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“The AMA (and the AAMC) Does Not Speak For Us.” – Oh, Yes They Do!

Posted on | January 18, 2017 | 1 Comment

Mike Magee

President-Elect Trump’s nomination of Rep. Tom Price for HHS Secretary has been ethically compromised from the start. The NEJM article last week, penned by the current and former department heads for HHS, simply defined the myriad of issues that undermine his candidacy in black and white.

The AMA and AAMC’s bullish recommendations of a strong “BUY” simply demonstrated how far these “guild” organizations will go to defend their vested interests, and served to highlight the medical and generational opposition, and the tools that opposition will use in the future to dog organized medicine’s power elite.

Two notable reactions were the appearance of the Twitter hashtag, #NotMyAMA, and the creation of an online petition titled “The AMA Does Not Speak for Us” signed by nearly 10,000 physicians. But a cursory examination of the structural design of both the AMA and the AAMC, and their reach, suggests otherwise. They do represent you, whether you like it or not.

The truth is that both organizations have evolved purposefully over more than a century to control and direct and protect the position of the physician guild and its role in care delivery, education and research. Together and intertwined, they are the pearl within the Medical Industrial Complex oyster.

Even if you are not a member of the AMA, it is very likely that you are represented by at least one of the organizations or associations that is a part of the AMA. The organization may be housed in Chicago, and represented by offices at 1101 Vermont Ave. NW, in walking distance from the Capitol, but their true power is nationwide and widely distributive. Fundamental is their highly orchestrated infrastructure of county medical societies, which feed state societies, which elect members to serve in the House of Delegates of the national society.

This system provides a career-ladder proving ground for up and comers, like Georgia AMA delegate Tom Price. It also has the ability to energize a wide political response, for or against an issue, which has a lively history including the coffee clutch days when AMA spouses gathered to listen to an AMA provided LP recording of Ronald Reagan warning that Medicare was the same as “socialized medicine” and would inevitability result in the government telling physicians where they could practice medicine.

In addition to this network, the AMA has deftly bestowed its generous moniker of “specialty society” on over 100 different organizations which are part of the AMA Federation. Originally designed to enhance membership and maintain “big tent” order on the House of Medicine, its lack of disciplined quality control is rapidly exposing the organization’s flank to some outsized potential class action liability.

The original Federation members like the American College of Surgeons, the American College of Physicians/American Society of Internal Medicine, the American Academy of Pediatrics, the American Congress of Obstetrics and Gynecology, and more recently the American Academy of Family Physicians are more than well-established and have lives of their own. The same is true for the multiple sub-specialty organizations they have spawned over the years, including the American Urological Association which I belonged to for years.

In more recent years, the tent has expanded to include others like the American Academy of Pain Medicine ,whose origins were so deeply entangled with the rise of Purdue Pharma and the overselling of “pain as the 5th vital sign”(which the AMA has subsequently rejected) and Oxycontin, that the subsequent downward bending of U.S. survival curves is viewed by critics as part of the organization’s work product. The deaths of thousands, and compromised human potential of many thousands of their children, raise high liability stakes for both the Pain people, and the Federation, should those harmed discover each other and seek out legal representation to track liability back to source.

Then there is the Association of American Medical Colleges or AAMC. As with the AMA, this is a carefully structured and overlapping group of organizations under one roof. The organization is almost as old as the AMA, originating as a group of 22 medical schools in 1876 with the stated objective “to consider all matters relating to reform in medical college work.” Now, nearly a century and a half later, their influence is far more extensive and far more organized.

At the core of the AAMC’s power structure, exercised from their offices at 655 K Street NW in Washington, DC, are their Council of Deans (includes the Deans of all U.S. MD granting Medical Schools), Council of Faculty and Academic Societies (more than 370 faculty representatives appointed by member medical schools and academic societies) and Council of Teaching Hospitals and Health Systems (400 member teaching hospitals in addition to its medical school community.) In addition their management also staffs 18 different affinity groups. And, like the AMA, their Government Relations program is aggressive and activist, not shy in mobilizing outreach at a moment’s notice. As they say, “Collaborations are key to advancing the AAMC’s advocacy agenda.”

Were this not enough, the two organizations are close and historic controlling partners of the Accreditation Council for Continuing Medical Education (ACCME) and the Accreditation Council for Graduate Medical Education (ACGME). The origins of these organizations date back to 1942 with founding partners being the American Medical Association, the American Board of Medical Specialties, the American Hospital Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies. Today they have their fingers in any and all deliberations regarding funding, manpower needs, educational reforms, conflict of interest, research funding and more. They also provide a meaningful interface for physician leaders like Tom Price intent on moving their careers up legislative or academic ladders.

The institutional reach outlined above and their non-profit status (AMA, a 501(c)6, AAMC, a 501(c)3), combined with historic professional autonomy that creates partial immunity from public criticism and prosecution, has helped fuel and foster a remarkable consolidation of power and influence over the past half-century, reinforced by both government and industry.

“The AMA (and the AAMC) Does Not Speak for Us” . Oh yes they do! And it will take more than signing an online pledge to re-establish appropriate checks and balances. How will legitimate grievances, such as the AMA and AAMC’s strong endorsements of Tom Price whose values are so clearly in opposition to those stated by both these organizations, be reconciled? Likely the push back will come through the back door as our legal system probes the weakest links of each of these highly profitable “non-profits”. Liability often finds its way back to source. More on that next week.

Comments

One Response to ““The AMA (and the AAMC) Does Not Speak For Us.” – Oh, Yes They Do!”

  1. Arthur Ulene
    January 18th, 2017 @ 3:11 pm

    Unfortunately, they do claim to speak for us… even though we do NOT like it…. and it will continue to happen until an effective alternative organization is created.

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