against AMA, but doesn't offer any alternative. Physicians do need a strong representation in Washington and on a local level especially now, when dramatic changes to health care are proposed. But no organization will be able to speak for all of us, because on many issues our interests differ. For example, PCPs have different interests from specialists etc. All of us will most likely loose under single payer system, but AMA is very strongly opposed to it, so on that issue it represents all physicians and should be supported. By the way I am not a member.

Nope, not a member of an AMA. But what I am sensing is a greater voice coming from Sermo. The AMA does not represent nor care about my specialty. Nor should it - it is a general organization devoted to its origins of FP and IM. The revenue generating it makes ensures that it is no better than any other corporate entity in my eyes.

It has always been clear and obvious that the AMA does not work towards the interests of its members, physicians. In fact, it's policies have at times been hurtful to physicians. One example was when the AMA, about 9 or 10 years back, led the crusade to urge pharmaceutical companies to stop giving physicians (who take prescription meds) any professional samples. This was because of the belief that if you are a physician who takes, say, an antihypertensive med, and you get this as a sample from a drug rep, you will be biased by this, and over-prescribe that drug. In other words, the AMA assumed that its members are gullable and dishonest, and can not be trusted to act and prescribe responsibly. That's when I stopped paying dues!!

We all have experience from within professional societies, and other large group organizations (churches, political parties etc.) which purpose to be "representative" of their members on the public stage. At the outset the intention is to gain and represent the "consensus" or majority view of the membership, broadly, in the market place of ideas. The purpose is the purpose of rhetoric or classical argumentation, being to move the opinion of the wider population toward concert with your own (or your membership). A voice that actually is the voice of a larger number carries weight even if it may give a wrong answer. It is still the single word of the many.
Because their statements carry weight the organization develops commercial value. Now many, both small and big (but especially those who lack the broader support needed for their cause to gain traction) seek first to add their voice to the organizations. Should these parties gain access their cause has the ear of the organization. Without a scrupulous, writen foundation, built in checks and balances accounting for the positions of the key structural groups who formed the original, and some form of authoritative executive power to deal with variation from these standards, the form of the original is gradually lost to voice and purposes of these "add-ins". Frequently this new voice is motivated by monetary gain, but, as with the current AMA, political power merely to survive becomes the goal that leads to the making of a "traitor" organization who no longer is committed to its founder/members purposes.
SERMO could go either way without vigilance

I've not sent them a check in almost 10 years - ever since the HillaryCare debacle - yet they still faithfully mail the journal to me. I guess they still count me as a "member" but I would never say that they speak for me.

I have been an AMA member for years and I am still proud to belong. However, I am frustrated with the focus of the AMA upon central government solutions rather than local "delivery" solutions. However, I do not belive this focus is unique to the AMA. Physicians just do not "come together" locally and enlist the support of their community leaders to lauch meaningful reform. I do wish AMA would spend more time focusing on this issue.

Below, I have pasted the links to three OP-ED articles on health reform (two by myself and one by another physician) that urge we focus locally. One is a satire that lampoons a single payer approach. They illustrate my frustration with the current focus.

Sermo Doc

Sermo Doc

Sermo Doc

Jim Felsen, MD
Charleston, WV

Who is going to ask how primary care offices stay open when most are already opertaing in the red every month and now the govt will want us to "sacrifice" and work for minimum wage so their new SuperMedicare budget stays balanced? Not the AMA who sold primary care out with original RVU/CPT "you only get paid for taking something out or putting something in, not for thinking and prescribing" system.

As an osteopathic physician, the AMA does not truly represent our profession, but I do believe that it represents an important voice for a large number of physicians, including myself, on multiple issues,

I don't know if and or by how much Daniel Palestrant, MD, Founder & CEO, Sermo, Inc. benefits financially or otherwise, by being the CEO of Sermo.

Or if increased physician membership in Sermo can be leveraged by Dr. Palestrant to increase Sermo revenue.

It would seem to me, it is an inherent conflict of interest, for Dr. Palestrant to write a editorial stating that the AMA is the biggest risk to physicians and that physicians need to turn away from the AMA and instead turn to Sermo to represent them.

I have seen the "reality" of AMA and its' membership erode greatly over the past 30 years. The organization is a lobby unto itself and certainly has never defended the physicians out in the real world of practice. When we saw the erosion of doctor - patient fee for service 20 years ago, the AMA did absolutely nothing to defend our turf. We would have been better off to form a union and fight the govenrnment over its legitimacy!
I salute Sermo for sending out this Reality Check!

he AMA by its very nature speaks for the entire "house of medicine" and by doing so has not represented the concerns and issues important to primary care physicians as forcefully and effectively as it should. That is why I feel that the ACP speaks on my professional behalf in regards to my practice of medicine much better than the AMA. I support the AMA and its general principles and will continue to do so but feel it does not adequately represent me as a general internist.

I agree that the AMA does not represent me accurately, but I don't think any single group does. Neither does my political party. Or my church. And my specialty society is way far from where I stand. I belong to the AMA because it is the largest physician constituency, even with a shrinking membership. It still has the largest voice, even if its voice is less and less my voice. Unfortunately a unified physician voice will never be heard. Just read the comments in this queue, they range from left to right. We couldn't find unanimity even on this comment board.
That said, the greatest threat to physicians (and to patients) is threat of loss of autonomy. It began over 20 years ago when some of us began voluntarily to accept discounted insurance payments as payments in full and submitting the insurance forms for the patients. The feds saw this and then forced us to submit all Medicare forms. Then they essentially forbade us from billing patients directly. Ironically this also prevents the patient from independently contracting with physicians, but no one seems to care about that. Anyone who thinks the "public option" will not further that loss of physician autonomy is indeed blind. And so presently the greatest policy threat to physicians (and to patients) is President Obama's intention to eventually nationalize our profession. When that happens we truly will be tradesmen only, having lost all professional autonomy and having lost any voice for ourselves or for our patients.

Did anyone else notice that during President Obama's prime time appearance on ABC to discuss healthcare in front of a live TV audience that Keith Obermans, President of the AMA was seated directly next to Ron Williams, the CEO of Aetna Healthcare? With 160 people in attendance from all areas of healthcare, doesn't that seem like a STRANGE coincidence? If you were representing the entire physician community (as the AMA still believes it does) wouldn't this be the LAST place you'd want to sit? And what does that tell us about the relationship between the AMA and the insurance carriers in this country? Could this explain why the AMA has been invisible while the managed care industry has virtually performed a corporate takeover of our medical practices? Hmmm......

I dropped my AMA membership over 10 years ago after realizing that the only discernible activity of the AMA on my behalf was their continual attempts to sell me insurance.

I do believe the AMA is changing to reflect a younger workforce and is attempting to balance the Specialty Societies vs. primary care.

I wonder what agenda Sermo has---yes, the AMA has 85% of its revenue from non-dues. It sells various periodicals, CPT coding materials, educational materials, and houses the physician database (which physicians can opt out of). Your point is????

How does Sermo get it's revenue?

In full disclosure, I have been a delegate to the AMA for 5 years. It's not perfect, but I do believe that they are moving in the right direction. They are a truly democratic organization. Instead of bemoaning the AMA (as I once did) I felt the best way for creating change was to get involved and attempt to make the AMA a better place rather than spew hatred and discontent on the internet.

If Sermo wants to create their own organized medical group so be it. I would bet they discover some of the same problems that face the AMA.

ROVSPA, that is the typical response of criticism of those who "are not involved". As a surgeon, you should understand that it is the rare working physician that has the time or extra energy to do what you say. And, it is becoming even tougher as all of us must work more hours and do more cases while our income is shrinking.

Yes, it's true that it's easy to criticize and tough to become involved to effect real change. In the past, physicians who became members of organizations like the AMA, did so freely, trusting that their colleagues represented their interests and beliefs. They paid their dues as their only mode of support because they were too busy with the day to day realities of practice to "get involved".

Something happens to people who become fully enmeshed in these organizations. It's similar in all of politics. Other strong influences come to bear and compromises are rationalized. The original purposes of the organization begin to erode, and soon the rank and file members begin to realize that what they originally joined doesn't exist or represent their interests anymore.

Yes, it's easy to blame the individuals who don't "get involved". But, it has been the leadership of The AMA and other medical organizations who have compromised, morphed into collegial political beings, and frittered away our identity and autonomy over the years. They deserve to lose membership. We vote with our checkbooks. And you can see that the Nation's physicians are voting no.

As a family of physicians, we left the AMA, along with many of our friends and colleagues, 20 years ago when they rolled over to the demands of the government. It is increasingly controlled by the only demographic it has left--the far liberals, who are, apparently, willing to roll over again.

I applaud your efforts. I believe you will have strong support from the disenfranchised medical community.

I hate to admit my ignorance and lack of involvement, but how exactly has the AMA failed us? Aggie78 has helpful information, defending AMA, and it would be good to hear concrete examples from Sermo administration supporting their lack of confidence in this organization

I did not quit the AMA for any of these thoughtful reasons. I quit because a. Too expensive and b. I am tired of getting JAMAs every week. Although I do read the art history page...

Having never been a member I would be classified as lacking the courage to participate in the work to change the organization. In defense of my apathy might be the recognition that it would jeapordize my mental health. I have had no desire from the beginning to be frustrated although in the beginning I did make my observations known about the AMA. In that distant era it was obvious to me that the organization was not representing physicians in private practice and I suggested openly that we needed a union. Many thought that I was in need of mental health support and did not fail to let me know. It became obvious that my efforts were to be of no avail. So in 1967 I made the decision to go it alone. This is a decision I have not regreted. My opinion of the AMA has not changed. They have been the hand-maiden of politicos and insurance industry for many a decade by their failure to educate the public. Now the politicians will own the health care industry, using it as a jobs program and worse. Physicians will be disillusioned and the quality of their care will suffer. It is all as predictable as the sun rising and setting.
I have just had a small taste of the future (socialized medicine) with a grandchild who was inadequately cared for at a military hospital. So I must say that I wish the best to all of the future indentured servants in medicine and the patients they treat.

Thankyou. The AMA has never represented my interests.
During my practicing career,its only been a reactionary organization,with its own self preservation at the center. They are even failing at that.

Physicians long ago ceded control of their practices to the government and the insurance companies. Layer after layer of regulations were imposed that gradually eroded any semblance of a profession. I'm on the faculty of a medical school where the dean's office is populated by more non-physicians than physicians, and I'm talking about people who plan curriculum for medical students.

In most U.S. medical schools, the tenured faculty is increasingly likely to be basic science PhDs rather than MDs. Imagine a law school where the majority of tenured faculty were not real lawyers. It's absurd, but it's all part of the same picture: physicians have done a really poor job of protecting not just their incomes, but their whole profession, beginning at the medical school level. We've allowed non-physicians to gradually replace us as teachers, as practitioners, and as employers.

I think that the problem with healthcare in this country is one of integrity (or lack of it). Everybody has been consumed by greed. Malpractice lawyers, big pharma, politicians, plaintiffs, and even physicians have the disease.
The AMA or any other lobbying group has become a manifestation of this greed (in my opinion). The debate is no longer about health but rather about how to divide the money pie. Who will get paid what!
As Americans we enjoy incredible luxuries and excesses of everything. As physicians we are not impoverished but we seem to be complaining a lot these days about money (or the lack of it). What difference does it make if some actor who plays an ER MD gets paid a lot of money? Why should it matter so much to a physician who chose this profession to ease human suffering?
I am not a member of the AMA and I do not support the idea of paying lobbyists to sway politicians. That is part of what has got us into this mess in the first place.

Whether you like and believe in the AMA is of no consequence in the present state of the country. When the president or the congress needs to speak with and/or deal with doctors, it is the AMA that is on the top of the list. Therefore, should we not work within the organization to upgrade its voice, so it speaks for more of us?

never joined & will never join AMA
only thing I get from AMA is junk mail scaring me into getting various insurances.
sometime in future, I intend to sue AMA for selling my prescription information to pharma
and perhaps for wasting my time by forcing CPT codes

good for you Dan! That's really impressive of you to take such a stand against an age old organization like the AMA in a forum such as this.
Your thoughts on this are spot on and encompass the general feeling of myself and many of the physicians I know. Also it is worth mentioning that the AOA is just as bad if not worse that the AMA. being a D.O. I am familiar with this and they also I believe are having trouble gaining members ( although I have no stats to prove this).
We may as well out them too and throw them under the bus along with the AMA since they are also incompetent in representing physicians needs in the country.
The question now is what do we do about all this and how can we manage to coordinate and have our voices be heard.

comments about doing what is right for patients no just the doctors shows the problem with the current mind set. we need to come to gether and stand up for ourselves. goals should be gov and ins get the hell out of our offices. quit making us buy icd manuels for the ever changing codes. let us set prices and allow balance billing for all ins and mcr contracts as a fact of law. we will then have to have price transparency so patients can see what they will have to pay to see any one physician. insurance reimbursement should be betweent he patient and the insurance company and we should not be a part of the equation. the ama has not represented us well for years and is way to involved in gov ass kissing and everything but physicians. asking us to join and fix it would be like asking someone in a life raft that had just abandoned the titanic to get back on board and try to save the sinking ship. I for one am not going to try to save something that will likely be the death of my profession.

Well put. Ready to move forward with Sermo.

The AMA gets listened to. This might make you unhappy, but it certainly is not going to change. I mean, the President just addressed them. If you think that the opinion of physicians is important in the healthcare debate, then it is likely that you will best serve that belief by active and continuing participation in the AMA. I am not a member, but my lack of membership has had the exact same effect as my signing of the Sermo Open letter, which is zero. The only thing I've ever done as a physician which had any appreciable impact is strike, and I paid a huge personal toll professionally, financially, and personally.

Personally, I don't think the public and particularly the legislators give a crap what we think, and why should they when the Harvard ivy league types routinely publish research showing that we are really just a buch of stupid whores who would gladly sacrifice our patients or even actively kill them ourselves for a nice dinner or a really good pen? The AMSA just gave my school a 'D' rating because of its association with Pharma, despite a fifteen year history of US News&World Report annual ranking in the top 10 nationwide in primary care education.

Doctors social worth = 0, the lawyers and MBAs run the show, and we are the same folks stupid enough to crack the books in our science undergrad curriculums while they were all out joining frats and partying. They all hate us, but only slightly more than we hate ourselves, as evidence by the editorials in JAMA/NEJM and the actions of our professional societies. Our re-imbursement will continue to fall if not plummet, our paperwork and harrasement in the name of 'quality' at the hands of the clip-board nursies and beancounters will continue to expand exponentially, and our overhead will continue to grow while the ATLA grows fat on our carcasses, while we still struggle to breath. Abandon hope, all ye who enter here.......

The AMA has been corrupt since
it defeated Frances Perkins'
first proposals for a national
health care in 1934.
Now the AMA is irrelevant.
Opposition to single payer
reforms has tolled it death-knell.

I am sick and tired of receiving mailings from the AMA for advertising life insurance, auto insurance, credit cards....

With all due respect to my specialist colleagues/friends, my biggest concern and that of many primary care physicians with the AMA is its tremendous bias towards the reimbursement concerns of proceduralists, specifically at the level of the RBRVS Update committee. This has tipped the scale too much away from simpler cost effective measures (e.g. physical therapy) and towards expensive procedural care pathways (e.g. spine surgery). These decisions made by this committee I believe is the inconvenient truth that has been central in driving health care costs beyond an unsustainable level. The current backlash against our profession has been fueled by the collective body and leadership at the AMA, especially those in the RBRVS update committee.

I have not been a member for some time now. I decided long ago that they do not speak for me on most issues... Yet, organization and a voice....are two things that are needed. The problem is "unity". I feel we would be hard pressed to come up with real unity on issues. Perhaps this is throwing in the towel too soon. Perhaps on some mainline issues we could find a grand agreement among physicians. Guess it's worth a try.

Dr. Motto, an elected physician leader, has advocated a constructive approach to reshaping the AMA into the organization that it surely was intended to be - representative of America's physicians.....I sadly agree that it is not (having recently resigned as an alternate AMA delegate from my State).....but I chose the easy and cowardly course rather than stick with it and attempt change from within.....maybe I'm too old or too cynical but the AMA is rather firmly entrenched and as currently constituted can't possibly represent all America's physicians - it needs to become an organization of organizations embracing the American Colleges and specialty societies......good luck - I've tried to fight the good fight for many years and it's time for a younger generation to assume leadership.....

We have the AMA to thank for the CPT codes. I believe they actually hold copyright on them or some such. Thus, the skewed valuation of services and focus on
a) procedures
b) specialists
c) disregard for innovation, esp in the realm of communications (and record keeping.)
d) bean counting as a means to assess what transpires in an encounter between patient/physician.
I think some of this is from the perspective of inpatient care, or "Acute Disease" care, rather than the concept of ongoing, continuity care. It's the "talking head" version of medicine.

I hate to say this, but look at media portrayals of physicians - inpatient all (we wont talk about the validity of the medicine), esp the likes of House, Grey's Anatomy, older ones such as ER, Chicago Hope, St Elsewhere, even Ben Casey. The only media portrayals of outpatient care (in some aspect) I can think of are Marcus Welby and, well sort of, Northern Exposure. .... (Oh, I've not seen this sill Private Practice, but I guess that is one version of outpatient care.)

By the way, the problem with the letter etc, is ....
Sermo is much like Twitter - by the noise you gather a "gist", a sense of the population, but not any one specific sentence/sentiment that will accurate represent the whole. (This is the one time that an editor might be useful.)

i was never a member of AMA. what a waste of hard earned money to pay their membership & dues!
glad, i stop being member, better late then never!
all they want us to purchase disability & other products but never send questionary to find issues, problems, concerns or difficulties to practise! what a joke?

thanks being sermo, but a caution, we do not get drag into politics with AMA or elsewhere?
let's stay focus on primary agenda.

yes, i am struggling to implement EMR for my solo practise. i have no clue what to do at this time & eprescribing. what is wrong with my pen? it is original. old is gold, standard.

or, it is my time for
EMR : stand for elective medical retirement or early medical retirement.
how painful, Mr. OBAMA , president.

At the recent press conference in which the President of the AMA attended, why was there no mention of the effect medical malpractice has on raising the costs of healthcare via defensive medicine? The AMA has been a stout supporter of tort reform and yet no mention at such a perfect forum!

When President Obama speaks of all "the responsibilities" insurers, pharma, and patients will need to muster why does he not speak of the trial lawyers "shared" responsibility?

Perhaps we need to scrutinize campaign finance contributions a little bit better.

The AMA has shown itself to be nothing more than the insurance lobby's and the pharmaceutical industry lobby's bitch. It's no wonder that the American people are losing faith with us and why the Obama Administration dismisses us as major players in the healthcare debate. The AMA has sold our soul.

agreed! well stated!

I have stated for many years that the AMA does not represent us. As an educator, I have discouraged students and residents from joining the AMA.

I agree. I do not believe the AMA accurately reflects the sentiments of the practicing US physician. As a fellow of the American College of Surgeons as well I believe they too are not representing surgeon's interest very well either.

I am sorry to see the CEO of Sermo attempting to position himself as a political spokesman for physicians. I hoped that Sermo would be an open forum for education and communication on many issues, without taking sides as a body itself.

That means that open letters, forums for and against new national policies etc, could all be part of the mix, but without interference from the management of Sermo.

I agree with some of the other correspondents that they have been bullied and browbeaten by other members when expressing views that are more progressive or left-leaning (eg the recent open letter).
I sense a not-so-subtle approval of such views, if not the tactics, of those right-leaning attitudes in the management of Sermo. It leaves me uncomfortable using Sermo as an expression of physician sentiment, when it may be manipulated rather than consensual.

In short, I do not think Sermo should attempt to position itself as a spokesman for physicians in a misguided goal of replacing the AMA, whatever its failings. I do not belong to the AMA and never have, but I will not sign on to Sermo for guidance in its place.

Any organization that's composed of members that can clap for Mr. Obama's and Mr. McDermott's health care plan is obvoiously not going to have my vote. The biggest problem with the AMA is that it is composed of physicians who share the disturbing sentiments of some of our Sermo members such as IDologue, who considers Sermo to be part of the rabid right-wing conspiracy, to Finacochea's openly bigoted comment that the AMA is "pale, male and stale". (Gosh, I'd love to see how the public would react to having somebody say that the administration is full of "dark, full of bark and off the mark". . . it's equally insulting and foolish, nor does it contribute anything useful to the discussion - so much for the right wing having a monopoly on "hate".) In short, too many Americans and American physicians are succumbing to the sirens that are drawing us to socialization. As many have said in the past, you can have it good, free or fast - pick two. America wants all three, and it's simply not going to get it.

Not only can we not afford it as a country, but the number of physicians who will be willing to work under the future plan is going to drop precipitously. The AMA has simply not addressed these issues, nor has any other organization of physicians that I'm aware of.

What we are missing most of all in this entire debate is the need for government money to be linked to responsibility on the part of the patient, and for physicians to finally admit to how much of what we order and spend is to cover ourselves against a lawsuit. I think most practicing docs know by experience that most of the money in the health care industry is spent on the care of people in the last 6 months of life, to order tests "just to be sure we haven't missed something. . . (that the jury would find interesting)", and for the repeat offenders in the ER's. That's where the work of paring down the cost of health care needs to start, but it won't as it's too politically incorrect to address these issues.

I almost needed CPR when Mr. McDermott stated that Medicare/Medicaid is one of the most efficient and administratively lean systems in the country. As efficient and user friendly as, say, the post office? Once The System is in place, I think we'll all find that our care experience will be similar to that of obtaining a driver's license: Time-intensive, overpopulated, dirty, unfriendly and not very good overall.

If Sermo is our only voice for sanity, then so be it. But I pray that the physicians in our ranks can see the writing on the wall for what is to be in a socialized system, not just for medicine but for what will happen if we completely divorce freedom from responsibility.

5 star post.

I agree. The AMA doesn't represent the true feelings of physicians.

Doctors for America more accurately represents me than the AMA.

Sermo Doc

I fully agree with Dr. Palestrant's perspective on this. Have come to conclude that AMA has other agendas that do not serve the interests of physicians or patients based on personal observations over the last several years.

For those who think Sermo is too "small" or "inconsequential" to make a difference, so what? Grassroots movements have to start somewhere, might as well add Sermo's voice about the elephant that's been sitting in our living room for 50 years. Sermo isn't the only voice, either, it's all over the news & web.

We have more to lose by saying NOTHING--as evidenced by the current state of healthcare and our inconsequential role in it. More voices, more outlets, more dialogue = GOOD.

Stardoc,
I am glad that Sermo is providing a forum for physicians around the country. Most certainly the AMA is not providing the leadership required. The older, more established organizations such as the AMA have spent too much time in bed with the politicians who are ruining the profession. They owe them too many poker chips to make the hard decisions and take a hard line approach to the problems that are confronting us.

One cannot lead by consensus.

I strongly doubt the AMA can be changed from within. It is too big and too political.

However, the AAPS has been serving physicians well, though they lack numbers.

www.aapsonline.org

And yes, thanks to the AMA for the whole E & M disaster.

The AMA doesn't speak for me as effectively as I'd like (perhaps 30%) but right now it is one of the few organizations congress will listen to. Better to have someone on my side than none.
I' ve been angry with the AMA since it got us into the CPT mess decades age. Everyone else gets paid for their time. Physicians get paid for their doccumentation as it relates to the CPT. I just love spending my evenings doing paperwork to justify being paid for my services.
But right now we're stuck.
I think the most effective way to combat the creation of an unknown/ unproven national system that could destroy medicine as we know it is to tell the public how we suspect a global overhaul might change their lives.

JMK

I'm AMA member-- why? Information. Connection.
Politically, is there any other force besides my specialty societies?
Disagree greatly with many things AMA does.

I want a hardball organization representing me.
I want a union style hard negotiating panel.

Agree E&M guidelines are an AMA disaster.

I will drop the AMA in a minute if I can get someone else to be a better job.
While Sermoans love to gripe about AMA, they don't seem to have anything better.

When you go to war you have to use the generals who you have.

jwwebb, I concur. It has been particularly troubling to me that the ACS has been drawn into the PAC game. As a group of professionals we should stand up and say that this is a corrupt way to do business and make policy and that we will not participate. As a national group of professionals, if we just said no to Medicare, Medicaid and ALL insurance plans and told the patients that the policies belong to them...you deal with it, people might begin to wake up to this incredible scam that has been perpetrated on all of us.

I think that it dishonors us as a profession to get into bed with the politicians, lobbyists and attorneys who have sought to dismiss us and destroy us. They need us...desperately. Therein lies our power, as trained medical professionals who can do what no one else on earth can do for our fellow man...save lives, care for them when they are sick. We are not a commodity, we are not slaves to some government collective. We are highly trained and skilled professionals and should be proud to stand for just that!

One step that AMA or any organization that is going to have an impact is to develop a media campaign. We are divided and show that by X MD organization talking about the AMA and Y organization 'Developing" - You can start with commericals talking about what a great job the government had done with businesses like the post office and fanny mae and freddie mac. You can also talk about the CURRENT governement health care that includes Medicare, Medicaid and the vets. I am sure there is more than enough material to make person not want this.

Another avenue is to pair up with the hospitals and the insurance agencies. If that Triad comes together and pools their resources, then they would be unstoppable.

The AMA does speak for doctors; specifically, those doctors who are employed by the AMA.

Do you think the Attorney's of America would tolerate being controlled by the US Government? The AMA has no gonads.

The AMA and my state medical society are self-serving bureaucracies. I have recently terminated all of my memberships. Unfortunately, because of that, I can no longer belong to my wonderful county medical society.

I guess Sermo will have to suffice.

If all of Sermo joined AMA, we could fix it. Better to rehabilitate than start over. DP for AMA prez.

I have a great fear the AMA will again sell the doctors down the river in the middle of the night in compromise for some payment, like they did with CPT for E&M.

The level of apathy among physicians has never been greater... 75% of respondents to this Sermo Poll are not AMA members? How many of these non-AMA members are routinely active in their state medical society, state specialty society, or national specialty society? Probably even fewer. This remarkable amount of apathy is why physicians have lost so much ground in the past, and has generated remarkable fragmentation of physicians in our country. We can thank "educators" such as mitchch above for undermining confidence in the collaborative efforts of the AMA on a philosophical level.

Even if you disagree with AMA, the public, our congress, and the president of our country still care what the AMA has to say about healthcare. I wonder if the physicians who so strongly oppose the AMA will do when healthcare reform transforms our country, for better or worse, will they up and leave, or opt out completely? We need to have some method of unifying our voice, across states, and across specialties, while recognizing that this voice may not always speak to our highly specific individual needs.

There is no easy solution for any of our problems in this country, but taking an apathetic approach and divesting from having responsibility for solving them is not a method that will every accomplish anything. Like they say about the lottery, you can't win if you don't play.

Recently I watched an interview on CNBC with a stock market investor who specializes in short sales. He stated that the "healthcare industry" has double the profit margin of other industries, an imbalance which is not sustainable, so shorting is a "no brainer."

Robert Reich wrote that in the present congress with the present lobying economics, a single payor program is not even an option. One system that can reduce costs of goods and services is a large enough pool of insured that can negotiate or dictate terms with suppliers. As I think about it, Obama is right in that we will continue to have multiple systems, e.g. the Veterans Administration, employment based programs such as Kaiser Permanente, County clinics, private practice, etc. I thought about Hawaii which has Kaiser as one choice and a public system as another choice, whether or not one is employed. In contrast to Hawaii's system, in other states the "silo" system means multiple separate coverage groups, each with separate budgets. One result for mentally ill is that cost savings for health budget by limiting ready (drop in) access to care and benefits increases incarceration which means higher costs for the jail budgets. The overall cost (and suffering) of psychiatric and other medical care is lower with more prompt evaluation and treatment.

I was fully trained in Pediatrics and then did another residency in General Psychiatry with additional year and a half of residency in Child Psychiatry.I worked for many years in solo private drop in practice in my office. Probably 90% of the patients had Schizophrenic Disorder. One patient, probably Bipolar, nicknamed it "The Schizophrenic Drop In Clinic" which was aliterative as well as an accurate description. Patients were seen 5 days a week as often as they and I wished without regard to income. I gave large quantities of sample medications to the ones who did not yet have Medicaid and wrote psychiatric evaluations and advocated for them to get disability benefits. The frequent doctor/patient contact made me the logical trusted source for these patients as their primary physician. However, I only treated minor non psychiatric conditions and referred every patient to some other source of general medical care, e.g. for control of diabetes, hypertension etc. However, waiting times grew longer and longer, especially for those with no insurance. The sicker ones had trouble making and keeping appointments which are almost always on week days and during the day, so I offered night drop in hours on week nights. Those who lost their antipsychotic medications could get more from my office. I have to choose to be on the mailing lists either in Psychiatry or General Medicine but cannot choose both in order to get free journals and invitations for free CME. My self concept of working as "Psychiatric Primary Care" or "Primary Care Psychiatry" is no longer a choice in the menu. Now that I am retirement age, I wonder if that means being excluded from Sermo, though not from AMA mailing list.

The notion of having patients "consumers" choose coverage options is not generally appropriate for the population I treated, and I wonder how realistic it is to expect young healthy patients, for example, to budget for the possibility of becoming disabled for many years and unemployed e.g. with Schizophrenia. It seems to me that whenever possible people, especially when ill, opt for convenience, as when getting prescriptions filled.

One of my younger teachers gave my cohort of residents in Child Psychiatry a 16 item questionnaire on attitudes about medical care. The results were presented on two axes. I recall that I expected to score as a right wing conservative. To my surprise, my score showed me as left wing Communist! I had to admit that I viewed medical care as something best prepaid, like the sidewalks, accessible to all, including unemployed homeless mentally ill.

Bold, Dan.

<<There can be no healthcare reforms that have any chance of succeeding without buy-in from physicians.>>

Would be nice if that were true. I suspect most physicians (not all) will stand up on their hind legs, turn around, lay down, roll over, play dead, then bark upon command to earn their treat. Head in the general direction of the treat drawer, and my dau's dog does all those things in one continuous motion without being "asked."

That is, after all, what history tells us (I think). When was the last successful physician revolt?

Even though there is good intent, it may be a premature posting without much ground work.

I am a member of both - Sermo and AMA
Hopefulness: frustration ratio
- with Sermo 60:40
- with AMA 55:45

I share many of the feelings of hopelessness about AMA as stated above -

Just two area of frustration/conflict with Sermo -
1. Dead people are still counted as members.
2. Non physicians are employed to executive positions where physicians could have done a better job - functional development is on snail pace.

" >85% of AMA's 282 million in revenue comes from sources othe than membership dues" per Dan Palestrant's e-mail.
My question is, who are those sources/Doners?

Talk is cheap folks-
What are you going to do beyond sitting in front of your computer and complaining?
The AMA has NEVER represented my interests, so this is not a news flash for me.
Back to the grassroots for me for some sho nuff community organizing.

I joined the AMA in Medical School like most of my colleagues (as we thought we "had" to). I attended an annual meeting in Chicago and was impressed with the inefficiency and bureaucracy. I also joined the County and State Medical Societies and saw how difficult it was to become a delegate from these organizations to the AMA (someone basically needed to die...people "waited in line" for a spot). I liked the County and State societies though.

To this day I do not understand the relationship between the AMA and the CPT codes. So, the byzantine system by which we code office visits, which is both inaccurate and confusing is published by the AMA at a tremendous profit?? I guess I always thought that if actual Doctors were in any way responsible for our coding and billing systems, they would be logical, simple to use and reasonably priced. What a scam.

While I whole-heartedly agree with the posters who state that it is easier to change an organization from the inside, that would involve paying ridiculously high dues and dealing with the old boys network. While I was still a med student, some of my classmates wrote a resolution that made it into the main body of the AMA for a vote. I got to witness that process and it was painful. I do not have the time or the energy to go through that.

I do not know what the alternative is, but we as Physicians need to find one. The AMA does not represent the majority of Physicians. I would join an organization that did not have conflict of interest issues and would represent Physician's best interests even if the cost was similar to the AMA.

As an aside, anyone out there familiar with the Sherman Anti-trust law and how it relates to Physician's inability to collectively bargain?? I would love to discuss this (perhaps on a separate post).

AMA represents its members, who are physicians. It is the largest organized physicians in the country. If you do not agree with AMA policies, join the organization. What part of democracy do you not understand Dan?

It is unfortunate that the AMA leadership (Board, etc) is defined by membership in AMA organizations that involve commitment to the AMA political rigidity. Thus the leadership of the AMA no longer reflects the needs and opinions of the vast number of American physicians. Physicians who have not "come up through the ranks" and do not reflect AMA conservatism are not welcome in their leadership. Furthermore, the affiliations of the AMA (insurance companies, pharmaceutical companies, etc) have unfortunately defined some of the organizations fiscal policies.
The AMA could begin a serious new direction by imaginative and realistic recommendations concerning health care in the U.S., by offering real cooperation to President Obama and his administration, by opening up its leadership ranks to imaginative physicians who think in terms of societal needs, and by severing inappropriate relationships to insurances companies, pharmaceutical companies, etc.

well Daniel, you have certainly stepped into the arena. everything that has been written here is true and indisputable. therefore it is easy to see that we have become mired down in stuff. what is required is a moment of silence, a pause for a deep breath. Then action on multiple levels; local, state, national. i think individual physicians of good will need to pick an area of interest and pursue that with the selfless goal of improving THAT particular issue. The rest will come out in the wash. might i timidly point out that while i read an emphasis on US here, and I get it, the profession and the politics requires an emphasis on our patients. Given the current state of the economy, something's gotta give! while i have been unimpressed with the AMA, i do believe the organization, for the most part, has acted in our best interest. That said, I am not a member, and quite frankly have watched concessions that were inartful at best. but as many here have said, it is easy to criticize. It is long time, that each of us to ignore the noise and get involved. and in that involvement, understand that the infighting and divisions work against us. everything cuts two ways.
regards,
pumamd

Obama said that he believes that single payer is the best alternative but that it is not politically feasible. Single payer is not politically feasible because of misconceptions on the part of the public that are fueled by special interests. The medical profession needs to counter the misconceptions so that Obama can do what he believes is right solution to the health care mess -- enact single payer. The AMA is not helpful and we physicians must reject the AMA. Hopefully Sermo can help us get the correct message across.

It appears AMA as a solid organization that is supposed to be
the voice of majority of practicing physicians ,has no longer
the clout to efffectivly oppose the beurocracts in Washington !!
President of AMA needs to speak against Universal Health Care
in no uncertain terms and be visible on every media possible.

Question #4 in this posting's poll is interesting: "Do you know that according to the AMA's 2008 Annual Report, more than 85% of their $282 Million in revenues comes from sources other than membership dues?"

Assuming what is posted on Wikipedia is true,
Sermo Doc
then, as of 2004-2005, there were approximately 244,569 AMA members in total, including about 48,868 medical students, and 24,069 residents. Let's tally-up the total revenues from membership dues:
171,632 physicians (244,569-48,868-24,069) x $306.25 (unweighted average annual dues for military, first year, second year, and other docs; most likely an underestimate of true, weighted average dues) = $52,562,300.
48,868 medical students x $17 (assuming all had a 4-year membership, the least costly option) = $830,756.
24,069 residents x $40 (assuming all had a 4-year membership, the least costly option) = $962,760.

Grand total = $54.3 million, leaving only $227.7 million, or 80.7% (i.e. less than, not more than 85%) coming from sources other than membership dues (unless my math is incorrect or membership numbers or dues have declined significantly since 2004-2005).

Dan,

I am appalled, offended, and frankly so angry with your comments that I will likely never come back to Sermo once this discussion in through. The AMA is still the single largest membership organization in medicine. Our voice has been fragmented because most physicians are joining their specialty societies rather than umbrella organizations such as the AMA. There are many reasons for this, the most significant of which is money. By becoming a member of the AMA, your state medical society, county medial society, and your specialty you can easily spend $2000+ per year on mememberships. Most physicians simply do not feel they can afford that much so clearly they join their specialty over the others where they can receive timely and clinically relevant information specific to their field of practice. In addition it is well know that people in my generation (gen X) generally are not "joiners". This has created problems for many different types of organizations both inside and outside of medicine including religious groups, community groups, etc.

Having an organization such as the AMA which can speak for all physicians is essential if physicians are going to have a voice in shaping the future of medicine. For too long we have stayed silent and been unwilling to speak up for ourselves and out patients. This is why our voice is not heard and not listened to by anybody. The government is about to take over the health care system to the detriment of patients and physicians. We need to stand strong and stand together. The AMA can serve as our mechanism.

I have been a member of the AMA for 11 years now - since starting medical school. The AMA has continued to evolve during that time to better represent the needs of its members. They have continued to give a bigger voice to students, residents, young physicians, and minority physicians in order to better represent the present and future face of medicine. However, the public still calls them an old, white men's club. This is simply not true. The public opinion is unwarranted in my mind. Dan, what is your specific issue with the AMA? As for their relationships with certain industries - the AMA like any organization makes certain partnerships to promote its mission as it should. There is no relationship with the insurance industry in any way, so I have no idea where you are getting that idea from. I find your point on that topic quite hypocritical due to the fact that Sermo has many industry relationships which in my opinion represent a conflict of interest and shape the content that you present.

As a young physician who has chosen to take an active role in organized medicine through various methods including involvement in the AMA, I look forward to this discussion and am happy to answer any questions that anybody may have about the AMA. I welcome the opportunity to dispel any myths about what I see as a great organization that physicians need.

I agree 100%! AMA is a bunch of traitors.
Physicians have to be more united outside of the AMA. I believe we should go on nationwide strike! We should stop the advent of communism in America. We should say strong no to Obama's Marxist experiments! We have no right to remain silent while Obama and his team of crooks stealing trillions of taxpayers money! To resist is our patriotic duty!

AMA stopped being relevant to average American physician many decades ago. I wonder what keeps that organization alive.

sfhunter-I agree
I have never responded on here before but do read the post. I am an AMA member and an alt Delgate from my state. I also am very active in my local society-Board Member and Legislative chair. Furthermore I am close to finishing my MMM degree and have had this discussion with several others.

Often the AMA does not represent my ideas, however, it does offer us some voice. This voice is getting softer as our numbers tumble. If we are becoming more as individual voices and small groups it is easier to disregard us totaly. I was told once by a memeber of Congress that we are a small group and donate little why should they care what we say. If the AMA diminishes we will have even less say.

Lastly to think the government has our best interest or even our patients best interest in mind is a bit naive. At the last AMA meeting there were several talks about one of the major ways the gov wants to have enough docs to cover everyone and be cheap is replacing us almost completely with nurse practioners. Drive the cost of our practice up through regulation and pay us significantly less and we will just quite and they will replace us with cheaper labor. The state licensing boards are already starting to offer doctor of nursing test which is just basically asking them to take step 3 and at the same time considering rather Draconian and pricey MOL criteria. While nurses are a very important member of the healthcare team I think a physician is too.

We really need to stand together in some organization in enough numbers to have a say. If it is not the AMA so be it but if we think it will just be a couple of individual docs swaying the government with their impassioned pleas I am not very confident.

I also realize that the majority of income from the AMA is not do to dues. It would be a poor business model to be funded completely in that way and would show even worse leadership if that was suggested. There have been several suggestions of not charging any dues. However, in the current economic climate that would also be a poor decision. I also would suspect if the AMA was not getting our prescribing info someone else would and that revenue gained may actively be used against us.

The AMA has often been unsuccesful in several of there campaigns. However, as I have seen in the local medical society often the greatest gains have been stoping very bad things from happening. These prevented calamities seldom get any press. Therefore, in summary, I warn against a rally against our only voice if a substitute is not readily available

I hate to say the same thing but ours is a lost cause. The sooner we realize that and move on the better. One definition of insanity is doing the same thing and expecting a different outcome. I have seen us physicians do the same thing for the past 15 years I have been in practice and it has only gotten worse. Face it, nobody really cares what we have to say, unified voice or not. No one is sympathetic to our plight because the public believes we are rich, greedy whiners. The only way they will listen is when no one is left practicing traditional insurance-based medicine. I for one, have left private practice neurology.

Junio -- Military medicine is NOT EXACTLY socialized medicine. Probably the biggest difference is that military physicians (after completing their initial obligation) have CHOICE. They also have accountability. These are missing elements in socialized medicine (for docs and patients). I spent 20 years as a Navy Pediatrician (17 of that in teaching hospitals, so perhaps my perspective is skewed) and did a lot of moonlighting in a large variety of civilian venues, and I must tell you that my military colleagues were among the cream of the crop (by and large) and always did well when exiting to civilian practices.
AMA -- I'm a DO and have never sent any $ to AMA; only on a few occasions to AOA -- mostly a function of being too far in debt from a late-in-life career entry w/ large family to justify the expense. I don't buy their insurance either. I can't see that I have missed any benefits.

Ben Kohn
Dermatologist Florida

Let us not bother to even waste time discussing the AMA!

What we need to do as all today is to come up with a vision for a future medical system that can work and reasonably address the majority of the most humble needs that people can see and identify in health care. If we are too selfish to seperate ourselves from our own individual interests we are no more worthy of being followed than all the others like the AMA, the Insurance industry and the Legal know it alls like our president and past president Bill Clinton.

I am still a member of the AMA, and a member of the Board of Trustees of the Maryland Medical Society (MedChi). I have said for a long time that the AMA has devolved from a doctors' organization to a public health organization. As a small state, we don't have a lot of clout, but they need to return to their roots as an organization FOR the doctors. The pharmaceutical and insurance industries are ALWAYS cognizant of the bottom line for their members, despite whatever rhetoric they espouse to the press and the Prez. The AMA has lost sight of this, which is why they are losing members.

Obama is going to nationalize Health Care soon - because he can. Rarely do you have one Party with solid control of the House, Senate and White House simultaneously. So, until mid-terms in 2010, Obama has a free hand and Democrats generally abhor the notion of free markets and competition (in all areas, not just Health Care).

Democratic Party operatives and all their friends and idiot nephews are going to be at the trough for excellent paying jobs for generations to come - all of them employed to watch over the expenditure of funds.

Best evidence practices, meant to educate Doctors, are going to be used for cost containment, rationing and mandated treatment protocols. Doctors are already referred to as Providers (like Nurses, physiotherapists, PA's, etc.).

Soon after National Health Care is implemented, payments to Doctors will no doubt be referred to by Politicians as the 'peoples' money' or 'taxpayers' dollars' and seek to restrict how much 'wealth' is transferred from the 'people' to whom it belongs to 'providers'. Two years after Universal coverage was introduced in Canada, Politicians jumped in to personally control how tax dollars were doled out to Doctors - no longer were fee schedules regarded as justified and reasonable payments for professional services - they were regarded as just another tax expenditure.

Elections have consequences and Doctors are going to be royally screwed as are 'large businesses' and banks and all their top employees.

This letter and its simplistic poll are appallingly ignorant.

I consider myself a progressive and never joined the AMA due to my understanding that they were just a very conservative bunch of old farts. When I heard the AMA came out against a single payer system, I was gratified by my decision. When I read the above, which confirmed my suspicions about a major conflict of interest, I was relieved I never gave them one red penny. For the same reasons our patients have become "consumers" or "clients", the idea of practicing medicine within a "business model" has turned always my turned stomach. Profiteering from medicine (and ultimately from patients) would seem to have been an institution in this country far before the advent of TV commercials for prescription medications.

The AMA doesn't speak for me, but neither does Sermo and its group of right-wing, anti-government complainers. But Dan has the nerve to state:

"In the best-case scenario, the AMA will shed its relationships with insurers and abandon tactics that take advantage of physicans to generate millions of dollars in revenue. It is an inherent conflict of interest to claim advocacy for physicians while profiting from a reimbursement system that makes it increasingly difficult for physicians to practice medicine."

Oh the hypocricy! Replace "AMA" with "Sermo" in that paragraph, and it would be just as accurate! Excuse me, but who's ponied up with Pharma, insurance companies, and other "clients" to generate a profit?!? Does Dan not sell our opinions to Pharma, insurance companies, and the like (his so-called "information arbitrage" to "clients")?? See Sermo Doc

Dan, put your money where your mouth is. If you want to really be a do-gooder, turn Sermo into a not-for-profit organization, which truly respects the opinions of EVERYone, and use any monies reaped from "clients" to advocate for us all. Right now this very biased "poll" seems to be nothing more than a bitch session with little hope for constructive change. I agree with IDologue's posting (5th comment) above; she or he is spot-on in my opinion.

THe AMA has always been specialist oriented. It has never spokenfor primary care practitioners adn though it hasfrom time to time tried tohelp inthatarea, effortshave always beenshort-lived. That, in addition to conservative political orientation, correlated with the wealth of specialists compared to the chronic underpayment of those of us in primary care, accounts for my not ever joining.

The organization has,been from inception, a conservative and specialtyoriented interestgroup, and opposed every innovative proposal ever put forward for health reform. Since the organization has hardly changed, why would anyone be surprised at its current position?

AMEN!!!
For the president of the AMA to be a sellout and appear on that ridiculous All Barack Channel extravaganza last Wednesday night and never bring up the topic of Tort Reform, he proved that he does not speak for any doctor in this country. Not only does he not speak for any of us, he is completely out of touch with what real doctors are dealing with in the real world. I am sure he did not receive an extremely large stipend to appear and promise not to mention tort reform. He should resign effective immediately.

It is truly a shame that we really have no voice speaking for us while they are going to shove Obamacare down our throats and ruin everything we have worked for professionally.

emsdoc1 and Thomas Jefferson said it best: "Truly we must hang together or most assuredly we will all hang separately".....the brave new world of medicine is upon us and we are griping about what is being said by the only voice invited to the table. Perhaps a better approach is becoming one of the voices within the AMA.

I have watched several organizations fragment and become less powerful (and ultimately regroup for practical reasons) because of the exact same short sighted sentiments Dan voices and others echo.

As someone who has approached a large organization as a "renegade", and through achieving leadership (along with similarly minded others) helped change the organization fundamentally, I can truly state that only those who fully participate and know an organization's agenda from the inside rather than from news snips earn the right to criticize honestly, and the ability to change what is objectionable.

My specialty is now being heard loudly and clearly at AMA, and as a relatively young specialty (with a very precarious position in current American medicine) we are making changes in that organization by becoming meaningfully involved.

The strength of the largest existing organization in medicine cannot be underestimated (let me see, has any other medical association ever been addressed by a sitting President?), and to attempt an organized or covert overthrow at a time like this seems wrongheaded, if not suicidal.

I am neither a member nor do I plan to be one.
The AMA is a prehistoric relic that serves it's own purposes and not it's members.
It should go the way of the Dodo bird.
Having a loud unrelenting voice is the only way to get heard ( think civil rights, gay rights etc).

By the way, I hope AMA is a "client" for this posting. It would be nice for them to see the array of opinions we have about them--not just the very biased poll geared to promote Dan's personal agenda. This posting gets a one-star from me for poor survey design and bias.

Another by the way, I support universal health care. So therefore neither the AMA nor the Sermo elite speak for me.

This is so very correct. I have cancelled my AMA membership.

The Association of American Physicians and Surgeons is a much better advocate for us, and I recommend joining them. They are a stand up organization not whoring themselves out to the insurance companies like the AMA.

Sermo Doc


"It is an inherent conflict of interest to claim advocacy for physicians while profiting from a reimbursement system that makes it increasingly difficult for physicians to practice medicine."

Like the typical physician I don't even have time to read all the other comments but I have something to say. Maybe the AMA should not make any decisions or statements until it polled it's members. It would them be obligated to stand for the majority of voices in the poll. If I knew I had a vote that mattered, maybe I would become a member. We already have state and district medical societies and an AMA. They should work for the members in them.

If the AMA actually wanted the opinion of every Physician, they could find a way to bypass the red tape and create a thoughtful opinion survey about the health care system and possible solutions. Then they could lure non-members in with an "Emergency Membership" at a reduced rate and get as many members as possible to join. Once completed, they could present the findings to Congress with true representation of the profession. But this would have to be done fast, something the AMA is not known for.

The AMA certainly does NOT represent me. Physicians need an organization that will help us organize (like the nurses have done) to protect our profession and to improve and provide health care for ALL Americans. Thank you Sermo for starting the fight.

Dan,

You did it, stirred the hearts and minds of our Sermo community.

Now what? If the purpose was just to stimulate discussion- you have quickly done it.

But if as you state we are truely in a crisis, what is the competitive organizational alternative that must be developed to organized fractured, non-united physician influence in this country.

If this effective organizational structure is not an outcome from your perspective, these discussions and postings have no connection to reality and will ultimately not create any real change or movement towards improving the current broken health care system.

Robert A. Beltran, M.D., M.B.A.
President
Latino Med Policy Institute.

There are a lot of anti-AMA doctors on Sermo so I guess it should come as no suprise that the founder of Sermo should also attack the AMA although I find it disheartening. Before I go on let me say that I am not a spokesperson for the AMA nor have I ever been an AMA delegate or board member. For better or worse the AMA is still the main organization speaking on behalf of physicians(http://www.nytimes.com/2009/06/11/us/politics/11health.html?scp=5&sq=american%20medical%20association&st=cse).

If we do not agree with the AMA we either try to work within the system to effect change or we can just sit on the sidelines complaining while reform is done for us. You can be sure that the other interest groups (trial lawyers, insurance companies,etc) are not complaining about their organizations - they get involved and donate money and time. It is a shame that at such a critical time for heatlh care reform, we physicians argue and bicker among ourselves. It is especially disappointing that the founder of Sermo would promote disunity and animosity without putting forth a viable alternative at such a critical juncture.

Agree wholeheartedly. The AMA sounds like a democratic institution, with input from its "representatives" (I'm not sure who they represent), but are these inputs translated into the policies that the AMA communicates? I doubt that. As always, the AMA leadership consists of a group of "fat cats" who do not practice medicine in the trenches on a daily basis. How many AMA presidents take Medicaid patients? I don't know the statistics, but I'd be willing to guess that the number is asymptotic to 0. An organization that is mainly supported by revenues from other sources than its membership cannot claim representation for its membership. I have previously posted my opinion that a basic problem with current medical care is the unprofessional way we are forced to bill. Unlike the legal profession, who are paid for their time and expertise, we must bill like auto mechanics, according to a coding book. Interestingly, the AMA derives a significant part of its income from publication and revision of the coding system. Who uses these codes? Are they providing even epidemiological data that help the public? No, they are only used to system the payments to physicians and increase overhead along the way. A recent article suggested that the average physician now pays out approximately $70,000 per year in order to satisfy the whims of insurers...including coding, recoding, contesting denials, rebilling, etc. At least the auto mechanic gets paid what the "book" says he will be paid and doesn't have to wait several months for the check... (and if the work isn't right he can just fix it without having to receive a note from the client's attorney threatening loss of professional status forever.)

I don't know if Sermo is the appropriate representative for medicine, however the AMA surely has been more of a hindrance than a help for a long time. Those who recommend reliance on the State and Local societies should realize that many, including mine, require AMA membership to participate, thus neutralizing their effectiveness as an alternative route to representation. I also don't know if single payer is the answer, but think that if the barriers to payment, i.e. coding, billing disputes for the sake of delay, etc.) were eliminated or even significantly reduced, while administrative overhead controlled to an appropriate level, much would be improved. The overhaul of the health system needs to be far more complete than a simple change in the insurers. Antitrust laws must be changed so that physicians can bargain. Coding must be eliminated in favor of a professional fee system that is time-based rather than diagnosis or procedure-based. Change in the malpractice system is essential in order to eliminate practicing in fear. It amazes me that the number of malpractice cases against attorneys is a tiny percentage compared to those against physicians, despite their routine abrogation of duty in respect to their clients. Win or lose, attorneys get paid their fees......all of their fees. Physicians, on the other hand are paid a small percentage of their fees, with inability to negotiate those percentages, and are sued when they "lose."

All in all, it's good to hear someone finally speak some sense.

It is truly sad how we as physicians are type A about everything related to obtaining a residency/fellowship etc but r passive about being informed about decisions and policies that affect us. but the impt issue here is how do we go about being informed and getting our voice heard when when r bombarded with so much information and we dont have a unified voice. how do we go about creating a version of AMA that truly conveys the physicians view and needs? We need protection and advocacy NOW! Thanks SERMO for taking the first step--but we need to make waves not ripples.

The AMA has never represented my interests. I was a member for years, but found myself disagreeing with every major move they made. Being the hardhead that I am, I stayed a member until I could no longer take it. I did not renew my membership 7 years ago and have not regretted it. I am happy that other organizations like this exist.

What is left unsaid in this letter is the reason Dan does not want AMA to represent us. The disagreenment is in positions and not on the number of members. So, if we decide to have an honest discussion maybe we can get somewhere.

When I was in AMSA in the 1970's I found pamphlets from the AMA written in the 60's opposing the establishment of Medicare. Think about that. I would have been proud to have been part of a professional organization that fought for patient's rights & freedoms, as well as our professional autonomy. But the AMA lost that battle. They were dead right about what MDCR would do to medicine and the nation, but the loss crushed them and broke their spirit. Now they are happy to be the government's lapdog. I have never belonged and never will. The AMA delegates that I know from Colorado are outright socialists who salivate at the prospect of socialized medicine. One even chided me for calling it socialized medicine, "That's a polarizing term." Listen up: Socialized medicine is a polarizing CONCEPT.
For my money, the American Association of Physicians & Surgeons gives me more bang for the buck. Maybe it's like voting for Ron Paul for President, but if he's the best man for the job, I will continue to vote for him, rather than the lame republican who used stand for freedom but now stands for government-not-quite-as-big-as-the-democrats propose.
Frankly, I think that doctors have done an excellent job of taking care of patients, and if they did that, who could complain? But while we were busy practicing medicine, vultures have swept in and eaten the flesh off our bones. The public will not rally to our cause. Politicians and lawyers have long been jealous of our success and high public standing and will delight in beheading us. I'm close enough to retirment that I don't much care, I don't think we have a prayer of maintaining our autonomy. I do worry about my daughter who is in premed however, and I worry about a nation treated by municipal employees with a computerized protocol and a crushing patient load.
The Decline and Fall of the Roman Empire was signaled when the people were satisfied with "bread & circuses" and no longer valued freedom.
Our nation is now satisfied with Cheetos and video games; freedom is not valued, and it will rapidly be lost to the vast army of bureaucrats who never went to medical school but know how to practice medicine better than we do.

For non-AMA members to comment here is a waste of time and effort. Go set up your own organization and SHUT UP. If people spent as much time doing something about the AMA instead of complaining we might have a legitimate organization backing us. If you are not an AMA member stop bitching about them. If you are an AMA member and are not happy with them (everyone on Sermo) then we who are members need to change the AMA. Don't complain about how the election turned out if you didn't vote. Don't complain about the AMA if you are not a voting member. Doctors are all a bunch of cheap followers with a "let someone else do it" attitude. That's why we are in our present predicament. I give this post a zero star for being worthless.

Dan must really , really be thinking. I haven't seen a follow-up post from him. Hope he did not start something he can't finish !!

I have to agree with OBGYNFlyer's comment. Those of us who are involved in organized medicine whether it is through the AMA, state medical societies, or specialty organizations often sacrifice our time with our friends and families in order to attend meetings, debate issues, and do what we can to improve the practice of medicine in this country. You have no right to complain with the job we are doing if you are not willing to put the time in that we do. Whatever organization you feel drawn to is fine, but become more than simply a dues-paying member. Let your voice be heard. ALL physicians need to be involved or else the government will continue to take over medicine.

It is more important to advocate for positions that solve problems than bad mouth constituencies that don't reflect our viewpoints. Let's propose solutions as physicians that elevate us to high moral ground, help our patients affordably get the evidence based care they deserve, and improve our country's health status compared to our competitors. Internally we should identify and act to reduce waste, identify best practices and practitioners and steer our patients there (when we can't do it ourselves), and prioritize meeting the unmet needs of our patients.

The comments are the most interesting part of this discussion, as is often the case. I was a delegate to the AMA 20 years ago and my attendance at the finance committee was enough to end my enthusiasm. The December sessions are good and the reports are useful but, if you attend the annual meeting at the time of elections to the board, it is enough to make you sick. The AMA also sold out in the RBRVS development and it seemed to me that surgeons no longer had any role once that decision was made. The local societies, at least in California, are going under as fewer physicians can afford the dues and few have the time to spend on volunteer activities.

The complaints by progressives seem excessive since you have your president and you should be content with his, and Speaker Pelosi's plans for the profession. I think it will be a disaster but I also think Congress is starting to realize that the financial aspects are simply impossible. There is a way to reform American medicine and that would be to use the French system as a guide. It is almost completely fee-for-service with free choice for everyone and has 95%+ coverage of the population. Most of it is funded from payroll deductions and, if the French economy was stronger, it would be nearly self funding except for the very poor. I have an analysis here:

Sermo Doc

I agree that the AMA is the best vehicle for physician input and, in an ideal world, it would be a possible union for physicians. Unfortunately, it has been focused on the best interests of insiders for decades. That could change but there is not much time left.

It is interesting to note that President Obama chose to fly out to Chicago to speak to the AMA about health system reform on June 15th, rather than addressing the membership of Sermo. I was in the AMA House of Delegates that day and never prouder to be a member of the organization that MANY (including the President of the United States) feel represents the physicians of this country.

Well the fact that DP has come out so strongly against the AMA is disconcerting. Don't get me wrong, I know the AMA is just another industry whore, but I enjoyed Sermo being a neutral, open forum open for discussion, where the management did not take sides so to speak.

The next few days will be interesting indeed... (says I with one eyebrow raised)

I don't have time to read all of the comments but my feelings are in agreement with you not just regarding the AMA but also the American Academy of Pediatrics. I keep up more with them than I do the AMA, but it seems like these organizations have been caught up in the Washington power scheme, and have left those of us who actually have to do the work behind. I personally feel that their sole interest is to maintain a fuzzy warm feeling with politicians and they seem to have turned into ambassadors for the government instead of ambassadors for us. Thanks for your comments. You must have done well, because it seems you've created quite a stir!!!

I advocate a townhall style metting with the president itself on SERMO . Just like Sen Specter did!!! He should go straight to the source And bypass the useless AMA. Not were the politicos tell him he should .
Kz

We are divided, our own worst enemy. There are as many different opinions on Sermo as in the AMA. Physicians are too independent to get organized. (The herding of cats analogy.) Each thinks our way is the right way. After reading many Sermo posts, I'm not sure what we want and which way to go. There is value in different opinions, but until we come to a consensus, we will fail. Consensus is difficult. You have to give a little and hope to get a little.

We have no recognized voice other than the AMA. There are other physician organizations (maybe too many) who have no where near the "membership" of the AMA? What is the membership of Sermo?

More can be accomplished from inside an organization. The more physician organizations there are, the more diluted we are. We need to get ourselves together, to know what we really want and be honest with ourselves.

Is it about health care? Is it about incomes? Is it about patients? We need to find out. Another organization will just peter out like other grass roots organizations have. We need to see the BIG picture, not only our own.

Are fees the real reason physicians are not AMA members? After all there are local society fees, county society fees, specialty fees etc. We get fee'd to death.

If we want to do something, and not just complain, we had better join the only organization the public thinks represents physicians. Lawyers do! Compare the participation in PACs, the ABA, and political organizations by the lawyers to what physicians do. In 2008, health care contributions to politicians were $95 mil; lawyer contributions were $235 mil. (www.OpenSecrets.org ) This is why we are not moving forward. Look at ourselves, not the AMA.

No organization is going to speak for all its members. But can represent a consensus of the majority. An organization of diversity is better than one where all think alike.

I think the AMA is trying to do the right things. However, its approach is too soft and not aggressive or firm enough in making the points that realy matter to physicians and the practice of medicine. I know the current president, and he is a good guy. Could someone tell him what physicians need and what we want the public to know? Dr. Rohak can begin by reading the Sermo letter if he has not already done so.

Dan ... I agree with your sentiments. I have not been a member of AMA for 30 years or more.
I have retired before my time plans because I was not able to earn any money without deliveries and major surgery. For my last two years of practice the overhead ate up all the income.

A new subject: What is the story with the $22,000,000.00 earmarked to help practitioners get an EMR system up and running? I haven't heard any Sermo discussion of this. It might have saved my practice if it happened 5 years ago.

paulff.
Medical care must be available to all.
All medical professionals ( physicians, nurses big and small pharma etc) must be free to work ethically. Who will broker the compromises?
I left the AMA because of their cosy relationships with big money, bureaucracy and SUNBEAM.
We need a body to speak for us ; the other parties have theirs in place. Is it not the AMA or nothing; have we not left reform too late?

For the 28 years I've been in practice, I've never seen the AMA represent me or my interests. Even the orgs like the ACP, have watered down their call for a single payer program and talk up ways we should be better compensated. Who out there is interested in why any of us should make more money. As an internist, I'm less concerned with what the government will do to medicine than I am concerned with my lack of a real voice in the process.
What is unstated but true is that primary care physicians have very different interests than specialists. We really can't be cut any more because we make next to nothing for what we do already! Any process that evolves will surely discover that specialty driven medicine and hospital based medicine is ridiculously overpriced. Cutting speciality remuneration will have the benefit of seeing more qualified young docs go into primary care because the opportunity cost of not becoming a specialist will narrow.
The thought that ANY new organization THIS LATE in the game will have a voice that people will recognize is insane. We needed an organization that would have self regulated the abuses that specialists have brought in the name of self interest to the payment process YEARS ago. Now specialists will live with the consequences and join their "colleagues" in a profession that will grossly underpay by today's standards of living.

So, radlaw, you would advocate and support the form of legalized bribery that the PACs represent because that is what works? Personally, I think we would be better off rejecting that approach as unprofessional and disgusting. I'd rather not join the pigs in the trough. Just let them know that we are leaving the barnyard, wholesale, and if they want medical care in America they need to sit down and listen. I'm not in favor of paying a dime to influence a politician.

Not an AMA member and don't need to be for this but as a FYI, some state boards like florida require a AMA profile for licensure. Question is why? What kind of a profile does the AMA have on me when I have never been a member!

sfhunter - I find it hard to believe that the AMA is providing you with any meaninful information to practice medicine. You diagree with them but continue to support them?Sounds like a bad abusive marriage to me.

good for you Dan....welcome to the party. Next step is to create Sermo Billing Codes, sermo insurance, sermo practice management esp for primary care, sermo captive for malpractice and the entire weight of sermo behind every single malpractice lawsuit filed......

Surgeon555 - very cogent and well said......and pendoctor, please define many, er - excuse me, MANY?

I just don't care any more. I'm slogging through my day. I know the AMA and Obama and everyone else who has power doesn't give a damn about me or my patients. I just want to retire as soon as I can before the trial lawyers take everything I own after 20 years of hard work. Nothing we say or do will change a damn thing because the lawyers run the system and just laugh at us behind closed doors (or in public hearings).

Right on !!!! drleerubin. In addition to responsibility we need to be accountable to our patients and our profession.

Apathy is what got us here and continued apathy is what is going to kill us !!! In my humble experience, physicians are for the most part more talkers than actual doers.
This is not about matters in a clinical sense but in the sociopolitical mix of heath care reform.
Except for surgeons of course. After all , who are the great innovators in the world. Surgeon by far lead the pack!!!

Thanks Dan for keeping us honest and leading the pack !!!

AMA = Against Medical Advice

Just read almost every post on here which was a little exhausting. A few things stood out. One quote in particular:

"It is clear that medicine is under attack by the government"

Some might argue, by virtue of the ever increasing health care expenditures year after year, that in fact society, and the U.S. government, is under attack by medicine. The current system and its expenditures are simply unsustainable. Who is at fault for this? Well, there's a lot of blame to go around: big pharma, improving/more expensive technology, malpractice premiums, public demands for "the best care at all costs", and (gasp) perhaps even some of the blame lies with physicians who do after all have an incentive to make a decent salary after years of sacrifice.

I've heard the analogy of physicians getting together with unity is like "trying to herd a group of cats". The posts on here echo that sentiment. As a group we are opinionated, we are diverse, we are type A personalities. Will any single entity represent us well? I think not. I'll go with my specialty society above any other.

For those who think Dan is "self serving" here to further his own website and agenda here, I have to point out, the same could be said of ANYONE who wants to lead and bring physicians together. Where else do we have a free forum, open only to physicians, available 24/7?

Does AMA have message boards on their website? No they don't. If they did you'd have to be a member and pay to access them. With over 100,000 members in a few short years, sermo has been quite successful--perhaps moreso than AMA whose membership is declining.

AMA could learn something valuable by looking at sermo and its success, which stems from giving physicians a FREE forum to discuss the issues that matter most to them--without trying to sell us insurance or anything else---and then LISTENING to what we have to say.

Never been an AMA member. Have been active and count officer of Texas medical ass. Difference? Texas one works and represents my interests. My biggest complaints about medicine are from the AMA. CPT and coding system in general and RUC committee.

I personally agree more wih woods3 & landrew (altho' I'm not an AMA member unless my American Psychiatric Associaztion membership makes me so).
Devaluing & defaming the admittedly-imperfect AMA is neither prudent nor expedient under prevailing circumstances.

Unfortunately, anti-trust laws (mentioned in) as currently apllied seem to inhibit MD organizations more than they do for other non-MD organizations. Only a little experience (interface) with hospital administration illustrate why this would be the case, e.g.hospital admin wants to attain & retain the reality & perception of control over the "powerful" MDs so that their image of supreme power is retained.

MDs' apparent apathy at large to organizational politics might be explained by contrast with, say, teachers' lifestyles who generally have weekends, holidays, nites & daytime after-hours plus professional training & pay as tierre-a-tierre assets for active & personal engagement in partisan & professional (trade union) politics.

MDs' overall timidity when accused of conflict-of-interest issues might be explained by the vulnerability of MDs to imputations & insinuations of putting pts' interests in second place because of the perceived influence of indicia ephemera (trademarked trinkets) whereas lawyer fee & retainership arrangements are not comparably scrutinized &/or criticized. Alternatively, blue collar arrangements of ownership & operation of a firm are rarely labeled conflict-of-interest (e.g. truck drivers can own & operate trucking firms with financial arrangements thereof rarely scrutinized; MDs owning & operating medical labs can come under remorseless & relentless legal scrutiny if the owning MD refers his own pts to his own lab with a discount in price--so I understand & granting that I don't own a lab myself.)

The above-mentioned is only one MD's view of part of the anti-MD strictures that are in existence in US society.

Insofar as the AMA is sincerely attempting to ameliorate the anti-MD trends & paradigms in our times, it is would seem to be worthy of at least my passive suppport.

Hope that this helps.

I concur with Dr. Motta's posting at 10:23am today.
If there were no AMA, we'd have to start one, and it would be costly, and most of the naysayers on this site would not ante-up. I recommend that you become part of the process and pay your AMA dues. Submit a resolution to change the AMA in the way you see appropriate. Run for office as an AMA delegate from your state or specialty society. Use the influence of our AMA to work in the best interest of your patients and our profession.
Dave Hannan, MD
Family Physician in rural Marion, NY
President, Medical Society of the State of New York
AMA Delegate from MSSNY

I don't quite understand the idea some folks have that we critics should join the AMA and work to change its policies. It seems to me that at this point a rush in membership would most likely be regarded as support for the organization. Unless there was an organized joining publicly promoted--loudly--as being for the purpose of changing policy and advocacy in a certain direction it would seem better to start over.

And as far as Sermo as a discussion forum, it has got some strengths but also some confounding weaknesses ($$$). And as far as the technicalities of discussion, it would be nice to have subthreads to comments, so that comments on comments were directly tied together. And also helpful would be a simple like/dislike feedback option.

I agree with drleerubin that apathy is a huge problem. I also agree that the AMA has not represented us well in the past. I am a delagate to the Texas Medical Association and serve on my County Medical Board. Getting people to be involved is very difficult. I also know the newly elected AMA president, Dr. Jim Rohack to be an honorable physician who is intent on representing doctors. He wants to shape the "new" health care delivery in a physician friendly way. He wants to repesent us . But how can he if we aren't members. Pehaps, if all of those who are unhappy with their representation, joined AMA and became actively involved politically , we would become a force strong enough to impact legislation for the benefit of our patients and ourselves.

Let,s change our status quo and fight.Iam sick and tired of all the present burocracy that our practices have to deal on a daily basis

Join the American Association of Physicians and Surgeons it the only organization that has shown the Cojones to step up for us .
Kz

redhawk, I think your comment about a flood of membership being interpreted as support is true. It would make more sense for a huge group of physicians to quit the AMA and then explain why...which may be starting here.

For all of you who are advocating membership in the AMA...give us a coherent reason...beyond "it's the only organization that represents us".

The dialogue between physicians really exists only on Sermo. It's a generational thing as well -do we have statistics about median age and specialties on Sermo? I am all for greater access to heatlhcare, especially for children. I think we are all going to become volume providers in some way, and EMR's will be critical in streamlining these processes. We're never going to go hungry, even if civilization breaks down and we're riding donkey carts to our patients in exchange for chickens and kisses from the ladies. I digress.

Things like Sermo trump the academic/industrial/Society monolith. My Sermo case presentations reach about 50-100 physicians -the cost in time and travel to get the attention of that many physicians for a conference is astronomical, but very very efficient on Sermo. Think about your colleagues who don't understand Sermo, Facebook, Twitter, or the Interweb/Google thingee, and you can see that they won't be happy in this brave new world.

I think we mostly get it (and those of you who don't know who you are). I vote for making David Palestrant our Surgeon Admiral -I'll gladly pull the oar -RAMMING SPEED TOWARDS THE AMA!

I have been involved with the AMA and my state medical society in trying to make the practice of medicine better for doctors, and for patients. I feel that my voice has been heard by them. This is because I have actually participated in these organizations by going to meetings, reading my member newsletters, and communicating with them. The AMA is a behemoth of an organization that represents all regions and all specialties in the country. One of the biggest hindrances to the AMA is the lack of cohesion amongst the specialty groups. Everyone wants to promote his or her own specialty's and region's interests. All of those competing ideas get filtered through the AMA's version of congress to come out as AMA policy. There will never be a time when everyone is pleased with everything the AMA dose. However, just like in our American government, your voice will not be heard if you do not speak it to the AMA and get involved.

Organized medicine is critical to protecting and improving health care in America. Doctors should strengthen the AMA, become members, and make their individual opinions known to it. Whether or not you agree with all of the policies of the organization, the AMA is the face of the medical profession. It is also dancing a delicate dance in a political environment that is pushing for changes that most physicians oppose. However it appears in the public spotlight, the AMA is fighting for us. No other organization for doctors is at the table like the AMA.

Rather than fight against them, we must support the AMA and participate in the organization. Otherwise, physicians will appear fragmented and out only for their individual interests. Sermo offers us a place to talk among peers in order to be better doctors. We should use this service to unite rather than promote division.

Until officially noted that the AMA is no longer affilliated with Sermo, I believe the AMA is stil part of Sermo.

So will the highest ranking physician in the AMA leadership, if he or she is a member of Sermo, please stand up and share your thougths.

Agreed.
I am not and will never be a member of AMA in its present state.
As a FMG , we know that AMA has NEVER supported or helped us.
I will never send even a cent to support this lousy organization.

Funny how alot of the above posts are written by AMA members and executives.
There must have been 100 prior posts about how the AMA has become completely disconnected from the physicians they purport to represent. Never a single post by ANYONE supportive of the AMA.

TODAY the CEO and FOUNDER of Sermo writes the same post we have been writing for months, and all these Big shot, full of themselves delegates start answering.

SHOWS YOU WHO AMA DELEGATES LISTEN TO. CEO'S AND FOUNDERS. NOT MEMBERS.

Just an observation so far today....
Of 1222 physicians responding so far...
76% are not AMA members.
90% feel the AMA does not represent them.
92% feel that the AMA does not reflect their opinions.

This is a small sample, but, if you were the AMA, wouldn't you be asking..."what are we doing wrong?"

Vickery04, I am amazed at your views. Do you think or believe AMA fights for physicians as ABA fights for lawyers?

Excellent Dan.A good begining.This is all preamble.When things get bad enough,there will be no talking,writing or teleconferences.Physicians can change everything with one simple move.It is inevitable.

Mark me down as agreeing with IDologue, ROVSPA, and mmotta

You go Palestrant! I am happy you have not put money over substance in this issue. AMA is a dead body which has not been properly mummified. Hence the stench. We need to stand up and say loudly " NO more BS" . We go back to practicing medicine. We will NOT deal with third party insurers, fill paperwork or please administrators..

"This is our time to educate the public about which voices truly represent us and our commitment to our patients."
Which voices would they be? Thousands of unorganized individuals without any organized impact? What do we replace it with--not on some happy future day, but right now--name the organization you feel represents us better TODAY. We cannot bargain collectively. Like it or not, the AMA is what we have.It can represent you if you GET INVOLVED with it, rather than sniping and griping from the sidelines. Yes, fewer docs belong--but they are not participating elsewhere. They have become passive. P. S. CMS has cut much of its financial relationship with the AMA, so AMA income is down and in the future a much higher fraction of income will have to come from members. Happy?

Bravo, Dan! It's very encouraging to hear a sympathetic voice after years feeling alone in the wilderness. I agree we have to create our own means of advocacy. I think that means starting with principles we support in an ideal health care system.
I'm for: Dr-patient relationship integrity (this precludes managed care), free market contracting between Dr and pt (this excludes government fee controls) and between pt and insurance co (this allows costs to be limited to the level tolerable to insurance companies, neutralizing excessive cost of malpractice insurance). I know this sounds glib and oversimplified. But it's a start. Anyone?

I have to agree. The AMA insists on taking hardline stances on issues while claiming that it is representing "all physicians". I shed my membership 2 years ago.

The AAPS used to be somewhat of a fringe group, but now it seems they are the main group actually standing up for doctors:

Association of American Physicians and Surgeons:
Sermo Doc

I guess they were just ahead of their time :)

I am an AMA member and agree with the organization on some areas, but not all. I am troubled mostly by the fact that the AMA is becoming more of a left wing organization to some extent as is seen by the stances it takes on some issues.
I do not believe the "national surveys" of physicians that show 60% favor a single payer system. Base don my interactions with physicians of both the conservative and liberal persuasion, a vast majority oppose a single payer system, contrary to IDologue's belief. Any physician with a brain knows that a government controlled system will kill health care in this country. How much more evidence do you need than the fact that most doctors will not accept Medicaid, and increasing numbers are refusing Medicare. Many are also leaving practice because of the increased government interference in practice.

It is obvious individuals like IDologue have no clue as to this fact. If they did, they would know more govt control will lead to even less physicians practicing. In addition, many physicians will not accept this new govt insurance Obama wants to establish either.

Most studies show that there is a substantial shortage of physicians in this country as it stands, particularly among primary care specialists, with the current insured population. So who will be providing care to these newly insured individuals? Considering we don't have enough as it is, and even more will quit because of how Obama wants to control every aspect of our practice and cut our salaries, there will be no one.
In the end, access to quality care will actually decrease under a government plan, and we will see a high level of care rationing. Eventually it appears that Obama wants to force doctors to accept any government insurance program he devises. It has already been talked about. He intends to tell doctors how to practice and what they can and cannot do through many of his programs. If you don't do what the govt demands, they will decrease your reimbursement. If that happens, I will leave medicine myself, and I am only 32 y/o. I will not let the government decide what is the proper care for my patient because they want to save money at the expense of what is best for the patient.

I will also not accept current Medicare reimbursement rates for all patients. I am only able to see current Medicare patients because of the higher reimbursement I get from all other private payers. This is not about greed, I could not afford it otherwise. And society will find that the ebst and brightest will no longer pursue careers in medicine, with the lengthy and rigorous training involved, for low salaries. These individuals will pursue other careers where they can get appropriately reimbursed for their skill set.

Maybe those favoring a government system should ask themselves why American Doctors are not practicing in any significant numbers in Nations with govt run systems, but doctors from those areas are coming in high numbers to the USA to practice. Why do the states that border Canada in particular, have high numbers of Canadian doctors practicing there? Why does the entire Nation of Canada have fewer MRI machines than the State of Arkansas, even though they have >10x the population? If we implement a similar system to other Nations here, we will see less physicians coming from abroad, furthering the shortage to yet another degree.

While he does not admit it, Obama knows that immediately following a govt run system is rationing of treatment and care. And he can lie all he wants about how he is not trying to have the govt take over healthcare completely, common sense does not lie. If a business can shift its health care cost burden onto the government and save thousands of dollars or more, it will. Businesses function to make money, and will decrease their expenses whenever possible. Obama knows that. If he does not, he is stupid, and is not fit to be President due to lack of intelligence. Take your pick.

IDologue, I admire Ayn Rand quite a bit and respect her philosophy. I do not appreciate being called a ':nutbag". Believe it or not, not everyone who likes Ayn Rand or puts doctors' concerns and interests first is Rush Limbagh-loving, Bible-thumping right-wing redneck you make us to be.

Daniel: Your heart is in the right place, even if somewhat Quixotic. We allowed ourselves to become "providers of healthcare" who are "reimbursed" for their time...maybe, at some point. AMA is, and always has been, worhtless and useless, while claiming to be our voice. We can't negotiate our fees as a group, that's price-fixing, you see. But when insurance companies do that, thats just fine. Every time we dare to express our discontent with what our lives become, we are treated with contempt, how dare we rich arrogant spoiled doctors complain about anything?

There was an earlier tread about a "strike". Alas, our woes know very well that no matter how much our lives suck most of us will not abandon our patients. And therefore they got us by the nads. But striking against insurance industry? Just telling all of them "thanks but no thanks", or FU, if that's more appropriate? What's wrong with that? I say do it before Obama &Co make that illegal, too

The AMA has never represented me, and they never will.

AMA consists of bunch of grandiose self serving individuals who are there for name and fame and have nothing to do with the interest of fellow physicians, so why are we expecting anything out of this big institute?.

Its the "working class" that has to join together and make a change. If we working people quit all together one day...tyhen we will get attention...take a look at Psychologists, they are getting prescribing authority without having to go through extensive medical training merly with persistance...and all we do is talk and bash each other...never unite..its about time, we working people unite and team up and stop work one day put the pen down one day and demand and raise our voice...will get attention...otherwise...forget it...

The AMA does not represent my views or opinions. We as physicians do need a political "union" to look out for our professional interest and those of our patients. The AMA, AAP and a host of other physician groups/societies do not represent our collect views.

It's easy to identify problems with the AMA as a representative organization -- although its components are still designed in a very democratic way. But, when you say "AMA doesn't speak for 'us,'" I'm not clear whether your 'us' is the same as mine.

Sermo has seemed to overrepresent the faction of doctors who believe in fee-for-service, private practice ("fee-for-CPT") medicine. This is Sermo's privilege, except that it annoyingly and presumptiously supposes that this faction comprises the dominant majority of practicing physicians, and that this particularly regressive and destructive economic model should be taken for granted as the preferred and correct template for the future of American medicine.

Until Sermo confronts the fact that there are multiple viewpoints among physicians, I certainly would not support any more social action by Sermo (like the ludicrous and embarrassing Open Letter) that does not fairly reflect at least a couple of sides to this critial professional identity problem.

My first proposal for an intervention would be to demand that the CPT be retired, that its replacement taxonomy for coding medical procedures be put in the Public Domain, that the E&M codes be totally discarded and the RBRVS be completely re-engineered to incorporate "value" rather than "effort" as its basis.

Great posting!I think it also shows that if you are not afraid of the answers, you will ask the right questions. And, oh' by the way, the public perceotion of the .....a..ma is even worse than ours:a bunch of FAt CATs (like on the cover of Monopoly) who don,t give two shits about anything other than money.
The sooner we can distance ourselves from that perception, the better.

Wow, don't think I have ever seen as many posts in as short a time span! As one of the meager 24% who belong to the AMA, I agree it is not representing me! I also agree with the lack of persistence that AMA showed in standing up for the original intent of RBRVS as created by Dr. Hsiao. If any of you oldies remember he did an excellent job in creating a formula that took into account everything that went into the physician's evaluation including time spent in training! That particular plan with its provider parity, especially in primary care, was deep-sixed by the then 1st Reagan administration, in favor of the current approach. Can we as a group truly reach a consensus on how to speak to the powers-that-be? I remain idealistic enough to believe it's possible. Anyone?!?

Bowdend- Do you really think that the best and brightest will continue to pursue careers in medicine if doctors are forced to take a pay cut? If you believe that, then you lack intelligence, and probably are not a very good doctor. I would not want to be treated by someone who was so stupid as to believe that intelligent people will pursue the prolonged schooling and rigorous training required to become a physician just to make an avergae salary. Who in their right mind spends many extra years getting educated to make the same salary as those who opt for easier routes? Why do you think med students are not opting for primary care specialties? Newsflash, specialties that have higher salaries are more popular and more competitive. Shocking, I know.

Physicians and medical societies need to quit hiding the truth, and that is most physicians DO care about making a good living. Everyone knows this, but is afraid to say it. Because of this, they miss the boat about what will happen to the healthcare system if physician pay decreases. Doctors will stop practicing, and applications for medical schools, as well as admission standards will decrease in the process.
This is not a secret, but the truth people want to hide.

Thank you, Dan, for articulating what many of us believe.
I quit the AMA 20 years ago after deciding that the dues were not worth it. I am a proud (& pleased) member of both my state medical society and my national specialty society. The AMA's recent rejection of a public health insurance option is disappointing, but certainly not surprising. What amazes me is that the AMA cannot learn from its mistakes: it's attempt to defeat Medicare legislation more than 40 years ago was a spectacular and costly failure. Few doctors realize that the one reform that the AMA DID support in 1964 turned out to be Medicaid. The AMA folks just don't get it.

epedimd go cry some where else. you sound like a typical ama bloodsucker needing us to support you. I am with you dan.

bravo, Dan.
Full steam ahead.

To rarmstrong:

PACs are a reality; whether you like it or not. To ignore, or avoid, them is like urinating in the ocean to raise the tide: it won't do any good.

So face it, because if you don't; those who do will win. When going to war use all your weapons not just the ones you like.

I do agree you, the AMA needs to look at itself and correct what they are doing wrong.

How many of us have tried to be active? I admit, it has been a number of years but at one time I was a bright eyed eager young woman who had been class president her sophomore year in med school and who had edited the med school newspaper. Was I encouraged by the entrenched medical establishment? Not much. So not just apathy but lack of opportunity for involvement. Maybe it's different now but now who can afford the time and money? Not those of us on the front lines.

I believe we have a widow of opportunity here. Just as many of the established institution are shaken by the new trends coming from the strenghts and weaknesses of the internet physicians also have an opportunity here to channel this newfound medium to further along our voice and create a balance that benefits both our interests and the interests of our patients. Sermo is just a reflection of this new trend.... as is the decline of the AMA.

OK, it's time for the AMA sucks big time, does not represent us letter from the godzillion docs here at sermo. If nobody knows they don't represent us, then it's our fault. Puleeze someone with better writing skills than me (most of you) get this together, we all WILL sign and get it out...to the media, papers, Katie Couric, Olberman, Matthews, Limbaugh, all the bozos.

I had been an active member of the Mass Med Society because I saw these organizations are the way to have any influence over policy. I backed off (still a member) partly because of their recent accolades about Sen Kennedy -not because they did it but because I did not have the guts to speak up about it. I felt I was wasting time if I did not say what I think.

THE AMA IS SEEN AS REPRESENTING DOCTORS WHETHER YOU LIKE IT OR NOT! All organizations are reflections of ACTIVE members.
If you want to influence the direction of medicine you have to get involved in an organization. I tried writing letters as an individual and it did not matter to those in power.

Quit bitching and do something. Just a few active people change everything. Make the AMA your organization, it is easier than starting over. And these organizations are hungry for participation.

(By the way before you criticize be sure you know what the AMA is representing. See letter by Aggie78 above. And the Hang quote is by Ben Franklin!! emsdoc1)

We could have more autonomy if we stopped contracting with insurance companies. That may mean not accepting medicare either. How many are willing to make that leap though. With enough docs accepting only fee for service, the current system would not longer thrive. Change is in our hands, but we are puppets for the insurance companies.

Patients would still need care and come to us. All those insurance company dollars should be going directly to patient services and care. I plan to stop working for the insurance companies this fall. Am I the only one willing to stop the maddness?

Your questions are very pointed to direct the answers the way you want. I am a member of the AMA and the NMA as well as my local and state constituents. There is as much an apathy for membership to organized medicine as there is any movement away from the AMA. Unfortunately, it takes a few who are willing to spend the time and effort to try to keep it together for all physicians.

The leadership of the AMA, Dr. Nancy Nielsen and Dr. James Rohack are quite attuned to the administration and what it is trying to accomplish without throwing us out with the bathwater. It would behoove us all to work toward a common goal of providing a healthy working environment so we can practice our craft.

DrVicki,

I am sorry that was your experience with trying to be active. Mine was very different. From day 1 of medical school, the older physicians in the Massachusetts Medical Society and the AMA mentored me and helped me to take on leadership roles within various organizations. I learned so much from them. It continues to be a wonderful experience for me. I am on the front lines seeing patients full time, raising a family, and doing my best to participate in organized medicine. I admit it is a struggle to make it all work, but I find it valuable to my life and my profession.

the AAFP speaks best for me.......in 27 years as a physician i have NEVER been a member of AMA!

The AMA opposed every last progressive change in health care in the twentieth century. It opposed private group practice at one point. I was never a member, and am not now. I'll admit my advocacy of single payer universal coverage, and my skepticism when people insist that private, for-profit entities are, a priori and solely thereby, privileged with respect to cost-effectiveness, integrity and freedom when compared to government programs.

That being said, I'll add two observations.

First, the letter Dr Palestrant wrote said nothng about actual positions the AMA has taken, for better or worse, nor whether or not those positions diverge from his views. Seems to me that's ground that needs covering.

Second, the common implicit assumption is that the AMA, werre it to represent physicians, would therefore be in an adversarial position to every other interest group involved in health care. If physicians are seen as guarding their interests at the expense of others', without simultaneously advancing interests of most of the people in the country, being part of a social movement larger than docs' interests, then physicians wil fail. If most people think docs are fighting for them, as well as themselves, then nothing can stop us.

Being a DO ,you might wonder why I would post on this. The sad part is that the AOA is following in the same pattern as the AMA and allows no voice but the party line. IF I didnt need to maintain membership to keep my specialty boards I would drop my membership like a hot potato. My state organization stands up for physicians rights far better and is swayed less by special interests.

radlaw, my point is simply this...PACs have also become big business. The lobbyists just love this. We throw more money away for influence. They are in existence BECAUSE we participate. If we just said..." we are not interested in participating with your schemes to bilk us out of millions of dollars while we are left hanging" the whole sick process would end. The attorneys can give all they want...if we don't participate in the government's plans or the private insurance industry's plans, what can they do...lock us all up?

As a retired military nephrologist, this looks to be the Administration saying, "You'll have to do more (patient care) with less (dollars)".The problem is that this is where we are told to not practice defensive medicine.However unless the administration and Congress is ready to take on tort reform,this will not happen as long as you can dial 1-800-BAD DRUG or get a malpractice attorney to look at your case on a contingency fee basis only.I would challenge anyone to take a car in for repair and ask the dealer, "Can I only agree to pay you, if you take care of the engine knock?" Also I find it strange for an Administration that has done such a pathetic job of limiting the bonuses of bank/investment CEOs/officers, is basically telling physicians, we will regulate your income/livelihood. I agree that as physicians we need a unified voice.The system has,is and will be broken unless we help fix it. As noted above there is no easy answer or quick fix.Either we will be players or spectators.

IT IS SHAMEFUL THAT THE TRUE NUMBER OF MDs WHO PAY DUES TO THE AMA CANNOT BE OBTAINED. I WAS SHOCKED BY THIS REVELATION IN THE POSTING.
AT THE VERY LEAST, THIS EMPEROR SHOULD BE IDENTIFIED AS A NAKED FOOL!!

The answers to the poll would be more interesting if the second, third and fourth questions were broken down further into non-AMA and AMA members.
Just a thought!!!

Ovedr the course of my 25 year professional life, the only thing I can say that the AMA has actually done is destroy Primary Care. Now it appears that the leaders of the AMA are willing to destroy medicine, in general, in exchange for the privilege of sharing the table with the "annointed one".

I dropped out of the AMA when they made it clear that they were more interested in legislating social issues than medical issues. I am not a fan of boxing but I do not want my dues spent lobbying to ban boxing. I do not remember ever having been asked my opinion about such issues yet AMA said that they represented all physicians in their efforts. When I questioned them about this, I was advised that they did not care what I thought. That is when I decided to use my money for what I wanted.

The AMA remains now and for the forseeable future the best hope for physicians to have a voice in the laws and regulations that affect every part of our professional lives. If all the members of Sermo would attend an AMA or state society meeting, you can be sure YOUR voice will be heard. Congress and the President will only hear you through an organized group action. If Sermo seeks to speak for physicians, they will have to start charging dues, hiring lobbyists, and in general acting just like the AMA. Joining organized medicine is a bargain compared to most other professions. If you don't like an AMA policy, you can change it! Of course, there are no policies that will make everyone happy. Yes, we can all opt out of Medicare, Medicaid, and all insurance contracts, but then who will care for those patients who rely on these plans to finance their care? If every US MD joined the AMA, we would be a lot better off as a profession; too many physicians just want to accept the benefits gained by the AMA (restoring Medicare cuts, just to name one area!) but not pay the dues. Stop being a freeloader, pay your dues, and then speak your piece. I represent Tennessee, but if you think you can do a better job and are willing to give up 3-4 weeks a year unpaid time to help make American medicine better, you are welcome to run for my delegates seat.

Italiaroma - You write that you would not want to be treated by "...someone who was so stupid as to believe that intelligent people will pursue the prolonged schooling and rigorous training required to become a physician just to make an avergae salary" - to use your own words (and spelling). I, on the other hand, would not want to be treated by a physician whose motives for going through such rigorous training were based primarily on financial incentives. The fact is everyone wants to make a good living no matter what route they pursue. I think the bottom line reasons we are compensated more is the general acknowledgment that there are usually a lot of loans to pay back and always many years invested. The personal sacrifice is a given - and should be. Frankly the concept you seem to suggest: that good doctoring necessarily means a higher salary - seems very offensive. Your response makes me feel lucky to have been taught well by my parents - just to follow my interests and passions, rather than any aspirations for some big payoff at the end of it all. I do what I do because I love doing it; and for whatever reasons you went through medical school, I hope you love it too - if only for your patients' sakes.

I think this commentary on the AMA shows exactly why we have failed to achieve meaningful healthcare reform in this country to protect our patients - our own colleagues insist on causing internal debate rather than working together to solve our country's healthcare woes. The AMA is - and always had been - the only organization with enough influence and presence in Washington to lobby on behalf of all physicians. The organization has accomplished tremendous successes - from stopping huge yearly cuts in Medicare reimbursements that would have left millions of seniors without access to healthcare, to working with Congress to pass thousands of pieces of legislation of public health, from smoking bans to elder protection.

When discussing healthcare reform, the vital importance of the AMA becomes even more apparent. 3 years ago, the AMA launched the "Voice for the Uninsured Campaign." The purpose of this $10 billion campaign was simple - to permanently address the problem of the uninsured in this country and make sure that everyone has access to affordable and meaningful healthcare. The initial target was politicians running for office - the goal was to make covering the uninsured the TOP priority of every political candidate. And clearly it worked. At a time of economic collapse, healthcare is still now the primary issue facing our national government and everyone is participating in trying to find a solution to the plight of the uninsured. The second phase of the campaign was public advocacy. Most of you probably saw the national television ad campaign explaining that 46,000,000 million uninsured Americans was 1 in 7 too many uninsured Americans and that people needed to call their Congressman to move this issue forward. And again it worked - in national polls, healthcare remains the leading issue of concern for Americans.

In addition to all the aforementioned, the AMA has been the leading source for pretty much every health-related item that we as providers rely upon. The AMA leads discussion on medical education along the continuum through its own policy and its work on the ACCME, ACGME, and AAMC. The AMA has always been the authority on medical ethics, and its Council on Ethical and Judicial affairs is so well regarded that its rulings are immediately put into law in many states. The Journal of the American Medical Association is one of the leading national journals. The AMA Foundation gives millions of dollars each year to support medical education scholarships, free health clinics, health literacy, etc. I could go on and on relating to science, public health, advocacy, etc., but I think you all get the point.

Dr. Palestrant - it saddens me that you have chosen to politicize this website in this manner as I thought it had really been serving physicians well as a source of education and discussion of difficult cases. I hope that your naive and short-sighted determination of the AMA will be the last of your attempts to politicize this site and that, henceforth, physicians can continue to benefit from this site as an educational tool. I fear that, if you continue along this path, you may see failure of the good work you have previously done here.

Remember - the best way to change an organization is from within. If you disagree with anything the AMA has done as it fights for physicians and patients, the best way to improve those concerns is by joining the AMA and fixing what it does. It is a democratic organization that does what its members determine is best. If so many physicians that are not members think that the organization does not represent them, they should join and make sure it does.

As physicians, we need to present a unified front now. We need someone to represent physicians and patients. I know the politics can be difficult at times, but this is no excuse for the apparent confusion that exists today. If the AMA will not represent us, who will? We need clarification on the important issues and elimination of the confusion. Confusion leads to divisiveness, which is expertly taken advantage of by those without medical interests in mind.

Nearly 2,000 answers and several hundred posts yet we haven't heard back from Dan. Dan is likely busy, but would hope he would share his impression so far with the rest of the Sermo community.

Sixty percent of the public favors universal single payer health care. 70 -80 % of primary care physicians favor universal single payer health care. By their own survey 59% of AMA members favor universal single payer health care. Yet, we hear the AMA telling Congress and the Obama administration that "doctors" are opposed to universal single payer health care.

Whom does the AMA represent? Where was the AMA when the insurance industry took over and began to dictate how physicians provide medical care? When physicians became "providers" and patients became "consumers"? When nurse practitioners became acceptable substitutes for board certified physicians? When HMO's hijacked Medicare with their "advantage" plans? When patients were so careless as to have mental, developmental, or pre-existing conditions? When the plumber pays more to ring your door bell than a physician gets for a complex office visit? Speaking of which - who hallucinated the "point system" whereby we calculate the number of items in the history, the # of items in the physical, the "complexity" of the decision making, etc. etc. etc. in order to try to get payment for our professional services?

We and our patients have been repeatedly disappointed, nay betrayed, by the AMA. It is time for new leadership.

Barbara Lee Perlmutter, MD, FACP
Hoboken, NJ

Amen. Everybody join the AMA and fix it. This is for emphasis. Yes I already said it.

Yes, we guard our interests first. No other group would train like dogs, work like slaves, and get sued like scoundrels, and expect anything else than to be the captain of the ship. We should be in a seller's market.

Stand up and act like it, guys.

Now more than ever it is CRUCIAL that we allow the AMA to be the central voice for medicine. If we continue to allow ourselves to be fragmented, we will guarantee that our influence and opportunity to be involved in the future of medicine will be gone!! While I don't agree with everything the AMA has said, the process by which they get to positions is very "democratic" and works! I've seen it from the floor of the HOD. I don't know of ANY organization that I agree with completely!!

There is only one answer to "our health care crisis"---it is quite simple-----HEALTH CARE SHOULD NOT BE A FOR PROFIT ENDEAVOR-----but try to get a nation that would truly "do anything FOR MONEY " to accept that fact and act on it-------no hope ! The AMA,the insurance industry,attorneys,all physicians that primarily do procedures,hospital administrators and all the other carrion eaters that feed off our dying health care system will never let it happen. Yea----the AMA is a pile of *#&^---but the pile is much larger than just the AMA!!!

Does anyone here belong to PHNP? I agree the system is broken. I am tired of the stress of having non insured patients or under insured patients. I need not detail what those stresses are as we all know them. Having more insurance companies and more prescription companies to deal with is not a fix. We need a single payor system.

Bowdend- I enjoy what I do, but I would not have sacrificed what I did to be compensated at the same level as an autoworker with little education. It does not make sense. Like I said, and what you failed to address is the truth about medicine. That is you do not continue to get the best and brightest by lowering salaries. That is true for any industry. Notice that when the tech boom was happening, and a lot of money could be made in that industry with less work than is necessary to be a doctor, med school applications dropped. A few years after the crash, applications increased again because the opportunity in the tech field had decreased, unless you had more education.
If you lower physicians salaries then those of everyone else in healthcare must be lowered as well. That is a given. An FP or Ped expects to get paid more than an NP, CRNA, or PA, who in return expect to be paid more than an RN, and so on. Do you think lowering salaries for PAs and NPs will increase their numbers? What about nurses that are already in short supply. Do you think if their salaries decrease the supply will increase? No, it will go down naturally. The fact is people do not pursue extra training, education, and responsibility unless they will see an increase in compensation in return. That is common sense. It has always been that way, except in Communism where people are forced into careers against their will.
So when all the salaries decrease, who will fill the healthcare jobs? Where will the extra PCPs come from when there is a shortage now primarily because of the lower salary compared to specialists?

The AMA has not stood for what I want for decades and when my state unbundled the dues, I gladly dropped the AMA portion. Aggie78 asked what we didn't agree with? Single payer, specialist being medical homes (come on, as an allergist do you really want to take care of your patients incontinence, diabetes, neuropathy and rotator cuff strain? I love my specialist, but they gladly send the patients back to me to handle all the paperwork and centralization of care) I've tried many times to make a dent in AMA policies- to no avail. I'm much more involved in my specialty chapter now and I'm willing to make it my voice.

I am not totally impressed by the work of the AMA
But the ASA ( American Society of Anesthesiologist ) does a stellar job in serving its membership and protecting their interests.
I am now a retired anesthesiologist and have nothing but respect for what ASA leadership has accomplished in protecting the interests of its membership and being a patient advocate in stressing safety in and out of the OR setting

While I agree that the AMA does not speak for me, neither does any other organization as I feel I can and have spoken for myself and my patients with my US Senators and House of Representative. I believe that the best way to influence the path of health care reform is to be involved as an individual as our individual comments, concerns and recommendations due carry weight with our elected officials.

AMA - have never given them a cent...never will. And they STILL send me JAMA every month

I agree generally with all the above. I have the vague feeling the AMA is not acting in my best interest as doctor, but that may be due to my lack of attention. My practice takes up most of my mental energies, and there, perhaps lies the problem.
Regarding the President (Obama) I have the distinct feeling he is behaving like a brash teenager who bursts in on a complex discussion and feels his simplistic argument is all that is needed to sort everything out. I can only think he will make matters worse, catastrophically worse.

With national health care on the way , the future of physicians as union members is inevitable. Government medicince will only respond to a cohesive group who can
vote with their pockets and feet. If the GM failure looks bad to you, wiat unit "Gereral Medicine" (US style) come into being. Hold ontoyourbed pans.

I was not surprised by the response %ages. I am surprised to hear about the funding underbelly, but thats par for the course these days. The goal of a well 'promoted' org is make the pols and pharma BELIEVE they are in apowerful position, not to actually be one.
Since my training is from psych background I would unlikely be an AMA member, and for them to keep track of my CME is a waste of membership as far as I can see. I have recently left APA, altho am more connected with groups like AAAP, ASAM and even AOAAM folks...more in tune with my practice.

Unionization is our next step. Who are these people invited to the white house, sitting at a table and making gestures toward compromizing over health care? They are neither my representatives nor people who I even know. THIS MUST CHANGE!

I don't see what is for profit and what is nonprofit from a doctors point of view. If we all want to be paid like pediatricians, who make less than veterinarians and have a much more crucial role, then we should espouse that we are "not for profit."

We are professionals. Our services are for hire. If someone wants to be Saint Francis they can donate all their worldly possessions and take to the mission field. Otherwise, we have to be paid. We should be paid at a level commensurate with responsibility, procudctivity and experience. We should not be paid less because the president thinks we should be.

The president is smoking something other than tobacco if he thinks MDs will accept anything less.

the practice of medicine in this country has deteriated since 1984 with the inception of insurance based large practices-drg's-ppo's-hmo's,with all of us not paying attention to what was going on administratively because we were concerned with the care of PEOPLE who were ill--we were taken advantage of by the non-physicians who ended up controlling our future-this was becausewe were depending upon those whom we trusted to represent us and our patients best interests=they failed-our representation certainly needs changing-and it certainly should NOT be the government---CM---surg

rdp537 otolaryngology The AMA does represent us. It is de facto the organization of organizations. All states and specialties are represented. The lower numbers of members reflects mounting physician costs not AMA value. Come to a meeting in Chicago and see what relly goes on!

To all the "Fix the AMA" fans:

Why would I spend $2000 to get on board a ship that is not only sailing in the wrong direction, but already sinking?

Why not make dues $0 for one year and then vote on a platform and find out what the docs in the trenches are really thinking? Though, from the postings here, most of our views won't be much of a surprise.

Good idea Dan. This really stirred the pot. Agree with suv and KZ.

Good suggestion suvarov...Is AMAprez listening?

Best way to make your voice heard is to become NONPAR on Medicare and drop those payor contracts NOW! It can take a year to get out of them so get busy.

The percentages of doctors doing this makes a huge difference. If you don't do it you give more leverage to the insurers and government.

i left the ama this year. i just dont see how my dues are doing any good. but i do like my local society.
i still dont understand why it is illegal for doctors to unionize. has this been challenged in the supreme court? if we could unionize, we could pretty much dictate policy. if we can't, then we will always be at the mercy of the govt and insurers, no matter what the ama says- the govt/insurers can always drive a hard bargain by threatening to go to a different doctor. if we have no leverage against that, why kid ourselves that we can change anything? it's freakonomics- all choices have an economic rationale.

I guess I am not suprised that the founder of Sermo is against the AMA but disheartened that he has no concrete suggesion or alternatives. Whether we like it or not the AMA is still the main physician organization representing physicians(http://www.nytimes.com/2009/06/11/us/politics/11health.html_r=1&scp=5&sq=american%20medical%20association&st=cse). Before posters start flaming, I do not work for nor am I a delegate or on the board of the AMA.

What I am arguing is that at this critical time physicians need to stand together and not argue among ourselves. You can be sure that other groups such as trial lawyers and insurance companies are not attacking their professional organizations. We can either work together (either within the AMA or another organization) and have a voice in health care reform or have reform done to us and our patients. I am disappointed that the founder of a large online physician community would create even more disunity and fingerpointing at this critical juncture

No, No, No! The AMA is our last, best hope. They are the only group standing up to Obama and his "reformers" in Congress that want to nationalize (socialize) health care in the US. The only boo's Obama has ever heard in his life came from the members of the AMA. The AMA needs our support.

that physicians are not banded together is the very reason we are in the fix we are in --- we have allowed insurance companies, lawyers and even patient's to dictate to us how we should be practicing instead of being the leaders in healthcare -- now we are going to have the govt and bureaucrats dictating to us as well --- until we are banded together and are willing to control healthcare ourselves i see no good outcome to this --- we will have socialistic healthcare rammed down our throats and that will create a further losing environment where fewer and fewer people will choose to be doctors or nurses with dwindling services based on anything but what is best for the patient--- i am tired of being squeezed by all fronts with no protection and the only way to get that protection is thru a unified front -- that requires agreement on what we want as a medical community --- and how best to deliver ALL services at the hightest quality to ALL concerned including us as physicians

This is the reality at this point
24 % are members and have spent the big bucks
76% are complainers and have spent nothing
95% of us expect better but don't want to spend a penny on it

Now, you 76% *hit heads, some are friends too, come up with your own ideas or set up a damn organization today, collect money ( you can have mine too) or join the AMA and DO SOMETHING besides bitching. At my age I don't need to worry much longer about the practice of medicine- I worry about being a recipient.

I am in total agreement with the commentaries.

AMA needs to pay attention to our collective mission of keeping Citizenary AND The Nation in GOOD HEALTH.
AMA's stand is NOT part of my Hippocratic Oath!

hqc

70-80% of primary care physicians favor single payor? Not in my part of the country.

And those of you who get your news on what the AMA is doing with health system reform from the New York Times, that's like getting your CME from Grey's Anatomy. Please. You're smarter than that. If it offends your sensibilities to get information directly from the source, ask your state medical society.

Just because the AMA President didn't mention tort reform in his question in the White House last week doesn't mean he hasn't spoken about it personally to the President. He has. And in multiple media interviews. He's from Texas and we know tort reform is crucial.

And yes, I'm an AMA delegate (not old or male, sorry) and we applauded the President when he spoke to us because, by God, he's the POTUS and we respect the office. We applauded the things we agreed with and let him know about the things we didn't.

You may think that AMA Trustees run off and say whatever they want to, but they actually stick to what the House of Delegates says is AMA policy. We argued for HOURS about how to frame our comments because that's exactly what our leaders were going to have to go out there and talk about.

It seems to me that the AMA has become the scapegoat, the symbol for our dissatisfactions with our profession. The single payor advocates and the libertarians both don't like it. The primary care folks and the specialists think the AMA favors the other. The Democrats think it's too Republican, the reds think it's too blue. We take one particular issue that sticks in our collective craw and make that the deal-breaker. No wonder no one wants to listen to us.

I resigned from the AMA because it no longer represented the interests of medicine, physicians, or patients.

Send this info to the AMA. They need to see what a horrible job they have done "representing" and supporting us. What an embarrassment they have proven to be.

Let numbers and honesty speak for itself. No one can argue with that.
Doctors among other things still retain credibility and compassion which is sorely lacking in general. No matter what, when people are sick, they want to see the doctor. The public knows this. We are pivotal in whatever happens.

Lets not let healthcare 'entities' or orgs gag us and speak for us.
If the AMA and the like can't or won't speak for the real physician community,
then let us.

Let's update the public.

Let's make it trully known just how long it takes to be a functioning attending physician
Break it down per field and specialty...

Let's make it as public as possible how long doctors work in the day-to-day, and how much they get paid per hour in military, public, and private settings and per fields.
Compare this per other 'on par' or similar professionals. I don't know any rich country club doctors who play golf on weds anymore do you?

Let's list how much doctors average in final school loans and how long it takes to pay them off. Cost of practicing medicine and the return on investment don't make sense anymore. Let's tell the public for the first time, doctors are not telling and in many instances discouraging their children from entering this profession.

Let's list how many malpractice lawyers there are out there compared to practicing physicians.

Let's list how much doctors pay per year for malpractice insurance coverage just to be allowed to practice. Break it down per state and perhaps a distrubing trend on doctor exodus per state might emerge.

And let us show how doctors spend un-godly hours, toiling in anonymonity, dealing with life and death daily, under extremely difficult circumstances and are trying to make a decent living after so much finanicial and personal and community sacrifice. And we still try to do the right thing by our patients no matter what. Especially show how many doctors are doing charity care.

It occurred to me many doctors no longer take Medicaid because what is paid is worse then insulting. If Medicare/public option is expanded and as a result, reimbursements decline to doctors and hospitals, maybe the day will come that many if not most doctors won't let this stand and opt out. More rules, more regs, more/sicker patients, less pay, fewer malpractices carriers and higher premiums = doctors are out of the equation.

Already, in my local hospital Medicare is denying Chest Pain ER admissions unless many stipulations are met...

If the once flowers of civilization (Sir William Osler) are now becoming trampled, only weeds will grow and people will ask where have the doctors gone.

I propose the above --keep it simple for the public and media to review this and just how other social media sites helped smuggle info out of tyrannical countries maybe they'll get wind of our plight and let it do the same for us.

Cut through all the hype, talking heads and list the above. It's only right to at least show the truth.

Let the public and real news outlets portray the truth and let the public come to their own conclusions.

If its ok to work us to death, make us legally responsible for everything untoward, and diminish our abilities and our ability to earn a decent living for our work, then I propose salary caps and legal insurance on politicians, sports figures, entertainers, lawyers, business guys...oh these are the ones calling the shots, I forgot.

The decision to change Sermo's public position on something like our relationship with the AMA does not come lightly. We struggled for well over a year to help the AMA engage with the Sermo community. I watched the AMA decline free access to this community in favor of spending hundreds of thousands of dollars on market research because they did not like what this community had to say. I saw Ron Davis (may he rest in peace) the former AMA President, bravely venture into the fray to engage this community, only to be chastised by the AMA beaurocracy for speaking directly to the physicians in this community without "clearing it with them first" (I kid you not).

I puzzled long and hard to try to understand why the AMA could be so completely blinded to the overwhelmingly negative sentiment to them. They called Sermo a renegade band of "non-joiners" when we were 20,000 physicians, they said we did not represent the true voice of physicians when we were 60,000 and now at well over 100,000 physicians, there is less interest than ever to engage (we've recently shut-off all of the AMA's access to the community after they declined to work with the community). Today, Sermo's membership is likely close in size to the number of "true" AMA members. All the while, the AMA's ranks continue to shrink. The trend is clear.

That power of self delusion is absolutely shocking. What I witnessed first hand is that the AMA will blame everything and anything rather than do some serious self evaluation. So be it. There are a lot of people at the AMA getting very wealthy off of licensing fees and subscriptions. I truly have no qualms with people making an honest living. After all, I am a Surgeon but I am also an entrepreneur and the (young) CEO of a for profit venture-backed start-up company.

Here is the issue. The pretense for the AMA's profiteering is provided by a falsehood that is fundamentally dangerous to the medical profession. I don't know if the AMA's ineffectual current state is because of their staggering beaurocracy (they have well over 1,000 employees) or their conflicts. But the ripple of effects of their actions have been massive. Nothing, absolutely nothing has done more damage to physicians and the practice of medicine in this country than CPT codes. The fact that the AMA makes millions of dollars licensing those CPT codes is deeply troubling. There is little doubt that the AMA has been negligent in their responsibility to prevent the downfall of our profession. Frankly, I believe the AMA has been complicit in that downfall. That is what this post is about.

OK, so enough with the AMA bashing. I've stated this before and I'll state it again. Sermo is not a public advocacy organization. It is a for-profit start-up. That being said, we have created the largest, most vibrant physician forum, ever. As such, I feel that we have an obligation to provide a medium for the path forward. In the best case scenario, the AMA can change it's ways and continue the struggle. If the AMA is to be our representative organization, we need to take it back. Anything worth having is worth fighting for. Having said this, I just don't think the AMA is worth the fight. Their resistance to change and focus on self preservation is impressive. There are an increasing number of other physician advocacy organizations that are seeing their membership swell. They are a very viable alternative to the AMA and they are ALL welcome to participate in Sermo. Membership is....free.

So where does this all go? Here is my thinking. If you want to see a radically different outcome, you need to subscribe to a radically different strategy.

For physicians we have let the issues that divide us define the debate rather than the issues that unite us. That must change. We need to take one step at a time and leverage our large numbers and consensus to advance a single issue, rather than falling into the constant infighting that has defined physician participation to date. The journey, no matter how long or how complex starts with the first step.

For better or worse, that first step needs to be distancing ourselves from the AMA. The AMA provides a pretense for those who would endeavor to appear that they are working with physicians without having to deal with the tough issues. For the parties that physicians must square off against, they could hardly ask for a "better" adversary than the AMA.

So first step:
Ditch the AMA.

Next step:
Take a stand. Tie a knot

Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.

The AMA is much like the newpaper business, dead and not aware that it is a has been and is being rapidly replaced by 'new media' such as blogs, Sermo, iMedxchange, and others. These media are an instantaneous 'two way street' for conversants. It is also accessible to others who are interested and need to make correct policy decisions. There is no 'watering down' of the message as it goes through 'committees' from local to state, regional and national representatives.

As to who speaks for physicians, and even more important, our patients? I say we all do, and far better than the AMA. Most of my patients (the educated intelligent ones), who have a lot to lose, as we do, understand the gordion knot that threatens to entangle all of us.

I am amazed at the number of comments made on Sermo in regard to political activism. It is one of the busiest forums and sections on a social networking site that was originally designed to have information that pharma and other sponsors could obtain surreptiously.

I don't believe Sermo speaks only for Dr. Palestrant... Does it, Dan?

Our problem with the AMA is the same as with our government. Our so called "elected representatives" no longer speak for many of us who are expected to work and pay taxes to support those who feel they should be taken care of "cradle to grave". There seems to be an increasing sense in government that we can continue to spend money we don't have and just print new money out of thin air and tax the ever diminishing productive sector of our populace to make up the difference. This is not a republican vs. democrat issue but more a systemic problem that those in power refuse to acknowledge openly. If the government were a business, the shareholders would have thrown everyone out on their ears (unless they were consistently lied to until it was too late and the business went bust...sound familiar?)
I'd guess that the initial concept of the AMA would be that practicing physicians would band together in common cause. The idea would have been for practicing physicians to represent us. Now we have representatives beholding to insurance companies and drug companies who feel they don't need us. It's the same with our government. Rather than having concerned citizens serve, the government is populated with career politicians who court special interests. They don't even read the multi-thousand-page bills they are presented with 2 or 3 hours before a vote.
With all due respect to drleerubin, the apathy is most evident in those who are blind to the above problems and continue to meekly vote in the two-party system and hope that the AMA will ever change. Real change will come from a grassroots effort to awaken the public (and our fellow physicians). Sermo can be a part of that effort.

I am a local med society district president and in general, a believer in organized medicine. I have been mentored by some truly great physicians. I however have been very recently disappointed in the AMA, insofar as they appear to be very enthusiastic to cooperate in the wholesale takeover of American medicine by the Obama administration. We need to shout stop!

I do agree with Dan's letter. However where do we go from here? I have written senators and congressmen, but feel like a squeaky voice in the void.

and, Suvarov, you do not disappoint me. Fascinating.

And dkames, yes, the enemy is us. Have far too often quoted the great Pogo. But I am at a loss. I talk to my patients. Some care. Many just don't believe the changes in healthcare will really affect them and their relationship with their own doctor.

I am old and grizzled enough to remember the days when people had insurance and went to whatever doctor they wanted, as long as he/she was licensed.

And, in the beginning, when I left med school, I didn't join the AMa because I couldn't afford it.

I do believe that Kristof's piece in the NY Times addresses the point dead on: "In fact the A.M.A. now represents only 19 percent of practicing physicians ( that's my calculation, which the A.M.A. neither confirms or contests). Its membership has declined in part because of it embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman's plan for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton's health reform plan."

In their recent Perspective in the New England Journal of Medicine, Fisher and co-authors call for physicians to "lead the change our country needs" in the dysfunctional healthcare system. While suggesting some areas for physician involvement, the authors say that physicians should "first help 10 create a shared vision that could overcome doctrinal divides" and that they must also "recognize that achieving savings sufficient to cover the cost of expanded coverage need not impose a hardship on patients or providers." Physicians must help with a health reform deal that "all stakeholders can support."

Below are some references.


Clark D. Hinderleider, M.D., Ph.D.
Principal Consulting Clinician-Scientist in Cardiothoracic Surgery and
Physiology, DOCS
Chair, Healthcare Legislation Task Force, Health Council of Marin
email: CLARKMDPH@aol.com

REFERENCES:

ACP, "Achieving a High Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries," Ann Intern Med 2008; 148:55-75

Altom, LK, et al., "Pay, Pride and Public Purpose: Why America's Doctors Should Support Universal Healthcare, Medscape Journal of Medicine 2007; 9(1):40-47

Fisher, ES, et al.,"Achieving Health Care Reform-How Physicians Can Help," NEIM 2009; online first, 20 May 09 [doi: 10.1 056/nejmp0903923]

Gruen, RL, et al., "Public Roles of US Physicians," JAMA 2006; 296(20) :2467 -75

Harris, JP, "State of Nations Health Care," ACP, 3 Feb 09

Hinderleider, CD, "US Physicians Must Support Universal, Comprehensive Healthcare," Webcast Editorial Draft, Medscape, Jan 2009

IOM, Insuring America's Health: Principles and Recommendations, 2004

Kristof, ND, "The Prescription from Obama's Own Doctor," NY Times Op-Ed, 24 June 09

McCormick D, et al., "Physicians' Views on Financing Options to Expand Health Insurance Coverage; A National Survey," J Gen Intern Med, online 9 Jan 09

Shortell, SM, "The Physician as Public Health Professional in the 21st Century," JAMA 2008; 300:(24):2916-18

I dropped out of the AMA several years ago and have never regretted my decision. The AMA does not speak for me and I would be embarassed to be a member of that organization after the last showing with President Obama.Physicians must learn to say enough is enough and to paraphase "we're mad as hell and we're not going to take it anymore".When will Doctors truly unify and take a stand against big government. If congress wants universal health care, let it begin with a 4 year trial of their new plan to initially cover all politicians, congress and government employees and thir families. As we all know ,that will never happen.The AMA represents itself and does not act in the best interest of physicians.Tort reform has been a glaring issue for many years and the AMA has been unsuccessful in acheiving any progress whatsoever towards this end.Tort reform must also be part of any new insurance plan and if it is not,then physicians should refuse to participate in it. Physicians truly need a strong voice that will support the physicians best interest and not the politicians best interest and one that would not be swayed by someone the like of Obama.

The AMA is a very socialistic organization and only represents primary care.

Dr. Palestrant makes the point that neither the AMA, nor any other group can speak for each physician's view. When I awakened to the reality that doctors were not in control of health care, I asked who was speaking for physicians and who were government and industry listening to? The AMA, the ACP, the ACS, and others have standing; but the AMA, and the state and local affiliates are the only ones that welcome me-a member of a smaller specialty. Following the adage that you can only be listened to if you show up and participate, I am now a delegate for my specialty society at the AMA House of Delegates (HOD).

Through the growing representation of specialty societies, essentially all physicians have a link to the AMA. All can speak to their groups' representative, if they chose to ask and make a phone call. No other group is trying to listen to and speak for all physicians.

The AMA is changing, and you have seen the recent TV campaign focused on the problem of uninsured patients, something every physician sees affecting their practice. The AMA, through the HOD, chose a strategy of being the organization that would help doctors to better care for their patients. Because it's the health of people that matters, and that we are charged with. That is not the old AMA that has had troubles with corporate politics, bureaucracy, and greed (because it's made of people).

The AMA can change if the right doctors speak up and participate. Drs. Davis and Nielsen are a couple that spoke up well. The result being that Obama, unlike Clinton, is listening to physicians through the AMA.

Physicians like drdmnto 1, give all physicians a "bad name" vilifying "big government " and "someone like Obama."

Medicine is about the PATIENTS' "best interests." Put down your balance sheets and pick up your oaths and get to PRACTICE not BUSINESS of medcine.

CDHMDPhD

IDologue,
Why are you criticizing those who are standing up for the very reason you went to Medical school in the first place? Did you think that after reading the open letter everyone's eyes would open? It doesn't work that way! You try, and try, and try, and after failing 100s of times, you try some more! Maybe you're satisfied with other people without any medical background telling you how to treat your patients, but most of us are not! If you're perfectly happy spending the rest of your life in dept, and eventually paying others for the privilege of practicing medicine, be my guest. These people are not ready to bend over and take it, and that deserves respect, not criticism!

39 years out of med school and I never once considered the AMA was representative, worsening with PAC money year by year. Take a look at the evolution of the AMA Guides to the Evaluation of Permanent Impairment as they have evolved toward the insurer benefit edition after edition, the worst or best example being the completely unwieldy 6th Edition - uncooked, markedly more difficult to use, yet no rise in reimbursements to docs spending more time to complete and justify a rating, much more subjective yet they are suppose to be objective, yet many entities make millions off of the publication. Just nuts .... Don't waste the time going after them. Build a new model and shove theirs off the road.

Amen.
The American Association of Physicians and Surgeons speaks for doctors today!

First step would be to improve Sermo -
How come the following Sermo member (with utmost respect - may she rest in peace) is still being counted as a member?
Sermo Doc

Make Sermo much more functional - make it a necessity
For one example - ask one person from each specialty to link all case conferences posted on Sermo within that specialty in a single posting, with brief introduction and reviews.
'Deactivated member' needs sub-categories & more functionality. We should be able to look Dr. Ron Davis' postings. He is listed as a deactivated member. Seeker left by choice. We should be able to read seeker's postings.

With great love for Sermo, kindest regards for the Founder, and all dear colleagues, this is a premature posting.

AAPS is an organization that is pro doctorAapparently this organization was large in 1940's.about 40000 strong. I would encourage all docs ,both MDS and DOS ,which it accepts all comers and see what there a about. See if they represent your voice.

The United States is not a free country. Anyone who believes this is still living in a grade school history class world. The laws of this country have made it illegal for physicians to form a labor union. This is why we have been pushed around for so long. We need to challenge the system like previous labor leaders at the risk of jail or fines and show who is boss. Nothing short of this will work.

Right on. This is the same reason that i have been "sorely tempted to drop out of my state organization. maybe we can get somebody's attention. thanks

Dan, I am glad to learn that the AMA has been cut off from access to this Forum. I have been holding back from freely posting here, and hanging out over at MedScape more, in the mistaken notion that they were still lurking.

I have strong opinions on this matter. I joined the AMA as a medical student, and was active in the California Medical Society as a student. I was part of the AMA RPS, at the time that Jim Rohack was part of it, and when Ron Davis was in the Medical Student Section of the AMA (may he rest in peace). I stayed in the AMA for a long time, and tried to be active in my state medical society. But, the "old boys" don't like to get out of the way. I finally left the AMA after the "Sunbeam" matter.

epediMA and Motto: Massachusetts is and always has been unique, and a more welcoming state medical society. They very early welcomed the involvement of resident and young physicians. I do not think that you can assume other state medical societies will be as welcoming.

As for joining the AMA and reforming it from within, I think redhawk has made a good point. A sudden onslaught of members will be viewed as support, and it is unlikely that we will be able to have instant impact, or even a meaningful one in enough time to matter. How many years has it taken Dr. Rohack to reach a position of influence? About 25 years, give or take a year or two.

The AMA is famously reactive, rather than proactive. Throughout the years that I was in the AMA RPS, we continually lobbied the AMA about residents' hours. We were told that "it was not a priority." It was not until Libby Zion died that the AMA took a serious look at limiting house staff hours. Reactive; not proactive.

Others have mentioned the need for accurate media portrayal of physicians. I recall that in, I believe, 1985, the AMA House of Delegates debated whether or not the AMA should pay for and run a magazine insert promoting the work of physicians--a positive PR campaign about doctors. It was voted down as "self-serving" in appearance. Of course, the Executive Committee did not seem to find it self-serving to endorse a line of products ten (or so) years later??

Dr. Perlmutter makes excellent points as well.

Yes, the AMA is a magnificent thing. To stand in the floor of the House of Delegates is a moving experience. To watch delegates from every state in the Union deliberate and vote on issues, to feel like a part of "The House of Medicine" can be overwhelming; the panoply is exhilarating. But. It also has become unwieldy, and not everyone there continues to act with the same diligence with which they started. There are, after all, no term limits in the AMA HOD.

In the main, I believe it is time for something new. I hope we can find a way forward that most of us can agree with.

>>> The level of apathy among physicians has never been greater... 75% of respondents to this Sermo Poll are not AMA members?

Hey, I am very politically active when it comes to healthcare, but not through the AMA who seems to always be on the other side of the tracks on issues s.a. CCHIT and certified EHRs, and has done little to nothing about Tort Reform. The are softly against universal healthcare, but I'm aghast that they allowed President Obama to even speak to a group of AMA docs! What were they thinking?

This post is a high point for sermonians! I'm proud to post here. What exactly is the association between sermo and the AMA now?

Al

Al, good to hear from you...Dan just answered your question...they have been cut off.

I left the AMA years ago when it became apparent to me that it seemed to serve only the interests of specialists. Primary care physicians were just too busy and too poor (monetarily) to make it into the influential circles of the organization where the important decisions were being made. I don't recall a single AMA policy that ever favored PCPs over specialists or did anything to even attempt to bring about REAL tort reform.

Dan,

Givem'n hell Dan. I agree. Cut those greedy self serving AMA off . Time for a new organization even at this late date. This is realtime disruptive innovation happening before our eyes.

Looks like you appropriately attempted to work with them and couldn't reach engagement with them.

The real question is how do we quickly pull together a competitive alternative organization that will likely get us to the White House steps with Obama.

This is not impossible, Obama comes from grass roots community organizing the Chicago way and if done right Obama will give us the necessary influence coming to the table with the hearts , minds and desires of 100,000 US physicians.

I am on board for the next steps. Enough postings. Time for a shake down. Why don't you do a Sermo 3 to 1 match funding raiser to get this new organizaiton off the ground or a 2 to 1 or 1 to 1. Whatever good faith $$$ Sermo is willing to put on the table.

I am happy to put $500 on the table. Just set up the buiness account and before you know it the $$$ will come and the zietgeist spirit will lead us forward to a better physician organization.

Give it a thought , Dan. The system is so, so. broken with variation and disparities, we are the only one who can start down a new road and journey to fix it !!!

We have nothing at this point to loose except our self dignity , profession and accountability to our patients and society.

75% not AMA members-- 75% freeloaders. The AMA is the ONLY reason your Medicare payments haven't gone down 10% and more. Specialty societies didn't stop that one. Only my state society has kept my Medicaid rates from going in the toilet. You freeloaders don't pay dues, but you get the benefits. Do you really believe a WEBSITE can advocate in Washington? Are you insane? Or just stupid?

Is the AMA perfect? No. How many of you willing to abandon the AMA are willing to do the hard work that political advocacy is? I'll bet fully 75% of the anti-AMA crowd couldn't even name their US Senator...

AMA is ineffective organisation with impotent voice,we need to make union and see how easily we will be heard and paid attention to.

I find myself in total agreement with Dr. Palestrant.

The AMA adds to the unnatural complexity and cost of health care through the CPT coding system. The AMA perpetuates and exacerbates the primary care shortage through the RUC. By consistently working to obstruct health reform the AMA presents medicine as a self-interested guild lacking compassion.
None of these seem to line up with the ethics and compassion that underpin our profession.
Gordon Moore

That is the beauty of disruptive innovation- we will soon separate the men from the boys.

The only thing at stake is our survival - who really cares?- the AMA or Sermo believers !!

I with the later, AMA has done very little to address underserved communities with huge disparities in care. Read the IOM reports and Commonwealth studies- were are hemorrahaging and in cardiac arrest- we need to shock ourselves back to life and move forward with new hope and a new organization.

Wizard, get off your high horse! I paid dues for 25 years, until this year. I have met personally with my Senators and Representatives. I support my specialty societies. Don't be so swift to condemn us because we have found a voice on Sermo.

I agree with Dan.

While most docs largely agree the AMA doesn't speak for them, my take is that this is for different reasons.

I'd guess about 50-55% of all docs nationwide think the group's policies are overly conservative and don't join because they see the Association as defending the status quo, but about 45-50% think it's too liberal and don't join because they see is as too close to govn't. And my take is that a cross section of SERMO doesn't necessarily reflect the average doc either.

The fundemenatal problem the AMA and all docs need to graple with: are patients and docs better off putting more faith in the govn't to run a fair system and improve access, or are we better off trusing Big Insurance to run the system. While we'd all like to say "neither" and develop botique practices, it may not be realistic to think that typical patients want to pay cash in this type of model. Hence, I'm not sure that "neither" is large-scale feasible.

The AMA's trying to split the baby, making tiny overtures to the govn't while screaming about the downsides of Medicare/Medicaid. But to paraphrase Howard Zinn, 'you can't remain indecisive on a crashing train...'

The AOA is even less of an advocate for practicing physicians!

Dan, looks to my humble eyes that we Surgeons have got to move this forward. Right on rarmstrong.

Trojan surgeons are the best !!!!

Here, here, amen to the distain for the AMA. I wrote a letter of protest to the AMA for inviting Obama to their meeting and allowing him to use the podium at the meeting as a pulpit to spew his lies and rheoteric. "High quality care at low costs", what baloney. What Obama intends to do is saddle doctors with the responsibility of telling patients, "sorry, you can't have that test(treatment), it's too expensive", and then leaving us to defend ourselves against lawsuits. The AMA has been a puppet to this administration and others when it comes to healthcare reform. They did not stop the Medicare drug legislation and will not raise their voice against this new reform. The AMA is not representing physicians, it is a way to get cheap services such as care rentals and insurance. We do need to stand up and reform the AMA before we can reform the nations healthcare.

italiaroma - You say you wouldn't have sacrificed what you did "...to be compensated at the same level as as an autoworker with little education"(?) You seriously give elitism a bad name.

As to your main point that "...you do not continue to get the best and brightest by lowering salaries", stating that this is true for "...any industry". The problem is precisely that medicine in the US is more of an INDUSTRY or a COMMERCIAL ENTERPRISE than the very special public service it should be.

I fully agree with clarkmdph who put it very cleanly "Put down your balance sheets and pick up your oaths and get to PRACTICE not BUSINESS of medicine".

I don't see anyone out there sending checks back to Medicare (and other payers using Medicare as a guideline) after the AMA fought off big cuts over the past several years. Does anyone really think this would not have happened if AMA had not fought hard here? This alone would pay your dues many times over.

And who do we think the AMA is, anyway? These are practicing docs who feel the same pain as you and I. Fine, let's have no organization representing the COMMON interests of physicians at the national level. Ler's have a bunch of specialty societies fighting over their piece of the pie.

There is no other trade or profession where fewer join their national association. The auto workers, the teamsters, etc., don't agree with or like everything their leadership does. But they sure wouldn't want to do without that voice. The AMA DOES represent you, whether you realize it or not - again, only on those issues common to us all. Shame on the 80% of US docs who get the benefits, meager as they may be, that the other 20% pay for.

Thanks Dan. I think it's about time that physicians true opinions get heard.

When LBJ was fighting for Medicare in 1965, the AMA forcefully (and shamefully) opposed it. Now most of their correspondence to me consists of sales pitches for their (overpriced) insurance. When they fight for universal health care, I'll support them!

I am proud to not be an AMA member. Member of the ASA, FSA, ASQ, ACHE
I believe AMA does not represent us and is bad for the medical community, but these days of 'health reform' no AMA can be worst.

Anesthesiologist

Never belonged to the AMA, and never intend to. I assume it is due to their one-time association with Sermo that I get JAMA, but I read only "A Piece of My Mind" and recycle it. I was heartened when Ron Davis came here to listen to us. He was a great guy and died too young. None of the AMA presidents since Ron have showed up here, and I doubt they will. It speaks volumes that the AMA is not interested in communicating with the over 100,000 physicians on this forum.

AMA may not represent your need, but it HAS tried to provide an interface with the person who's money is at stake. If they hadn't been around, we'd have been using 70 different ICD-9 coding manuals. Please read below.

Next move? Unless the holders of the purse string is the patient, we are bound by the system that pays us to play by thier rules. It is their money. The AMA is positioned to guide this premise and until it changes, all the rest of it is hot air.

Starting a "new voice" is noble but will have NO significant voice with no significant history.

But let's look at the "best voice" if the AMA is no longer "representative." Where could the best advice come from? The primary care and larger specialist groups are biased. Not them. The local and state medical societies are the most non-partisan as medical professionals have to offer.

Thus, I would suggest using the state and a selection of local medical societies be invited to participate SOON!

Finally, on another note to keep in mind, we all must be aware: if you were the payor, what would your "rules" be and how would you enforce them to reign in the natural greedy human instinct? Everyone who touches the patient wants to earn $100+K a year. (providers, therapists, orthotists, pharmacist, the list goes on.)

EACH group wants their part of the pie... Physicians must cooperate and lobby with the caregivers that we depend on: nurses, patient aids, physican therapists, and Hospitals. These are the tools for good patient care.

Lets think what's best for the patient and THAT combination will have the most power in Washington. It is complicatedly simple!

The most fascinating observation from reading the nearly 300 posts today is the variability of how people view the AMA policies. Specialists think it promotes the primary care physician's agenda. PCPs feel the AMA supports mostly specialists. Liberals feel the organization is too conservative. Conservatives feel it is too liberal. This validates exactly what I have observed during my 11 years in the AMA - they really do represent the views of the members on each individual issue. However, they may not represent YOUR particular views on a specific issue. Each policy is debated at length before any stance is made. The AMA members, delegates, trustees, and officers come from many different specialties, backgrounds, and parts of the country. They have different views. When a vote is taken sometimes the conservative viewpoint has the majority, sometimes it is the liberal view. On some issues the PCPs seems to benefit and on others the specialists. Any organization that tries to represent all physicians is going to have a dilemma finding common ground due to the varied agendas of each physician. However, it is important that we do come together and do speak in a unified voice. How would something like SERMO be any different. Just today we can see the wide variation of opinions even among the anti-AMA crowd. Some feel the single payer will be the end of the world, others think it will be the savior. Why would you think that any single group could satisfy you more? There are many times that I do not get my way when I am testifying on the floor of the house. However, there are times I do. That is the beauty of a truly democratic organization such as the AMA. Everyone does have a voice. Remember the delegates are chosen by the states and the specialties. So anybody active in the constituent organizations can have a say in who represents you.

Dan,

Ever since I joined Sermo two years ago I have hoped that you would realize that you are the natural leader for a new physician voice. This day has come. Thank you. I will do anything I can to help.
So.....sign me up Dan, I am on your team
:-)
Peace

YEAH !

There are many issues that unite us that we can stand up for. This country is founded on people united at first in small numbers to make a change. If other groups can do it , so can we.

Any medical group that claims to represent physicians will fail. The medical community is a heterogeneous group divided broadly by specialty and may be even more important by geography and scope of practice. The insurance companies are too big, smart and rich and they know how to divide and conquer.

My Suggestions:

Create multiple groups of specialties with a leader of each group ( this is already done)
The leaders then meet to formulate a broad understanding of what the problems are.
Package those problems and one person goes to the government and present the package.

Personally I do not know who the AMA is and I have been practicing for over 10 years. I am in rural America and all I take care of, are people with Medicaid ( over 50%) of the practice. I work solo and I do just fine. So if we go to a single payer system, am sure it will not change my practice much.

I do wish though that the government knew the kind of issues I have and took that to consideration as they deliberated because it will not help them to give money to insurance companies only to leave a bunch of my patients uninsured.

There is also no money given to improving access to health care. Once you have insured everyone who will take care of them? Do we have enough doctors there who will work 12 hours a day for 20 cents to a dollar and be happy.

I am just saying, Someone out there better start thinking and talking to some body

Although I do not agree with all that the AMA stands for, in the end, it is still the MOST powerful voice we have (politically speaking). We cannot create change by becoming EVEN MORE fragmented. We need to find the time to become involved. If we don't get involved in our future because we are "too busy" I can assure you that the lawyers and politicians have the time to make decisions FOR all of us.

Here here Dan P. We need to join the AAPS. Go to aapsonline.org.

I think we should consider Suvarov's earlier proposal of parties. Too many of these discussions get dominated by extremists and/or obnoxious people and we lose many thoughtful viewpoints and ideas which would help us move forward.

I concur that no one organization would be capable of being representative of all physicians, as we are quite a heterogeneous group (easier to herd cats, as they say) !
There is no use in furthering our fragmentation by demonizing any organization that in the end, would not exist if it did not have some legitimate interest in protecting the rights and interests of physicians in general. It is possible to belong to various physician organizations, and not fully agree with any of them with regard to the totality of the positions they have taken. Often organizations take positions that are politically correct in order to project some image that they have determined serves a P. R. advantage. Politics lead to strange bedfellows, as they say.
When you see the AMA House of Delegates applauding the President, the majority of those individuals are showing respect for the person and the position, and not realistically intending to express enthusiastic support for the program that the President might be promoting in actuality. When Hillary Clinton addressed the House in the early 1990's, she also got a respectful standing ovation, and I was one of the Delegates in that era. I can assure you that only a small minority of those physicians actually supported her proposals. One can applaud out of respect, and out of appreciation that the speaker has shown to honor the profession by addressing the organization. One can applaud simply because the speaker has expressed their ideas in an eloquent manner, and because one wishes to acknowledge that one does not choose to ignore the speaker's opinions, even if one might not in fact agree with their conclusions. We can choose to keep an open mind, and listen to all inputs, without being perceived to be endorsing the package that is being presented or the viewpoint that is being expressed. Physicians are complicated and intelligent, and we can disagree with each other on many points, not to mention disagree with any given speaker that may address any of our constituencies, without being disagreeable.

Rural Blade hit the nail on the head. The useless AMA is also responsible for not defending physicians against diminished reimbursement from insurance companies that has helped to erode the physician-patient relationship to the point it is today. Maybe health care costs wouldn't be so expensive if we could actually spend time with patients to tell them that a study/treatment is futile! Oh, and too bad we can't get the lawyers out of Congress. If we could, we might actually win a battle on TORT reform (hello reduced medical costs). I am so disgusted with the AMA and this administration. Everyone needs to vote for the right party this time in 2010 and tell your friends. We can no longer be complacent or pretend to be a bunch of softies that just want to help everyone. We need to defend our profession so that we will be able to have the freedom to provide our patients the care that they need. If the government offers expanded health insurance that is less expensive, the other companies will be out-competed. There is no choice in anything that Obama has offered. He is spending our hard-earned money like a person would who never had to earn money. He is passing bills that no one can read and is single-handedly changing the face of our nation. This is not merely paranoia. Any of you who intend to sell your homes shortly may wish to take a peek at the new energy bill. Wake up to those of you who voted for Obama. They will probably be swooping down on me while I write this. I'll be sure to inform you when this happens.

Is the sky really falling?

I just invested 50K in new office software so that I could hope to run my horrendously over-regulated practice like the business it has been transmuted to by outside forces. Thank you Mr. Obama for PQRI and E-RX funds, not to mention the the 50 K for "meaningful " EHR use in the future. I expect this new system will save far more in overhead searching for charts each and every year than it will cost me this year.

As long as we continue to fucus on the incredible privlege we have as physicians, to help others in ways that no one else can and bring our values and our value to the public we should not lose. If we cannot remember to treat each patient as we would want a member of our family treated; if we forget to try to do it it the first time; if we try to fix something that doesn't need it; if we forget to be nice and tell the truth, and if we fail to expect excellence from ourselves and deliver it to others always, then we should not hold ourselves out as physicians worthy of the profession. If you want respect, do something to earn it. All medical care is local, delvered in the interaction between the physician and patient. If all patients felt they had physicians who cared for them, we would have no political problems at all, having every patient in the country on our side and lobbying for us.

Just my thoughts and the 5 rules of my practice, for what it's worth

Leland...I disagree, watch any state of the union adress and see what happens when policy is not ageed upon by the other party, they sit on their hands, and stay seated. It's not that they are disrespectful, it is that they are voicing a silent opposition to policy. When the delegates applaud, they are in agreement. Can you imagine the impact if at the end, the room remains silent except for a scattered few....

you know what they call someone who stands and applauds policy that is not in their best interest, or the best interest of the people they are supposed to represent?

Cowards.....

I agree with drleerubin as well despite my inherent discouragement. Now is the time for the AMA to approach the physicians through SERMO and apologize for poor representation in the past and reassure us that this "change" won't happen with the AMA lying down. I will then join the AMA immediately.

funny eyedoctom1

I tend to look at what an incredible privilege society has to have the top intellects in America going to medical school. I certainly am priveleged to be a doctor, but it was not GIVEN to me, I had to work for the opportunity, so did you. And as far as the PQRI and ER-X funds. Why are you thanking Obama? you should be thanking me and everyone else like me. You should be thanking the American Labor force since you see we are the taxpayers that made the money through hard work and dilligence that allowed you to have the privelege of getting those funds.

If you want, you can probably get some free cheese too if you try.

Bowdend- Believe what you want, but it still does not change the reality. It is what it is. Just because you believe everyone should be willing to sacrifice 11-16 years of their life either going into debt or earning a pittance while working extremely long hours all in the name of becoming a public servant for an average wage does not change the fact that the vast majority of people won't. And you definitely will never see nearly enough who are qualified to be physicians willing to do that. Again, why do foreign trained physicians not stay in their homelands earning less money in the name of "public service" to their home nation's people? And even with these docs, we still have a shortage in this country. How are lower wages going to fix that?
Medicine is a business as well as a practice, and the moment you forget that you will go broke. That is unless you are wealthy before you enter the practice of medicine. I for one came from a poor, 1-income(truck driver) blue collar family. I will inherit nothing when my parents die, and I must provide for my family's future completely from my own earnings. My wife's family is poorer than mine. She grew up with a welfare Christmas every year. I have no one else to back me up if I become disabled or die. The expensive insurance policies I must take out will have to suffice. So yes, I do look at my balance sheet, because if I don't, my kids won't go to college, I won't have a retirement, and my parents may never be able to fully retire as well.
How many other "public service" jobs take such a significant amount of training, and have human lives in the balance with every decision? And how many public servants will be sued for, and possibly lose millions because of a bad outcome even if they were not at fault? What public service jobs are there that follow your belief? Can you name any? School teachers will go on strike for better benefits and pay, even in places where they average $65,000/year. They will close students out of schools for a month or more waiting for their demands.
Politicians are the ultimate "public servants" and are reimbursed very well, with the expectation that they will do even better after their years of "service" as well. Just look at how much more money the Clinton's have now versus before his Presidency. Al Gore also has a significantly greater net worth now than 10 years ago, by millions.
The only true public servants are the military personnel, and even they expect to be paid , and care about their bank accounts.

I've been an AMA member since my first day of med school and cringe every year when I see how high the membership dues increase while the membership declines (25 - 30% of US physicians according to a 2005 Lancet article). When you exclude all the med students, physicians-in-training, and retirees, the number of active physicians who are AMA members is much lower. I, like most other physicians, get a lot more out of my speciality society (American College of Cardiology) than I do out of the AMA and even my state and local medical societies and can't blame other physicians for cancelling their AMA membership, especially with how expensive membership dues have become.

Having said that, the AMA is still the largest group of organized physicians in the country with considerable influence at the federal level. No other speciality society comes close. Furthermore, with all the conflicting interests between specialists and internists, cardiologists and radiologists, surgeons and clinicians, etc., it's tough for physicians to advocate a unified voice at the federal level. For instance, primary care groups want higher payments at the expense of specialists, radiology groups hope to limit spending by restricting office-based imaging by clinical specialists, and vascular surgeons opposed efforts by cardiologists to expand reimbursement for carotid stenting. With all these conflicting viewpoints from differing medical societies, it's impossible for Congress to take physicians seriously, since the speciality societies are looking out for their own and not for the greater good.

Again, I can't blame anyone for cancelling their AMA membership, especially given how expensive our practice expenses have become. However, even large speciality societies like the American College of Cardiology and American College of Radiology don't have the size, influence, and unified message that the AMA and state medical societies provide.

Unless we can unite and close the hospitals down nothing will change. If we did close the hospitals, we would face massive lawsuits for abandoment. We are in a no win situation, we can't revolt, the changes are out of our hands, and our own society doesn't protect us. The physicians in Canada went on strike in 1965 when the government wanted to put Medicare in place. You know what Canada did, they hired the former director and founder of the British NHS, he brought foriegn doctors from India and Europe to act as scabs. Of course eventually the Canadian doctors gave in and now Canada has universal "crappy" healthcare. Same thing would happen here, except that the foriegn doctors would not leave and we would all lose our positions.
We have govt owned banks, govt owned motor company, govt owned insurance company, so why not govt owned healthcare. Socialism will rear its ugly head in a previously free and democratic America, that's how the Nazi's did it in Germany during the 1930's. First they get the people to turn against each other, find a scapegoat, or several scapegoats, then they start to take possesion of private companies for the good of the nation and economy, and then they take over our lives. I am not equating Obama with Hitler or the Nazi's but, for those who have studied history, I am starting to see de ja vu.

Thanks sbhakta for the reaffirmation about the state medical societies. They and local chapters are inherently more attune to your and my local problems. Sermo is also unique in it's well represented membership. Yet, the line of insurance vs single provider will divide each of the societies. AMA happens to have become lopsided by the status quo and simple reality that we as physicians had to play ball with the payors. IT IS THEIR MONEY, not ours.

Who is AMA. It is YOU. If you not a part of it, YOU are the problem, and you have no right to complain. What ever your specialty, do you agree with you colleagues, in the same or different specialty? All I hear is specialties (and their members) fighting for their territories and payments.
If you want power in Washington and want your voice heard, then join the AMA.
If you have to pay to join the SERMO, then I will see how many will join!!!!

I concur with sbhakta's point (above) to be sure. And, louermd, I respect your comments as always. Often we feel conflicted when we participate in group activities ... it's not easy to sit on one's hands when people on all sides stand and applaud. I must admit I was in shock at the reception Hillary received at the annual meeting in Chicago that year.
But sometimes a speaker expresses platitudes that are easy to applaud, yet arrives at conclusions that an individual that attends such a presentation cannot possibly agree with. We are social animals, and group dynamics are extremely complicated phenomena. We are all familiar with the behavior of masses ... and such behavior is not always entirely rational. I admit that I was quite young, and more easily influenced in that era, perhaps, than I would be now as a wiser and more senior physician. Alas, I no longer have the enthusiasm for political participation that I did when I was younger and more ambitious ( I guess) !

I have not been an AMA member for many years; I can't afford dues for the AMA plus my state and speciality society dues (which I do pay). I think the AMA is currently, and will remain for the forseeable future, the most influential voice of physicans. The AMA has a tough job representing the very diverse views of physicians. Influencing the AMA is easy; get invloved with your state's medical sociiety..Sadly, what I have experienced in the two state I have practiced is apathy byf most physicians. They are (1) not members of the state society (2) are members but nevery make an effort to influence the state group. This is analogous to what has hapened generally in the U.S. in political matters; noninvolment in the political relm and gereral contemp for Congress. Lack of involvement in the political processes of government or organized medicine has the same result; forfeiture of decison making to special interest groups. We reap what we sew.

Politics is not a spectator sport. And if 75% of Sermo physicians are not members of the AMA, it shows alot about why medicine is in the condition it is. Think about the political power the AMA would have if, say, 75% of physicians participated in it, instead of mentally masturbating on Sermo with little, if any, politcal response coming forth. You might not love the AMA but right now it is the ONLY medical group the politicians are sitting at the table with when it comes to healthcare talks. So if you aren't a member, expressing your opinions to leadership, you only have yourself to blame when it comes time to reap the "benefits" of healthcare reform! By the way, do you think any politicians and policy-makers are reading this post right now? Nope! Only doctors, and discussing healthcare within Sermo isn't going to get any new ideas on the table when it comes time to finalize the ink on healthcare. JOIN THE AMA IF YOU WANT ANY KIND OF A VOICE!

wow....so far only 50% of the AMA members feels that the AMA speaks for them which means 50% are in it just for the journal or the AMA insurance or because they are getting reimbursed for their dues.

only 12% of American Physicians feel the AMA speaks for them

Having been an AMA member from 1994-2000, I got out when I realized that AMA was the reason I had such a hard time getting in for my residency as an IMG. I continued my state Med soc membership till 2006 when I was told by the PA Med Soc President that physicians' progress and welfare were not their primary responsibility as their major funding was coming from other sources. The AMA and its affiliate state societies are crooks-in-arms as far as I am concerned. My blood boils every time the media makes them "the representatives of physicians".

I agree that there is still time for the AMA to fess up to its mistakes, agree to dismantle the CPT and RUC process, and announce openly that in order to serve its physician members' interests, it will renounce all previous pronouncements and will only work to restore pride in the medical profession and the physician-patient relationship. As Suvarov said, it could ask practicing physicians to sign up for a fee-free year so they could participate in deliberations. I propose this knowing full well that the AMA does not have the spine nor the honesty to engage the physician community in this (open) manner. They can only function in their bureaucratic, secretive ways.

Now, Dan, please explain your "tie the knot" statement.

Let's see. I joined the AMA at $400+ a year. I joined Sermo for free. AMA has at least 2 delegates at all of Obama's big Healthcare Reform meetings, Sermo has none. AMA says it represents all docs, as every state medical association and all specialty societies have a seat at the AMA House of Delegates. Sermo has a broad collection of physicians but no political driver in place. So my suggestion is to have Sermo charge docs $400+ a year to join, and if membership beats the AMA, they can become organized medicine's spokespersons. In the meantime, I'll stick with the AMA.

I dropped out of AMA years ago because I did not feel it represented my values and priorities. I do not think it is realistic to expect it's corporate structure to change by my joining again. There need to be alternative voices, just as we should really have more political choices. I would not become active in the Republican or Democratic parties expecting them to change eithewr.

PDMarzek.....this has been visited before.

Here is my idea.....no charge, but create a sermopac similar to AIPAC or other political action coallitions, partner up with every specialty college.

start with cash CONTRIBUTIONS to sermo. I'll donate 1,000 dollars Dan to start.

Dan let me know, I'll cut a check tomorrow.

SermoPAC (looks good)

louermd, the statistics are not as simple as the four question survey that Dan designed would imply !!! When one has to click one statement or the other, sometimes one wishes that there was a third statement that would in actuality more closely express one's personal position.
What if I felt that the AMA speaks for me 12 % of the time when it opens it's bureaucratic / collective mouth. Well, if that is the only voice at the table in Washington that speaks for physicians AT ALL, gosh, it might not be that totally illogical to want to at least have THAT level of influence on the eventual outcome. We are in a difficult situation politically, and we have to face we will not have it our way in the end. To have some input is better than to have no say at all !

We have met the enemy and he is indeed us. I speak as a Chief of staff of a hospital in California and CMA and AMA representative, which I do in my spare time from my very busy, full-time family practice. I am continually amazed at the schzophrenic whining and apathy that seems to characterize our profession. We assume someone else should fight our battles, then complain about the organization we will not join or support for its lack of results. I would say that the real problem with the AMA is quite simply not enough docs are members. If they were, they wouldn't need to get drug company money, etc, to survive and advocate for us. Look at the AAFP. They are heavily supported by the drug industry with no squaking from members. Why? Because it keeps dues down. Physicians are quite a group. Bitching about paying dues to their national organizations and making among the top incomes in the country, as if this is their god-given right. They need to check out Canada, GB, Europe to see what the future will be like if they abandon the field to the other monied, powerful and very committed vested interests.

It is really tough to take when doctors either don't join the AMA and then complain about the lack of results, or if they are members, complain about their perceptions of what the AMA does or is about (usually wrong because they have no idea what the AMA is doing or fighting for) when they have never bothered to participate in the organization to express their views with their fellow doctors.

The problem with abandoning the AMA is that there is no other viable alternative for physicians. We have no other unified voice that has any clout. None. I have the greatest doubts that Sermo could ever pull off anything, get physicians to act, or, heaven forbid, charge enough money to it's members to be have the kind of lobbying clout to compete with the drug companies, hospital organizations, ivory tower institutions, etc, that really do think that physicians are in the way, making too much and are the problem with health care. You've already got that organization. Now join it and shape it by your participation in it!

Again, we need to join, not abandon, the AMA and make it the organization we want it to be. I think most physicians would find that it is trying desperately to represent and fight for us, hamstrung by physician apathy, and that very committed and intelligent doctors are the heart and soul of it, doing the work FOR FREE for their fellow physicians.

I'm not putting forums like Sermo down, but come on, they are a information sharing service and forum, not a physician organization that exists in the real world to attempt to fight for our rights to create the future of health care in this country.

Leland...I disagree

It is that simple

Thank you Dan. Louermd said it right, only half of those actually willing to be members feel the AMA represents them. If you asked primary care physicians I doubt you could get 5% belief in AMA help for us.

AIPAC is one of the single strongest political forces in this country because their membership gives money, because the cause is important, and they hire the right people to lobby on their behalf.

we can do the same

jbluster.....you do know that the entire regime in Iran will soon fall because of bloggers and information sharing services

I have always been proud to be a non-member of the AMA. As a pediatrician, I saw no advocacy by the AMA for pediatricians in regards to the large discrepancy in reimbursement between medicaid and medicare. To the president of the Mass. Med Assoc, the answer is not to "get involved in the AMA" to change it. That is like telling John Boehner to join the Democratic Party to change it. We are out of time. There is no time to fight the sell out of the AMA. We need to aim our efforts now against this juggernaut that could cost many of us our independence, our practices, and our homes. I am not a rich man. I have 3 kids either in college or getting ready to go. I am terrified about their future for so many reasons. For the first time I feel powerless to protect them.
Thank you, Dan for your strong words. If you march I will come.

>Let's see. I joined the AMA at $400+ a year. I joined Sermo for free.

Sermo 1, AMA 0.

>AMA has at least 2 delegates at all of Obama's big Healthcare Reform meetings

Sermo 2, AMA 0.

The AMA should have told him to piss off. You don't sit at the table with your executioner or your sworn enemy...and make no mistake, any POTUS that proposes or entertains the notion of single payer is just that to American doctors...it legitimizes them. Remember, there will be photos.

And for everyone who says basically "Yeah, the AMA is flawed, but there is no alternative.."

Well, pardon me, Dan, for presuming to speak for you, but ISN'T THAT THE BLEEDING POINT OF THIS THREAD? TO CREATE AN ALTERNATIVE?

If it is not, we are wasting our time here.

ABSOLUTELY!FINALLY ,SOMEONE IN AN IMPORTANT POSITION SPEAKS THE TRUTH. THE AMA IS ,AND HAS BEEN A DISASTER FOR PHYSICIANS.IT DOES NOT REPRESENT THE NEEDS AND INTERESTS OF THE AVERAGE PRACTICING PHYSICIAN. IT IS A SELF-CENTERED ORGANIZATION, INTERESTED ONLY IN PERPETUATING ITSELF, AND IN ITS PROFITS. IT HAS MISREPRESENTED US,AND CONTINUOUSLY UNDERMINED OUR INTERESTS.EVERY TIME A GOVERNMENT BUREAUCRAT OR INSURANCE EXECUTIVE OR POLICY MAKER CONCOCTS ANOTHER TORTUROUS PROCESS TO SCREW PHYSICIANS, THE AMA FIGURES OUT HOW THEY CAN MAKE MONEY OUT OF THIS OBSENITY,BY PUBLISHING REGULATIONS AND CODES AND PROCEDURES AD-NAUSEUM.IT CONTINUES TO HAVE THE AUDACITY AND ACTS AS THE ULTIMATE ARBITER OF MEDICAL ETHICS AND MORAL AUTHORITY. IT'S A SHAM,AND,THANK GOD, PEOPLE ARE SAYING IT MORE AND MORE.

We all have a right to disagree, that's what makes this country great. Demonizing those that disagree with us does not serve any great practical purpose, though. You can be sure the AMA does not support a single payer system, and it is the one organization within the physician community that is powerful enough to stand in the way of that movement. Goodness knows there are single payer advocates within the Sermo community, so there's no use pretending that Sermo speaks with one voice, or for all physicians, any more than any other entity !!!
I wonder if Dan's sudden turn in opposition to the AMA has nothing to do with the fact that the notion that Primary Care Physicians might deserve better compensation, even if that requires some adjustment to the level of remuneration that more procedure oriented specialties have received, has caught on in a number of circles, not just with certain elements within organized Medicine.

As physicians, we are among the most privileged people in the world. How can you people possibly be so preoccupied with feeling sorry for yourselves and pretending you are downtrodden or ill-treated? You have a great deal of power, you are mostly just too lazy to use it and prefer to blame others for your situation. I am ashamed for our profession to see that so many of us are so much more concerned with our own pocketbooks and commercial turf than we are with patient access to good medicine and evidencing our professionalism to the community. Over half the physicians who complain about these issues in my local medical society are millionaires. I do not view maintaining your lifestyle as our major priority in medicine or politics. Get over yourselves and go work at your local homeless shelter for a while instead of playing golf this weekend, and maybe it will restore your perspective on why you went into medicine.

AMA stands for AGAINST MEDICAL ADVISE. Leaders of AMA have air-in-head syndrome.
Sadly, alternate organizations for physicians are poorly organised

AMA is a joke and I dropped my membership in the organization many years ago. Now The American College of Physicians has joined them selling physicians down the river. I am dropping my membership in ACP this year. I agree with you Dan. Organizations like Sermo, AAPS, and SIMPD (Society for Innovative Medical Practice Designs) represent my views much better. It is time for the physicians of America to wake up and take a stand against all this abuse from the Insurance Industry and Federal Government. We are the ones that can practice medicine and care for the patients. We should not stand by and let the insurance companies and politicians dictate our future.

Clearly none of you anti-AMA docs have been to an AMA house of delegates meeting in a very long time if ever. I'm a delegate and have been for the last five years and I am neither old, pale or stale, thank you!

What has the AMA done for me??? Waaaa. What have you done?

They don't represent me! Waaa. Guess what...they sure don't if you don't get involved.

They sold us on the E&M. Waaa. Well thank you to all you docs who were around at the time and didn't bother to get involved to stop it.

Where is the AMA? The question is where are YOU? What is the AMA doing? Instead ask what are you doing? Stop bitching and get to work, people. My goodness. My specialty society has 40,000 members. The AMA has 250,000 and it represents states and specialties combined. Who do you think the country sees as representing us as a group? If all you ninny whiners would stop being so darned polarized, realize that the AMA will never represent everything YOU want, but does it's best to advocate for physicians and patients and get involved, we might really get somewhere. Guess it's just easier to complain and take polls. That's working really well, huh? I'm out of here. I've got work to do for my state, specialty and national societies (AMA member since my first year of med school in 1996 and proud as heck of it!).

MT good points

I notice that you are also a member of sermo

and I bet more people will read what you just said hear than will ever listen to what you said on the floor of the AMA

welcome to the real fight

apomidor.....so what you are saying is that it is far less virtuous to take care of people people who pay for their health care (i.e. aren't homeless) than those who are, and that the only real way to feel valued is to give your work away for free?

the ER.....it's where the homeless really get their care, feel free to volunteer any time you'd like...I'll even buy your lunch.

AMA is a joke. I think majority get on it because the membership is reimbursed by med school and residency program, at least that was my incentive and yes those free journals swayed me too. The messed up big time with those RUC recommendations and treat primary care like step kids.

AMA is a self serving institution that poses to represent the physicians and patient interests for name sake only. AMA acts as a double agent who represents their personal interests and after an initial meek protest they usually endorse government's anti physician anti patient policies. AMA became an ineffective, impotent ,senile body to fight for the well being of health care providing physicians. Government monopoly in health care succeeded in reducing physician payments every year, criminalizing physicians for billing errors and with out proper meaningful tort reform trial lawyers are let loose to squeeze the physicians out of gas. The governments play the old game of divide and rule the physicians by pitting medical physicians versus surgeons. The 2 trillion dollar health care industry has become a giant in the economy of USA. The government monopoly wants to usurp the reins of medical sector by creating a scare of class war between the 300 million public and1 million physicians. Government wants to tarnish physician's image totally by blaming them for rapid rise of health care costs and disruption of whole economy while totally ignoring the increase of senior population due to increased longevity, better heath care and expensive technology ,litigation, insurance industry and reckless patient life style. Today Politics became synonymous with social medicine or the other way round. Lilliputs like AMA are no match to fight the Goliath- government proposed socialized medicine. The heath care big baby is too risky to deliver due to placenta previa, the economy. The socialized medicine offers the "C" section. The bottom line is to stop the bleeding economy by cutting cash payments to physicians. We have to create a David to save us - The Superman SERMO.

could we at sermo form a steering committee, we could elect our representatives from those we know well through postings. Could we then develop our program, and vote for the components? We have had a large variety of posts that we all agree on:
1. tort reform
2. Pay for time, not cpt codes
3. eliminate interference'
and so forth.
Then we do need a media strategy, and we need to hire a good PR firm to get the word out, once we have agreed on our Word. Maybe Dan can do this. He has done a fabulous job with Sermo, providing outstanding service to the medical community, and enlisting new members, and maintaining an amazing vitality.

I like Suvarovs idea, but i would like to start with positions that we all agree upon. we can spin our wheels forever with parties and so forth. we do need to take action immediately.

alternatively we can have a hostile takeover, as sfhunter just suggested, and change the AMA quickly. Is that really a possibility, or just a fun fantasy?

I applaud Dan for starting Sermo, and now for having the courage for stepping into the breach and opposing the AMA, and starting Sermo as a competing entity.

Dan, you must have some ideas. Please let us know what they are. As you know we can argue, philosophize, complain, and be extremely creative, but we do need a leader. I trust and support you, and exhort you not to be reticent, now that you have come out against the AMA. What is your platform?

In May, 2009, Medicare demanded that I get a dial-up modem for my computer to electronically bill them! They could not allow me to access the protal via broadband which has encryption far surpassing anything that dial-up could offer! DIAL-UP modem was the answer in 2009! Is this what I have to look forward to from the technology department in socialized government-run health care? Can you extrapolate out and see what kind of health care we will receive?

I agree with Dan's sentiments.

The AMA has only made things WORSE for doctors, especially with the CPT and ICD-9 conspiracy. I haven't given them a dime in 20 years.

Two common misconceptions the public has is that (1) All doctors belong to and agree with the AMA, and (2) the AMA is a powerful lobby.

In repsonse to some comments above, I do not think that Sermo is right-winged at all. I think it is pretty balanced, with a few strong opinions on either end. I consider myself moderate, and see comments that land on either side of my position.

There are too few doctors in the U.S. compared to other interest groups to have a meaningful number to influence government. We can't agree on policy, and even if we did, we no longer have the financial leverage to affect change.

Our only hope is to revolt, and refuse to participate with Medicare, Medicaid, and Health Insurance Companies, but I don't see that happening, because we are too financially entrenched with them at this point.

Nonetheless, forums such as Sermo provide a place where we can brainstorm together and try to find ways to make things as good as we can for our careers, our loved ones, and our patients.

What about the idea of coming up with and voting upon a statement which would best reflect the majority of physicians' views as to how the high cost of medicine should be dealt with. It should cover a number of individual costs within the system. It should be constructive and not inflammatory. If we could then get a very large number of physicians to sign a document which could be emailed to a central location, a single document containing their names could be sent to the media and to the president as a grassroots representation of our views that is not influenced by other entities that have a stake in this. I think that attaching our names to it and having a comprehensive, constructive statement would do more for us than sending anonymous opinions on individual topics as the Sermo president has proposed. The other idea would be for sermo to consolidate our solutions by asking the membership how they would solve individual pieces of the puzzle and then creating the document which would be sent in with our names on it.

what are thhe sources of money for ama

Just to be VERY consistent. The strategy here is ONE step at a time. Focus on the things that unite us rather than the things that divide us. We will speak louder than ever by having large numbers of physicians with a cohesive message. Believe it or not, we are already making dramatic progress. 2300+ physicians voting in less than 24 hours. 90% say that the AMA does not represent them. The general public will take note. It is probably the clearest, boldest statement physicians have made since the Lister revolution.

Every time we degenerate into squabbling our opponents win.

My strategy is simple.
One step at a time. One Voice. Focus on the things that unite us. Tell a friend.

First Step:
Ditch the AMA

Second Step:
Take a stand. Tie a knot.

Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.
Daniel@sermo.com

Great letter and posts. AMA too ill to fix....too many mets.

The biggest risk to physicians is taking pure polemical stances in expressing opinions and arguments as evidenced by this "opinion stream" that does not unite but divides physicians by setting up a boggie man. Sermo: look at yourself in the mirror and realize how trite you have become.

Again, thank you Dan! Let's keep this focused and we can truly make a difference in the future of health care in America.

This is what I've been waiting for!!! The aggregation of these surveys and opinions will greatly impact the 'reform agenda' and the future of the AMA. We are exposing AMA's dwindling support and their ability to 'Pimp' the lobbyists. If we organize correctly through SERMO, we should be able to effect a coup and take control of the AMA. This in fact should be a byproduct of our reform agenda. If we storm the halls in an organized fashion, we can elect proper leadership in short order. However, the totality of the power and capabilities of online collaboration (SERMO), may make AMA organizational model obsolete. We need a 'think tank' devoted to this consideration pronto.

'Health Reform' has evolved into 'Social Reform' with serious 'Civil Rights Implications'. 'Vocally Organized Physicians' (SERMO) will attract the attention and support of health consumers - the politician's constituency - OUR PATIENTS. The only way to break the backs of the lobbyists is to impact the electorate. The lobby money cannot help a politician that cannot get re-elected. The public now understands the power of small contributions and is looking for direction to elect and de-throne. We must develop a political 'HIT LIST' of those that need attitude adjustments.

These are but a few of the tactics of 'Social Activism', the only tactics that work to achieve 'Social Reform'. It is clear from comments that many of our colleagues are still not aware of these tactics. The tidal wave that Obama surfed into office on is a result of these tactics - learned while 'community organizing' no doubt. However, seizing the time is critical to these tactics. We, like Obama was, are in the midst of a 'Perfect Storm' of circumstances - reform is THE issue, empowered electorate knows they are being denied and taken advantage of and we are poised with SERMO.

I am convinced that we will have consensus on enough critical issues to seriously impact the reform agenda and it's outcome. What we want for our patients and practices is the cure for our sick health care system. When the public and physicians DEMAND their list of particulars, the politicians and financiers will sort out THE WAY FORWARD - that is their only reason for being.

crater2731md,

Good luck on developing that "hit list" through SERMO. You are grandiose to an extreme with that statement. SERMO will "de-throne" the AMA, yes sir. That is close to delusional.

The dues for the AMA are way too expensive. We don't all have country club memberships and huge tax writeoffs anymore. BUT, I think the AMA represents my opinions better than the American Academy of Pediatrics, for instance. The AAP is full of academic docs who get paid by government entities, no matter what. A small subgroup of them endorsed Hillary-care a few years ago, even though the majority of AAP members did NOT endorse such a system. They made a statement that the entire AAP supported Hillary-care which was absolutely untrue. They made that decision on their own without polling their rank-and-file members.
I hope the AMA doesn't get "bought off" by Obama and his minions. He is trying to shove universal payer down our throat. Some naive people on here think that is great -- well you will basically be asked to work for a pittance, and you will have way more red tape than we already experience. Wake up, people, and take a stand!
Of course you notice that Obama's plan doesn't address tort reform -- of course not -- his many friends and supporters are trial lawyers! So the trial lawyers will still be able to made ungodly amounts of money suing doctors for often frivolous reasons. In the U.K. and other socialized medicine countries, people can't sue the government or other entities so easily. In the U.S. I think Obama wants to have his cake and eat it too. It isn't going to work. He will bankrupt our country.

If you're wondering what the AMA has done for you lately, just look at our sister organizations in dentistry - the American Dental Association an the American Orthodontics Association. These organizations are thriving, as are their respective industries - irrespective of the economy. We physicians have sat on our hands for decades, assuming the historical value of our "product" would sustain us with little collaborative participation. We have spent more time arguing with one another than with those who threaten to take our industry toward socialism. We have sat idly by as others have decided what kind of care we should provide and how much that care should be worth. We have watched physicians leaving clinical practice in droves, where a generation ago saw the vast majority of us practice with pride, pleasure and satisfaction well into our golden years. "Me first" needs to be replaced with "we first" if we are to stop this slide toward medical mediocrity. The AMA is the way it is today due to neglect - it simply has not been tended to properly by its constituents (us!).

Healthcare is two camps, specialists and primary care. In some cases, there is overlap, like OB and primary care, as they function as primary care for healthy younger women. The problem is that there is a schism between the two groups, as they have fundamentally different agendas. Primary care seems to be focused on financial parity with specialists and specialists circle the wagon and want to preserve their specialties and payments, which largely reflect the greater number of hours required. The AMA is like any large medical group, it is driven by consensus, which means it is lowest common denominator. The specialists societies have a narrower focus and can afford to be more aimed at preservation of specialty needs. I have attended state AMA societies and listened with dismay as primary care docs put forward proposal after proposal increasing scope of practice for nurses and practitioners as they help their lifestyle, and refusing to listen to specialty societies who warn of the potential damage to their specialties.
I think the AMA has to be two organizations, specialties and primary care, with different mandates and needs.

This is just getting out of hand please read the latest on from our "Voice" The AMA.
First they oppose to a public health plan now they embrace it ??? Has the world gone mad what happened to sticking to your principles

Sermo Doc

Kz

mrowensmd, the dentists and the orthodontists have a very workable business model and for the most part do not deal with CMS, JCAHO, etc. You are correct that they have a unified front. If we were all ophthalmologists(for instance) with mostly cash practices, we would be more unified in our approach.

Wow, Dan sorry I was late to the party. I have been seeing patients. I also thank you for starting Sermo.
I would support you
Louermd
Suvarov of course
The AMA stopped speaking for me along time ago.
The state medical association does a better job down here in Texas.

I did not renew my membership this year because of this. The last president of the AMA that was voice-fully representing physicians was Russel Roth in 1975 when he was vehemently demonstrating in the media and DC against the Gov't expanding its role in Medicare and Coding. Coding was the way to planned reduction in reimbursements. Later AMA representatives sold us out to the democrats (CARTER). Sounds familiar!
I created a new AMA logo--see below. The last 3 letters should be in RED for traitor. The AMA presidents question on the ABC Love Fest was probably the worst. It played directly into the obama lie. Is that the best the AMA can do if so that in itself is reason to cancel AMA membership. SERMO should produce its own PRESS RELEASES, It could be our media voice.


ObAMA

Bowdend- I realized something from your comments. You are a Communist. Your ideals are straight out of the Communist Manifesto, which I am sure you wholeheartedly support. You should at least be open about this, unless you are afraid that most doctors oppose communism and won't take you seriously if you admit it, which is the case.
The ideas of serving as a public servant without regard for payment is communism, and ideology that does not work. Why do you think Communist countries fail, and have to force their people to remain there. That is why the Berlin Wall was built. You were killed if you tried to leave. If it was so great, people would stay voluntarily.

I have never been a member of the AMA. I sometimes find it difficult to locate a group that unifies and supports physicians without outside interests: insurance groups, big conglomerate medical centers run by business folks, etc. I have found that being on Sermo I feel more supported than with most other groups maybe because it is run by docs for docs...and that is a model we need. I agree our image is misperceived by the public. We have such a range of professionals from the sub specialist to the primary care doctor, yet we need to have a united front. I am amazed how united some labor groups are and how much they get done! We need some of that power behind us.

I don't think the AAFP is really any better at this point. I am only a member because someone else pays my dues and I like the journal.
Consider that the AAFP President recently said that retail clinics are "good" for family docs because they forced us to extend our hours into the evenings and open our offices on Saturdays. I am sorry, but being forced to spend less time with my family does not seem like something that has been good for me. I would like to hear from the family docs who are happy that they were "forced" to do this, and those that feel that less time with their family has been better for them.

As a family practice physician I really don't have the time or inclination to remotely understand what the AMA is supposed to be doing. But, I have a strong suspicion that one of the reasons I barely have time for my patients AND family, let alone the AMA (because of the suffocating mass of paperwork required to justify nearly every decision I make that remotely counters the medical guidelines set by third party payors) is largely due to the efforts of the AMA and our elected officials.

Since so much money is bled out of the medical care system and so much of the bulk of the health care "team" is occupied by these individuals, why do we need physicians at all?

It is obvious that we cannot speak with "one voice" or "unite" around any meaningful platform simply because we all have a medical license. The good news is that it is not at all necessary to do so. (I would go so far as to argue that it is a bad thing to even try but, in any case, it's not necessary.)

Our problems are rooted in our dealing with devils -- third party payers, both government and private. It is completely under our control whether we continue to do so. We have voluntarily given up our freedom and sold out our patients by agreeing to play by their rules in return for "reimbursements". We can each free ourselves and return to a commitment to the good of our patients simply by not participating in the third party payer system. Each of us can do this today.

Those who want to advocate for more, better, or different government involvement in health care can continue to do so. None of us (so far) have to participate. Contract with your patients to care for them under terms that are mutually acceptable.

You don't have to organize. You just have to set yourself free.

FYI, for all of those that keep blaming the AMA, they have nothing to do with ICD9. They do have the copywrite on CPT. Better them than BC or United Health Care. Dan, I don't think you have accomplished anything with this post except to get more hits on your site, let people vent their anger which will do absolutey nothing, no solutions offered, meanwhile slick Obama steamrolls on, Sermo docs "feel" better blaming the AMA and we still get screwed.
Dan, unless you are planning to start a PAC this entire discourse is non-productive.

Dan, for all the online rhetoric here and all the frustrations, I wonder if you've considered something more concrete---like an actual meeting of sermo physicians and perhaps some kind of more specific platform other than "AMA sucks".....

drleerubin,

I do agree about apathy among physicians. However as a premed and medical student I tried to be politically involved in organizations including the AMA. But as I advanced through my medical training, I saw that the AMA does not represent nor protect its physician members. I would say the same of the AAFP. I noticed that the administration and physician representatives of organizations such as the AMA go to meetings and discuss topics of no import to practicing physicians. These physicians then pat one another on the back for a job well done.

My observation has been that these physician organizations exist solely for the membership to masturbate one another and feel good about it. They do nothing for practicing physicians. For example, the AAFP and the "patient-centered home" initiative. The AAFP is worried more about some esoteric objective than these facts:

- reimbursements are down from insurance companies
- medicaid is a joke and these patients are in essence uninsured and a burden to the health system
- paperwork (including electronic) is insurmountable
- the electronic medical record is cost prohibitive in many cases for small independent practices
- new physicians cannot afford to start and build a practice from the ground up anymore
- primary care physician's are threatened by the DNP and independent nurse practice
- PA's are clamoring for independent practice
- minute clinics are cutting into revenues and providing shit care
- and pharmacists have lost their god-blessed minds and have been giving medical advice for years and undermining physicians and interfering with patient care.

I cannot even comment on the stupid white coat policy instituted by the AMA.

I agree that physicians should be more active and get involved in addressing these and many other issues, but neither the AMA nor the AAFP are the organizations to work with in accomplishing real-life, tangible goals.

I'm glad you finally figured this out. I've felt that way since the 80's.

So, there are an estimated 900,000 physicians in the US. The AMA claims to have 250,000 members but this information seems to be debatable. Assuming that it's even close to true, that means only 28% of physicians in America are members of the AMA. The point is simply...the AMA does not represent or speak for the majority of America's physicians.

As a corporate entity, they have rigorously pursued their own economic agenda which is very understandable as a business. Whether or not this agenda has been a help or a hindrance to physicians is a portion of this debate, which is healthy.

It would be refreshing to have the AMA just stand up and say what it is...no posturing, no branding, no media blitzes to try to convince physicians and the public of it's ultimate good. Just some straight talk from the AMA president about the issues that truly matter to America's physicians. That would be transformational.

I wrote an open letter to the AMA 2 years ago.

Sermo Doc

Hey , Hey, Good Morning from California. What an incredible 24 hours of rants by frustrated and angry colleagues.

Are we doers or just talkers. I am willing to put up $500, someone else is willing to write a check for $1000 for SermoPAC. Thanks fine with me to start a PAC.

As California goes, the rest of the nation goes. We are ahead of the game. why not collaborate with us on our Federal PAC- Sermo brings alot to the table. Who can argue with Coordinated Care, Advancing Medical Excellence, Fair Pay for Physicians. On the national level we have 15 other organized medical groups that have joined the national organization.

MEMORANDUM
To: CAPG Board of Directors
From: Don Crane, President and CEO
Jay Cohen, MD, Chair
Re: CAPG Federal Pac
Date: May 30, 2009
CAPG Board of Directors:
As you know, we have formed a Federal PAC to support our federal advocacy. Last Tuesday I sent you an authorization form which, when signed and returned, allows us to solicit funds from you, your physicians, and your co-workers. So if you haven't signed and returned the form, please do so now. A copy is attached to this memo for your convenience.
A few weeks ago Jay and I sent out a memo to the membership asking for donations to the PAC. We explained the importance of having funds to make contributions to the Congressmen with whom we are meeting. We indicated that we would recognize those who contributed to the PAC at upcoming Board meetings, and we established three categories for recognition: Diamond ($5,000.00), Platinum ($2,500.00), and Gold ($1,000.00).
In retrospect, we realize we failed to make it clear that donations of any size would be appreciated. (To make sure it is clear that all donations are welcome, we have added a "Contributor" level for contributions under $1,000.00). We did make it clear that the donations must be made by individuals, they can't be made by your organizations, they are not deductible, and may not be treated as reimbursable business expenses. We recognize that these features don't make contributing attractive. This is unfortunate because the need to make political contributions is an indispensable component to our over-all advocacy effort. A failure to make contributions and attend fundraisers will undermine our other efforts, devalue the significant budget we have committed to the mission, and represent a lost opportunity to leverage on the excellent advocacy underway.
Unfortunately, our initial solicitation produced sparse results. While we're thankful for the several checks and pledges we have received from the individuals listed below, we clearly have fallen far below our goal. Though not yet discussed with the Board, the
target our team regards as optimal for the moment is $50,000, a fairly small number compared with the lobbying budgets of other organizations, e.g., United at approximately $1.5 million in just the first quarter of 2009 as recently reported by the news media.
Consistent with our earlier promise, I want to list and thank the several individuals that have made or pledged the following contributions. They are:
Jay Cohen, MD Platinum
Don Crane Platinum
John Jenrette, MD Platinum
Bob Severs Platinum
Bart Wald, MD Gold
Bernie Katz, MD Contributor
With this memo we are reiterating our request for your help. Attached is copy of a pledge form that is being sent to each CEO. Please treat it like an invoice and send in a donation of the amount your personal finances allow. We will promptly add your name to the list of contributors that will be acknowledged at our Board meetings.
In addition, reflecting the importance of this effort, each member of the Executive Committee has agreed to contact a list of member CEOs to follow-up on this memo and personally ask for their participation.
In conclusion, based on the fairly remarkable meetings we have recently had with the Energy and Commerce Committee staff and its consultants - conversations we will describe at the Board meeting -- it appears distinctly possible that health reform legislation will usher in a new era of Accountable Care Organizations ("ACO") within Original Medicare and bring an entirely new business line to CAPG members. We'll need that to offset the cuts in MA funding that appear likely to occur. Needless to say, there are many miles ahead for health reform legislation, and the outcome can't be predicted, but as you will hear in more detail this Wednesday, we are encouraged by the progress our federal advocacy efforts are beginning to yield.
It is an exciting time for CAPG, and if there was ever a time for us to step up to make our federal advocacy stick, it is now. Please help us make that happen by making a donation.
Thanks in advance.

Here a follow up donation :

CAPG Member CEOs:

Just thought you might like to know......

that Diane Laird has successfully caused 100% of her Board and executive team to contribute to CAPG's Federal Pac. Some of her rank and file physicians have also seen the importance of the cause and contributed. She has raised $21,010 so far, and there is another $3,000 or more in the pipeline.

Congratulations and thank you to Diane!

I hope this email inspires you all to match this excellent performance. Your contributions will be money well spent. As you may have seen from this morning's newspapers, or from Bill Barcellona's report yesterday, the House has just released its draft health reform legislation. Within those 853 pages is a pilot program to drive seniors in original Medicare into ACOs -- your organizations - and compensate you with either partial capitation or under a shared savings arrangement. The devil will of course be in the details, and the legislation may never pass, but I daresay that the prospect of tripling your senior population merits our close attention, our advocacy, and your financial support. So if you haven't yet asked your Board to contribute, or you haven't yet submitted a pledge form, please do so now.

Thanks and happy Father's Day to you fathers.

Don

Hey, Guys . We are not perfect in California. Some might even call us wierd. Let's focus on what Dan said- stay UNITED AND FOCUSED. Effective communication and execution will determine our success or failure.

I am sure we could set up a SermoPAC. That's fine with me, but we could also get some quick real time influence and capture/leverage the spirit of the time to our advantage by collaborating with the national organization- Physician Groups for Coordinated Care.

Lets get the Sermo Steering Committee up and running today . This would be a great second day milestone in our formation.

I am in anyone else !!!!

Count me in.
Our profession should stand for the ethical practice of medicine & surgery. We stand with our patients and call out those who would divide us from those we serve.
L Gordon Moore

Attacking the AMA will probably not solve anything. We have a physician Senator in Congress who proposed a workable healthcare reform that is sensitive to patients and providers. The media has kept it buried. When Sermo presents a discussion with Senator Tom Coburn then I will agree that your voice will be stronger than the AMA.

MTbabydoc, I bet a decent proportion of us who are bashing the AMA here have in fact been active in the past. I know that I have, on local, state and national levels. Here's the problem -- The AMA is NOT a democratic institution in any way and thus is not easily co-opted by those wishing to make a change.

Who is eligible to be on the ballot for leadership positions? Are those names placed in nomination by the state medical societies? Or the partnered specialty societies? Perhaps with several hundred signatures of members? No to all the above. There is a committee (usually called the Nominations Committee but I don't recall now if that's the term the AMA uses) composed of the old and loyal who personally select a couple of names of other old and loyal (to the current administration) members. These are the people the HOD can vote for to fill leadership positions.

So to be considered, you have to have been there forever, and to voice support for the status quo. The same goes for lesser leadership positions (committee heads, etc.) that propel one to higher leadership possibilities. At every step of the way, members are selected more and more for acceptance of the status quo, protecting the association from conscientious objectors to rise through the ranks.

It's not at all unlike the leadership structure in the US House and Senate, although admittedly it is much easier for an "outsider" (relatively speaking) to ascend in that forum.

So yes, many of us have in the past tried what you suggest. The only way for a group of physicians to truly take over the AMA and steer it into a new direction is for a hundred or so young docs join, get very involved, act as though they are loyalists to the enemy for about two decades, acting as a secret cabal until they fill the leadership positions. Maybe that could happen by 2025 or 2030. Maybe...

But there's always the greater likelihood that spending all that time undercover like that will make one begin to drink the Kool-Aid. It happens to undercover cops. It happens to eager young populists heading to DC. And it would most likely happen to us as well...

Wow. Reality is a bitch. The rate of posting has significantly slowed down from yesterday.

What the hetch- it's physicians- big talkers, but little doers. Should be interesting to see where we are come the end of the day.

Having started yesterday when there was about 800 votes and up this AM about 5:30, with 2400 votes, to wade through the almost 400 comments it is apparent the AMA has one thing to do:

Look at the numbers!

Many say that we who are not AMA members should quit whining and get involved I would say ...why? The AMA doesn't represent my desires or concerns. They sit at a table determining what the future will be for my patients and myself and yet they represent less than 20% of active physicians.

Every physician in America has concerns and should be able to have a say in how this system should evolve. Whether we are Red, Blue or Mellow Yellow in political leanings our voices need to be heard.

So here's the deal. To the AMA, scrap your dues (what's a measly $57M) and include ALL physicians in the decision making process. If you really want to be the representative of American Physicians - prove it.

How? Just the same way Dr. P has. He sent an email to all registered members of Sermo and asked for their votes. In 24 hrs he has some pretty impressive results. The AMA has access to every physician's name, address or email if they so wished. They could do the same and truly have a representative sampling of all voting physicians. If that method was good enough for BO then it should be good enough in this case for the AMA.

Kz - thanks for the update on the fancy footwork by the AMA on whether they want a public insurance plan or not. I wonder whose knees got dirty on that one.

Our unified demands (without pissing on each other) could be:
1) reimbursement concurrent to service
2) reimbursement based on unified physician with payer negotiations
3) tort system taken completely out of the health care injury claims adjudication process
4) minimization of documentation requirements; maximization of methods to get non-punitive feedback about outcomes
5) aside from per seat payments of <= 500 dollars, no payment by physicians for full integrated EMR/EHR capability with Open Formulary, concurrent to the visit analysis of reimbursement claims with immediate payment to the physician based on transparent (to the physician and patient) reasons for the payment, multiple proven modes of input of information to the EMR, order entry (and other designated functionalities) that can be initiated by a medical assistant and signed off by a physician, absolutely NO ACCESS under any circumstances to the electronic record by lawyers or representatives of lawyers....etc
6) certified ability of the physician to utilize behavioral economics to incentivize the self-care of the patient
7) medical school loan forgiveness provisions based on entry into and continuity of primary care.
8) elimination of middlemen in US Healthcare with shift of saved monies, in part, to increase the reimbursement of primary care physicians and maintain reasonable reimbursement of non-primary care physicians.

CBeauchamp, good for you! That's more like it. I believe that the majority of physicians in America just want to be able to take care of their patients without all of the extraneous BS that the government and third party payers throw at us in the name of "quality".

I think that all physicians would like to be paid fairly and reasonably for their services without the hassles of an extremely complicated system(which the AMA owns).

I also think that we would like to be removed from the threat of legal action for just doing our jobs.

These are simple points...but they are the basic important ones. I'm sure there are more. But, my feeling is, they could be all bunched under the heading of "job satisfaction" or "career satisfaction"

This has nothing to do with whining or complaining. We need a voice that we haven't had.

I appreciate the comments and agree completely - in fact just a few weeks ago I published a letter with two of my colleagues including Dr. Mark Beers who recently pasted. In the letter we point out that not only does the AMA not represent primary care providers they force societies to have their members join as a requirement to sit on key AMA committees - given this type of extortion and limited positive impact of the AMA we are advocating moving to an organization like MedPAC or AARP.

Stefanacci RG, Wasserman MR, Beers MH. (2009) Moving Beyond the American Medical Association. JAGS.57;6:1117-8.

Richard Stefanacci, DO, MGH, MBA, AGSF, CMD
University of the Sciences in Philadelphia

Here is the president of AMAs email (J. James Rohack). Tell him yourself.

amaprez@ama-assn.org

I sent an email already letting him know that I would make a decision on further participation in AMA on the basis of the actions of the leadership in the next several months.

Ok, Ok. Now we have some evidenced based literature. That should make some of the doubters more comfortable.

Next steps per Cbauchamp- looks like a good SERMOPAC Charter. Whose stepping up to the Steering COmmittee?

Dan will Sermo cover cost of phone conference call to pull this together and administrative support to create letter head , etc.

Effective communication and execution- it's still morning in California, east coast early afternoon.

Let's declare our Freedom as Physicians- It's July 4th !!!

The AMA will not change. If they say anything in our favor, it will be lip service only. Their actions over the past several decades have been deplorable. The AMA is a dinosaur.

I think that Dan is ready to be the leader.
I think he already has a plan.
I will follow his lead.

I am really concerned about the huge majority of comments on this discussion. There has been so little discussion about what it means to be a profession which has such an important role in society. Our patients need us to be their partners not their enemies. To maintain that contract with society we need to be good stewards of our image in the public mind. That image comes from practicing the best medicine we can and fostering learning for even better treatments in the future. Quality is patient satisfaction. Period.

It's too easy to point a finger at our professional organizations particularly the only one that has any chance of preserving that brand we call "Medicine". We are no longer "health care" but one part of the many who provide health care to our society. We luckily have the right to opt out of insurance and not join hospital staffs if we wish but in my mind that keeps me from doing what I do best, treat individuals for their illness. The world has changed from the days of Norman Rockwell paintings and rely on all those parts. So it becomes political to maintain our place as the captain of the health care ship. We should not give that up.
To criticize because you are angry is fine but realize that it is highly unlikely that any organization as powerful will never exist again if we give up on it. Change it but don't give it up.

As to those who cry that the AMA won't change. Oh you haven't watched in the last 20 years. Yes I don't agree with some of the moves of my government in Washington (Dem or Repub) but it is mine and I wouldn't change it for anything. Likewise for my professional organizations. Join, participate and change from within. It HAS happened at the AMA (and of course more always needs to be done). Don't throw away our ability to communicate concernsby circling the wagons and firing inward. Make change by challenging within and moving with consensus.

Physician 3- your ideal world may happen if the AMA -like they did with African Americans- offers an official apologize to US physicians for their failings.

This olive branch could change things- ideally. How practical that is. Very doubtful.

Maybe you have influence with the AMA- give it a shot. I gave up years ago and seems like many others have.

We need to move beyond, create a new during this changing times. There is great opportunity for something new to take hold and great peril for something old( AMA) to die if it doesn't do something to engage a greater number of physicians.

There is only one solution to health care in America, and within the next 10-20 years you will all come to see this. As with Taiwan and Britain, we need a universal single payer system. Our costs would go from 17% to 10 or 12% (of the GDP) and everyone would be covered. It's sick that 20% of people (50 million) have no insurance and its wrong that 70% of doctors are specialists. The AMA is crap but so are insurance companies, hospitals, PHARMA, and specialist organizations that are all only around to protect their own interests. Where did the patients interests go? PCPs such as myself, who work in health centers get 15 minutes to take care of the sickest patients with multiple problems, we often can't get them what they need, and we can't get people to go into primary care b/c of the way the system is. We have the hardest job yet get the most hassles and least pay. The system is an upside down pyramid and anyone that thinks otherwise needs to educate themselves. Here are a few suggestions:

Overtreated by Shannon Brownlee
Second Opinion by Arnold Relman
How Doctor's Think by Jerome Groopman
Our Daily Meds by Melodie Peterson
Hooked by Howard Brody

When you're done, I think you will know what's wrong with the system and please
consider joining PNHP (Physicians for a National Health Program)

Apathy got us here, Apathy will kill us !!! Unite, Focus and Organize.

Any takers ???????????????

Dan will Sermo step up to the plate -offer administrative support to form the Steering COmmittee?

I am newly out of residency, and didn't even make it through my training before I stopped my membership in the AMA. The reasons were many, one being that they sold my name and info to so many businesses that my junk mail at home was ridiculous.
Additionally, when several weekly e-mails came through where the first bullet was promoting their new GLBT wing of the organization, I could clearly see they were more concerned about promotng social agendas than tackling issues that face this country's physician population as a whole.
Now, I'm actually more involved in my specialty organizations, but I don't think that is ideal either. All the specialties need to be united together in this fight. Right now, they are trying to pit one specialty against another (divide and conquer technique....) and it is working, unfortunately.

latinomd, I may have criticized you in the past but I will join you in this. If we can set up an effective PAC you will have my money.

The AMA is our BEST defence against complete government takeover of healthcare. It certainly doesn't speak for every physician nor do I agree with every policy or action of the AMA. It certainly has a conservative, private practice bent which I endorse. The AMA seems to want to keep the best of US healthcare by pushing back against socialized medicine.

Physician3: "Quality is patient satisfaction. Period."

With respect, nothing could be further from the truth. The two concepts sadly often have little to do with one another.

Ask your local ED doc about drug seekers or pediatrician about ignorant parents demanding antibiotics for viral infections if patient satisfaction comes from quality medical care.

Ask your local radiation oncologist who has to spend hours each week explaining why Cyberknife is not appropriate for treating the stage IIIB lung cancer or Stage I breast cancer patient in front of them thanks to the disgusting and pervasive DTC advertising by the company that makes the machine.

Ask any primary care physician who bangs their head against the wall trying to appropriately prescribe hydrochlorothiazide as a first-line antihypertensive for a patient with newly diagnosed hypertension when that patient is kicking and screaming, demanding the new $300 a month medicine that doesn't work any better, just because of the cool TV ad they saw the night before.

No, quality and patient satisfaction are in fact very much NOT synonymous. Period.

Now, back to your regularly scheduled AMA bashing...

"As to those who cry that the AMA won't change. Oh you haven't watched in the last 20 years. Yes I don't agree with some of the moves of my government in Washington (Dem or Repub) but it is mine and I wouldn't change it for anything. "

20 yrs !! AMA in bed with lobbyists, politicians,,, had only GRANDFATHERED sibblings of corruption, prostitution of health care, ets, etc, ... and how precisely can AMA CHANGE when the BONDAGE of being financially supported by NON MEDICAL interests blinded, dazed the pristine FACE of an ORPHANed docs like you and me... are we eing delutional without doing anything!!!!

Change... is not too late!

Thank you Daniel for posting this!

Lack of proper physician representation is indeed one of the main reasons we continue to get marginalized. As physicians we must put our voices and energy behind efforts that create better conditions for ALL physicians, ie, for the greater good as mentioned by "sbhakta" above.

We have all witnessed recently a lot of distressing signals and proposals that in the name of "reform" pose a real threat to the interests of physicians while contributing nothing to the process of improving the healthcare system. We have to step up to the plate and become engaged and active participants in the evolving debates about the future of our profession. At the end of the day, we all share the same professional values and foundation.

Adawaal -- so nice to have you back...

All of us who are over 60 have heard all of this BS about a "new Voice" for practicing physicians many times before--- and it just workks to divide us still further!!!, reducing what little influence we may or may not have left.
As a Past-President of a State Medical Society -as well as an officer of a Specialty Society, I have seen how we splinter and divide- on moral, ethical and even scientific grounds. Leading Doctors is like herding cats!! We are a group of leaders--- we do NOT follow-even our own elected representatives!!!!! AND ESPECIALLY WE DO NOT FOLLOW IF IT EVEN MIGHT HURT OUR WALLETS!!!
Face Facts --- every specialty society represents the ECONOMIC interests of its members. - and no one else's!!!
Who speaks for ALL physicians.?? ONLY THE AMA. Its very hard to represent ALL of us as our interests are conflicting, and our goals are diverse!!!
Who speaks for Medicine at the State level? (And remember the state licensing boards are Legislative bodies at the State level)(and who "licenses nurse-practioners and Physician -assistants?) and yet-in my state(NJ) less than 40% of our physicians are members!!! Too expensive-too much trouble-not worth the money--my partner is a member, so I get the bulletins, etc. etc. We have no one to blame but ourselves!!!!!

The answer-- get involved with ORGANIZED medicine!!! Its easy to become a leader!! Just speak up. Come to few meetings! You'll be on Executive Committees in less than a year! You'll have little opposition as most will be glad YOU are willing to invest the time!! You can't win if you don't play!!- and taking your ball and going home and sulking is a sure recipe for further destruction of a once-noble-profession!!

Disappointed in the original post... It is akin to my friends who don't vote and then complain about the government or lament their inability to impact change. Most of us are apathetic and uninvolved in our profession just as we are in government. We concentrate on running just our own practice and leave others to do the macro stuff. I think this is a societal change seen over several decades. Everyone should join the AMA if they want to be part of the conversation on healthcare's direction. It is physician run and it is in the best position to speak on our behalf.

Thank you, Dr. P. I quit the AMA over 20 years ago. It has never represented me or my interests.

I am very concerned that the AMA, which I feel has presided over the downfall of American Medicine (approving the SGR which doomed us within a few years, setting up specialists against general docs, proceduralists against cognitive, signing off on P4P, and kissing Obama's tail when so few details are clear), has such a poor membership because docs see it for what it is. The politics of the AMA, the campaigns for election to positions, the perception on the Hill of a disingenuous organization that required so many specialty spin offs to make its points, does not bode well.
We have been flat in our incomes for almost a decade, we are looking at a 21% hit in a few months, the Obama administration does not have a clue how to incorporate 45 million people into a health care system, the idea of a totally socialized health care system which has failed in most countries and increased physician workloads and responsibilities while decreasing incomes to almost blue collar levels (relative to education and time put in and hours worked) does not make sense as a way of "reform" and "fixing what is so broken.".
The NY Times has said that the Democratic house's plan had no details or budget attached...what kind of a plan is that and who is in charge?
I do not see a clear plan with a budget that can be financed without destroying small employers that will provide fair incomes to physicians, tort relief, respect and doable work loads.
We should be attacking for profit health insurance. It is a start.
Physician numbers have not grown... the only way to include millions of patients more in the mix is to use physician extenders more and more. If they can handle the bulk of problems, why do we have to go to medical school, incur so much debt, spend so many hours etc.?

I don't see the AMA has providing adequate leadership at this point in time (or for decades) but everyone being polite with the organization...while people just don't join year after year. The self serving AMA leadership does not understand the "doc in the street" and it will slowly self destruct...along with the profession, I fear.