American Medical Association

American Medical Association

Motto	Helping Doctors Help Patients
Formation	May 7, 1847 (1847-05-07)
Type	Professional association
Headquarters	Chicago, Illinois, U.S.
Location	United States
Membership	217,490 as of 2011[1]
Official language	English
President	Andrew W. Gurman, M.D.[2]
Key people	Board Chair Patrice A. Harris, M.D.; CEO & EVP James Madara, M.D.
Website	www.ama-assn.org

The American Medical Association (AMA), founded in 1847 and incorporated in 1897,^[3] is the largest association of physicians—both MDs and DOs—and medical students in the United States.^[4]

The AMA's stated mission is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education. The Association also publishes the Journal of the American Medical Association (JAMA), which has the largest circulation of any weekly medical journal in the world.^[5] The AMA also publishes a list of Physician Specialty Codes which are the standard method in the U.S. for identifying physician and practice specialties.

History

In 1847 after a report by physician Nathan Smith Davis, members of the AMA met in Philadelphia as a national professional medical organization, the first of its kind in the world, going on to establish uniform standards for medical education, training, and practice, the world's first national code for ethical medical practice. Ever since, the AMA Code of Medical Ethics dictates professional conduct for practicing physicians.

Policy positions

The AMA has one of the largest political lobbying budgets of any organization in the United States. Its political positions throughout its history have often been controversial. In the 1930s, the AMA attempted to prohibit its members from working for the health maintenance organizations established during the Great Depression, which violated the Sherman Antitrust Act and resulted in a conviction ultimately affirmed by the US Supreme Court.^[6] The American Medical Association's vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup, supported by Ronald Reagan. Since the enactment of Medicare, the AMA reversed its position and now opposes any "cut to Medicare funding or shift [of] increased costs to beneficiaries at the expense of the quality or accessibility of care". However, the AMA remains opposed to any single-payer health care plan that might enact a National Health Service in the United States, such as the United States National Health Care Act. In the 1990s, the organization was part of the coalition that defeated the health care reform advanced by Hillary and Bill Clinton.

The AMA has also supported changes in medical malpractice law to limit damage awards, which, it contends, makes it difficult for patients to find appropriate medical care. In many states, high risk specialists have moved to other states that have enacted reform. For example, in 2004, all neurosurgeons had relocated out of the entire southern half of Illinois.^[7] The main legislative emphasis in multiple states has been to effect caps on the amount that patients can receive for pain and suffering. These costs for pain and suffering are only those that exceed the actual costs of healthcare and lost income. At the same time however, states without caps also experienced similar results; suggesting that other market factors may have contributed to the decreases. Some economic studies have found that caps have historically had an uncertain effect on premium rates.^[8] Nevertheless, the AMA believes the caps may alleviate what is often perceived as an excessively litigious environment for many doctors. A recent report by the AMA found that in a 12-month period, five percent of physicians had claims filed against them.^[9]

Claims that the AMA generates $70 million in revenue through its stewardship of Current Procedural Terminology (CPT) codes appear to be a mischaracterization. The estimate is based on a distortion of the transparent financial information the AMA voluntarily offers in its Annual Report. The AMA has publicly reported this figure represents income from its complete line of books and products, which include more than 100 items, not just CPT.^[10]

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

Collections of the association's papers dating from the late 1860s to the late 1960s are held at the National Library of Medicine.^[11][12]

Politics and lobbying

The American Medical Association headquarters building in Chicago

Throughout its history, the AMA has been actively involved in a variety of medical policy issues, from Medicare and HMOs to public health, and climate change. Between 1998 and 2011, the AMA spent $264 million on lobbyists, second only to the American Chamber of Commerce.^[13]

• In the 1930s, the AMA attempted to prohibit its members from working for the primitive health maintenance organizations that sprung up during the Great Depression. The AMA's subsequent conviction for violating the Sherman Antitrust Act was affirmed by the U.S. Supreme Court.^[6]
• The AMA's vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan. Before Medicare passed, according to Steven Schroeder, Wilbur Cohen inserted "usual, customary and reasonable" charges into the Social Security Act of 1965 "in an unsuccessful attempt to placate" the AMA.^[14] Since the enactment of Medicare, the AMA stated that it "continues to oppose attempts to cut Medicare funding or shift increased costs to beneficiaries at the expense of the quality or accessibility of care" and "strongly supports subsidization of prescription drugs for Medicare patients based on means testing". The AMA also campaigns to raise Medicare payments to physicians, arguing that increases will protect seniors' access to health care. In the 1990s, it was part of the coalition that defeated the health care reform proposed by President Bill Clinton.
• The AMA supported the War on Drugs, providing a medical rationale to clamp down on marijuana-use in the 1990s.
• The AMA has given high priority to supporting changes in medical malpractice law to limit damage awards, which, it contends, makes it difficult for patients to find appropriate medical care. In many states, high-risk specialists have moved to other states with such limits. For example, in 2004, not a single neurosurgeon remained in the entire southern half of Illinois.^[7] The main legislative emphasis in multiple states has been to effect caps on the amount that patients can receive for pain and suffering. These costs for pain and suffering are only those that exceed the actual costs of health care and lost income. Multiple states found that limiting pain and suffering costs has dramatically slowed increases in the cost of medical malpractice insurance. The state of Texas enacted such reforms in 2003 and subsequently reported in 2005 that all major malpractice insurers were able to offer either no increase or a decrease in premiums to physicians.
• Another top priority of the AMA is to lobby for change to the federal tax codes to allow the current health insurance system (based on employment) to be purchased by individuals. Such changes could possibly allow millions of currently uninsured Americans to be able to afford insurance through a series of refundable tax credits based on income (for example, the lower one's income, the greater your credit) .
• The AMA has made efforts to respond to health care disparities.
  • As such, the AMA created an advisory committee to assess the nature of disparities within different racial and ethnic groups.^[15] One such committee focuses on the health of the Gay, Lesbian Bisexual and Transgender community. In 2005, the AMA president Edward Hill gave a keynote address to the Gay and Lesbian Medical Association at its annual conference.^[16] Since that time, the AMA has worked closely with GLMA to develop AMA policy towards better health care access for LGBT patients and better working environments for LGBT physicians and medical students.^[17]
  • The AMA responded to the government estimate that more than 35 million Americans live in underserved areas by stating it would take 16,000 doctors to immediately fill that need, and the gap is expected to widen due to rising population and aging work force. "And that will mostly be felt in rural America," said Sen. Kent Conrad, D-N.D., adding, "We're facing a real crisis." Fueling the shortage are the restrictions on allowing foreign physicians to work in the U.S. after the September 11, 2001 attack, and may become more restrictive after the attempted terrorist bombings June 2005 in Britain, still under investigation, linked to foreign doctors.^[18][19]
• In June 2007, at its annual meeting, the AMA discussed its opposition to a fast-spreading nationwide trend for medical clinics to open up in supermarkets and drugstores. The AMA identified at least two problems with in-store clinics: potential conflict of interest, and potential jeopardized quality of care. The AMA went on to rally state and federal agencies to investigate the relationship between the operating clinics and the pharmacy chains to decide if this practice should be prohibited or regulated. Dr. Peter Carmel, neurosurgeon and AMA board member asked, "If you own both sides of the operation, shouldn't people look at that?" The AMA also noted some employers reduce or waive the co-payment if an employee goes to the retail clinic instead of the doctor's office, inferring that this practice might negatively affect quality of care.^[20]
• In 2008, the AMA issued a policy statement on global climate change declaring that they "support the findings of the latest Intergovernmental Panel on Climate Change report, which states that the Earth is undergoing adverse global climate change and that these changes will negatively affect public health." They also "support educating the medical community on the potential adverse public health effects of global climate change, including topics such as population displacement, flooding, infectious and vector-borne diseases, and healthy water supplies."^[21]
• In July 2008, the AMA focused its energy on blocking cuts to Medicare. Through advocacy efforts and communications campaigns, the AMA and all the specialty societies and state medical societies it comprises came out with a temporary victory. Despite a presidential veto, H.R. 6331, the "Medicare Improvements for Patients and Providers Act of 2008", passed with wide, bi-partisan majorities in both the U.S. House of Representatives and the U.S. Senate.
• The AMA has affirmed, through continual policy statement (policies H-460.957, H-460.974, H-460.964, and H-460.991 for example), its support for appropriate and compassionate use of animals in biomedical research programs, and its opposition to the actions of other groups that impede such research, such as some actions from animal rights groups, and its opposition to legislation that unduly restricts such research.
• The AMA's Office of Alcohol and Other Drug Abuse promotes temperance and lobbies for a reduction of alcoholic beverage advertising and an increase in alcoholic beverage taxes, among other activities.
• The AMA supported the Patient Protection and Affordable Care Act as a step toward providing coverage to all Americans.^[22]
• The AMA approved a resolution in 2015 declaring that there is "no medically valid reason to exclude transgender individuals from service in the U.S. military". The decision was lauded by the Human Rights Campaign.^[23]

Criticisms and historical controversies

In historical terms, the American Medical Association's policy of allowing its consistent groups to be racially segregated in areas with widespread prejudice faced considerable opposition from doctors as well as other health care professionals. This came to a head during the African-American civil rights movement, pressure coming from organization such as the Medical Committee for Human Rights (MCHR), and the AMA finally gave up the policy in the late 1960s. Retrospective articles by the AMA's own publications have criticized the AMA's past tolerance of discrimination as against fundamental medical ethics. One such 2008 article used the title "African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide".^[24] The intersection of race and health in the U.S. has long been a disputed topic relating to many factors.^[25] As well, in terms of history, the AMA's foot-dragging in helping foreign-trained medical professionals fleeing to the U.S. from Nazi-controlled Germany and adjacent nations has brought criticism. Despite a widespread need among natural-born Americans for health services, particularly in the context of the Great Depression, the number of newly licensed foreign-trained doctors after Adolf Hitler came to power remained similar to previous totals.^[26]

In economic terms, several critics of the American Medical Association, including Nobel Memorial Prize winning economist Milton Friedman as well as his wife, Rose Friedman, have asserted that the organization acts as a guild and has attempted to increase physicians' wages and fees by influencing limitations on the supply of physicians and competition from non-physicians. In the book Free to Choose, a work associated with the television series of the same name, the Friedmans stated that "the AMA has engaged in extensive litigation charging chiropractors and osteopathic physicians with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible."^[26] Counters to this argument have appeared in publications such as the Wall Street Journal, in which AMA-related doctor Cecil B. Wilson argued that the AMA "has been supportive of medical school expansion to help ensure there are enough physicians to care for all Americans." Wilson remarked specifically as well that the sum of "medical schools accredited by the Liaison Committee on Medical Education, of which the AMA is one of two co-sponsors, increased from 125 in 2006 to 137 in 2012" and that the "number of medical students in the U.S. is also increasing."^[27]

Profession and Monopoly, a book published in 1975, also condemned the AMA for limiting the supply of physicians and inflating the cost of medical care in the U.S. The book asserted that physician supply is kept low by the AMA to ensure high pay for practicing physicians. It states that in the United States the number, curriculum, and size of medical schools are restricted by state licensing boards controlled by representatives of state medical societies associated with the AMA. The book is also critical of the ethical rules adopted by the AMA which restrict advertisement and other types of competition between professionals. It points out that advertising and bargaining can result in expulsion from the AMA and legal revocation of licenses. Restrictions against advertising that is not false or deceptive were dropped from the AMA Code of Medical Ethics in 1980 (AMA Ethical Policy E-5.02). The book also states that before 1912 the AMA included uniform fees for specific medical procedures in its official code of ethics. The AMA's influence on hospital regulation was also criticized in the book.^[28]

The belief by the AMA and other industry groups predicting an oversupply of doctors and negative issues as a result, the AMA limiting at least somewhat the number of new doctors, has picked up criticism for having created a problem in the other direction. More recently, the AMA changed its position and acknowledged a doctor shortage in multiple areas instead, predicting U.S. trends could worsen.^[29]

It has been argued, through a commentary article, that the AMA's CPT monopoly has been created by the government and makes the organization subject to government influence. Further, the restricted access to CPT codes may not be in the interest of its constituents.^[30]

In a 1987 antitrust court case, a federal district judge called the AMA's behavior toward chiropractors "systematic, long-term wrongdoing". The AMA was accused of limiting the associations between physicians and chiropractors. In the 1960s and 1970s, the association's Committee on Quackery was said to have targeted the chiropractic profession, and for many years the AMA held that it was unethical for physicians to refer patients to chiropractors or to receive referrals from chiropractors.^[31]

Structure

The AMA is composed of various internal groups that discuss policy twice a year. There is an annual meeting, always held in Chicago, IL and an Interim meeting set on a rotating schedule for different locations.^[32] Within the AMA, there are sections that can make up the total AMA. These sections include Medical Students, Resident and Fellows, Academic physicians, Medical School Deans and Faculty, Physicians in group practice setting, Retired and Senior Physicians, International Medical graduates, Woman physicians, Physician Diversity and Minority health, GLBT, USAN, AMA board of Trustees, Foundation and Council.^[33] Externally to the AMA, there are organizations that come to these meetings by sending representatives. These representatives meet two a year in the House of Delegates at the Interim and/or annual meeting. Representatives come from medical societies that are either from a state, specialty or the federal services/government services. These organizations are called AMA member organizations.^[34]

Membership

Published membership figures as reported by the AMA include:

Charitable activities

• The AMA Foundation provides approximately $1,000,000 annually in tuition assistance to financially needy students. This has to be seen on the background that in 2007, graduating medical students carried a mean debt load of $140,000 which rose to $220,000 after 4 yrs of negative amortization during residency^[39] medical student debt has increased by 7% each successive year.^[40] By the time debt is paid off, it's almost half a million dollars.^[41]
• Funds awareness projects about health literacy
• Funds community service, community health, and healthcare education events held by local medical societies and student chapters
• Supports research funding for students and fellows around the U.S.
• Provides grants to community projects designed to encourage healthy lifestyles (of diet and exercise, good sleep habits, etc.).
• The Worldscopes project is a collaboration with the medical community to collect stethoscopes and the funds to buy them. The stethoscopes are then distributed to those in the global medical community who normally lack the resources to obtain the instruments. Thousands of stethoscopes have been sent to physicians and others in the medical community around the world who lack access to this medical instrument.^[42]

See also

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

References

Further reading

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

External links

• Official website
• American Medical Association annual meetings collection (1866-1890)—National Library of Medicine finding aid
• AMA Deceased Physicians Masterfile (1906-1969)—National Library of Medicine finding aid