American Medical Association

American Medical Association
Motto	Helping Doctors Help Patients
Formation	1847
Type	professional association
Headquarters	Chicago, Illinois
Location	United States
Membership	240,000[1]
Official languages	English
President	Nancy H. Nielsen, M.D.
Key people	President-elect J.James Rohack, M.D., Chair Joseph M. Heyman, M.D.

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

Scope and operations

The AMA's stated mission is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education. The Association also publishes the Journal of the American Medical Association (JAMA), which has the largest circulation of any weekly medical journal in the world.^[3] The AMA also publishes a list of Physician Specialty Codes which are the standard method in the U.S. for identifying physician and practice specialties. Ronald M. Davis MD finished his term as President on June 17, 2008 at which time Nancy H Nielsen MD, PhD was sworn in as the Association's 163rd President.^[4] J.James Rohack, MD, a senior staff cardiologist at Scott & White Clinic in Temple, Texas, became the 164th president of the American Medical Association (AMA) in June 2009.^[5] While its membership has declined in recent years, the AMA claims approximately 22% of U.S. physicians and medical students as members.^[1]

The American Medical Association's political positions through its history have often been controversial. In the 1930s, the AMA attempted to prohibit its members from working for the then-primitive health maintenance organizations that sprung up during the Great Depression, which violated the Sherman Antitrust Act and resulted in a conviction ultimately affirmed by the U.S. Supreme Court. American Medical Ass'n. v. United States, 317 U.S. 519 (1943). The AMA's vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan. Since the enactment of Medicare, the AMA reversed its position and now opposes any "cut to Medicare funding or shift [of] increased costs to beneficiaries at the expense of the quality or accessibility of care" — and it also "strongly supports subsidization of prescription drugs for Medicare patients based on means testing". However, the AMA remains opposed to any single-payer health care plan that might enact a National Health Service in the United States, such as House Resolution 676. In the 1990s, the organization was part of the coalition that defeated the health care reform advanced by Hillary Rodham Clinton and her US President husband.

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

The AMA obtains about $70 million to $100 million annually from its monopoly of maintaining and administering the Current Procedural Terminology (CPT) medical coding system that physicians and hospitals have to use to get paid for their services.^[7]

History

The American Medical Association headquarters building in Chicago.

• 1844: A doctor named Nathan Smith Davis serves in the Medical Society of the State of New York. He works to better medical schools and licensing.^[8]
• 1845: Davis introduces a resolution endorsing the establishment of a national medical association to "elevate the standard of medical education in the United States."
• 1847: Nathan Davis founds the AMA at Academy of Natural Sciences. The Committee on Medical Education, Code of Medical Ethics, and first minimal standards for medical education are created.^[9]
• 1849: AMA studies quack remedies and tells the public about the dangerous effects of such treatments.
• 1858: AMA starts a Committee on Ethics.
• 1868: AMA Committee on Ethics allows qualified female doctors.
• 1869: Archives of Ophthalmology and Otology is created.
• 1870: AMA advises Congress to adopt quarantine rules.
• 1873: AMA Judicial Council created.
• 1876: Sarah Stephenson is the first female member. AMA promotes sanitary city water and sewers.
• 1882: Journal of Cutaneous Diseases (later Archives of Dermatology)
• 1883: Journal of the American Medical Association (JAMA) is created.
• 1884: AMA condones experiments on animals.
• 1897: AMA becomes incorporated.
• 1898: AMA Committee on Scientific Research gives grants for medical research.
• 1899: AMA Committee on National Legislation is created, the AMA's special interest group. Council on Exhibits educates the public on health. AMA studies tuberculosis, and how to control it, educates the public, and advises the building of government sanitariums. AMA tells local boards of health to pass mandatory smallpox vaccination.^[10]
• 1900 to 1939: AMA creates the House of Delegates, inspects 160 medical schools, sets standards for internship, adopts standards for specialty training, and encourages the recognition of specialty boards.
• 1940 to 1960: The AMA accredits programs for the MD degree and opens an office in Washington DC. The AMA forms the Joint Commission on Accreditation of Hospitals, the American College of Surgeons, American College of Physicians, American Hospital Association and the Canadian Medical Association, Medical Association News, and the AMA Educational Foundation for financial aid to med students.
• 1961 to 1979: The AMA discourages smoking and allows students and residents to be members.
• 1968: The “color bar” excluding black physicians from most AMA branches, and thus from most hospitals, was ended.^[11][12][13] The AMA publishes Current Procedural Terminology (CPT) and Guide to the Evaluation of Permanent Impairment. The AMA forms the American Medical Political Action Committee (AMPAC) a special interest group, the Resident Physicians Section, and the Medical Student Section.
• 1980s: The AMA starts the AMA Consumer Publishing program, Organized Medical Staff Section (for hospital staff), resolution against AIDS patient discrimination, and National HIV Policy that urges doctors to help HIV patients.^[14]
• 1990s: The AMA moves to Chicago and starts the AMA website. AMA discourages family violence, euthanasia, gag clauses, rushed maternity stay, smoking ads aimed at kids, and gifts to doctors from the pharmaceutical businesses. The AMA starts Health Access America (greater health insurance coverage), Patient Protection Act II bill, Institute for Ethics, National Patient Safety Foundation, antitrust relief, training for quality end-of-life care (through EPEC), organ donation awareness program, Physicians for Responsible Negotiations (PRN), The Cultural Competence Compendium, AMA Alliance, and health insurance reform. AMA lobbies for the proposed Patients' Bill of Rights.
• 2000s: The AMA starts a health literacy campaign, National House Call campaign, Reducing Underage Drinking Through Coalitions (RUDC), Disaster Preparedness and Medical Response Web site, Restored Earnings to Lift Individuals and Empower Families Act of 2001 (financial aid to med students and residents), Covering the Uninsured initiative, "No Butts About It…Tobacco Stinks" project, AMA HIPAA Link, National Advocacy Conference in Washington, D.C., AMA National Summit on Obesity, AMA Member Connect, Patient Safety and Quality Improvement Act, Commission to End Health Care Disparities, Tsunami Relief Project, and "Voice for the Uninsured" Campaign. The AMA sets limits on residency hours and consecutive hours on call. The AMA successfully lobbies against the 4.4% cut and then 5% cut in Medicare physician payments.^[15]

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^[16] medical student debt has increased by 7% each successive year.^[17]
• 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.^[18]

Political positions

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

• In the 1930s, the AMA attempted to prohibit its members from working for the primitive health maintenance organizations that sprung up during the Great Depression. The AMA's subsequent conviction for violating the Sherman Antitrust Act was affirmed by the U.S. Supreme Court. American Medical Ass'n. v. United States, 317 U.S. 519 (1943).
• The AMA's vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup supported by Ronald Reagan. Since the enactment of Medicare, the AMA stated that it "continues to oppose attempts to cut Medicare funding or shift increased costs to beneficiaries at the expense of the quality or accessibility of care" and "strongly supports subsidization of prescription drugs for Medicare patients based on means testing". The AMA also campaigns to raise Medicare payments to physicians, arguing that increases will protect seniors' access to health care. In the 1990s, it was part of the coalition that defeated the health care reform proposed by President Bill Clinton.
• The AMA has given high priority to supporting changes in medical malpractice law to limit damage awards, which, it contends, makes it difficult for patients to find appropriate medical care. In many states, high risk specialists have moved to other states with such limits. For example, in 2004, not a single neurosurgeon remained in the entire southern half of Illinois. The main legislative emphasis in multiple states has been to effect caps on the amount that patients can receive for pain and suffering. These costs for pain and suffering are only those that exceed the actual costs of healthcare and lost income. Multiple states found that limiting pain and suffering costs has actually dramatically slowed increases in the cost of medical malpractice insurance. Texas, having recently enacted such reforms, reported that all major malpractice insurers in 2005 were able to offer either no increase or a decrease in premiums to physicians. At the same time however, states without caps also experienced similar results; this suggests the cyclical nature of insurance markets may have actually been responsible. Some economic studies have found that caps have historically had a dubious effect on premium rates.^[19] Nevertheless, the AMA believes the caps may alleviate what is often perceived as an excessively litigious environment for many doctors.
• Another top priority of the AMA is to lobby for change to the federal tax codes to allow the current health insurance system (based on employment) to be purchased by individuals. Such changes could possibly allow millions of currently uninsured Americans to be able to afford insurance through a series of refundable tax credits based on income (for example, the lower your income, the greater your credit).
• The AMA has made efforts to respond to health care disparities.
  • As such the AMA created an Advisory committees to assess the nature of disparities within different racial and ethnic groups.^[20] One such committee focuses on the health of the Gay, Lesbian Bisexual and Transgender community. In 2005, the AMA president Edward Hill, MD gave a keynote address to the Gay and Lesbian Medical Association at its annual conference.^[21] 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.^[22]
  • 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 crisis are the restrictions on allowing foreign physicians to work in the U.S. post the September 11, 2001 attack, and may become more restrictive after the attempted terrorist bombings June 2007 in Britain, still under investigation, linked to foreign^[23][24] doctors.^[25][26]
• 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 copayment if an employee goes to the retail clinic instead of the doctor's office, inferring that this practice might negatively affect quality of care.^[27]
• 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."^[28]
• 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, amongst other activities.
• The AMA supported the Health-care Reform bill, HR 3200 in an official position statement from its VP, Michael D. Maves.^[29]

Criticisms

• Critics of the American Medical Association, including economist Milton Friedman, have asserted that the organization acts as a guild and has attempted to increase physicians' wages and fees limit by influencing limitations on the supply of physicians and non-physician competition. In Free to Choose, Friedman said "The AMA has engaged in extensive litigation charging chiropractors and osteopathic physicians with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible."

• Profession and monopoly, a book published in 1975 is critical of the AMA for limiting the supply of physicians and inflating the cost of medical care in the United States. The book claims that physician supply is kept low by the AMA to ensure high pay for practicing physicians. It states that in the United States the number, curriculum, and size of medical schools are restricted by state licensing boards controlled by representatives of state medical societies associated with the AMA. The book is also critical of the ethical rules adopted by the AMA which restrict advertisement and other types of competition between professionals. It points out that advertising and bargaining can result in expulsion from the AMA and legal revocation of licenses. 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.^[30]

• The AMA and other industry groups predicted an over-supply of doctors, and worked to limit the number of new doctors. But recently, the AMA has changed its position, predicting a doctor shortage instead.^[31]

• It has been argued that the AMA's CPT monopoly has been created by the government and makes the organization subject to government influence; further, the restricted access to CPT codes may not be in the interest of its constituents.^[7]

Membership

Physician membership in the group is thought to have decreased to less than 20% of practicing physicians.^[7] In 2004, the AMA reported membership totals of 244,569, which included retired and practicing physicians along with medical students, residents, and fellows. The medical school section (MSS) reported totals of 48,868 members, while the resident and fellow section (RFS) reported 24,069 members. Combined they account for almost 30% of AMA members.^[32] If every other member of the AMA was a fully qualified practicing physician then the AMA would represent 19% of America's practicing physicians (There are currently approximately 900,000 practicing physicians in America). However, MedPage Today estimates that the AMA only represents 135,300 "real, practicing physicians" as of 2005 (15.0% of the United States practicing physicians).^[33] When asked about this, Jeremy Lazarus, MD, a speaker in the AMA House of Delegates, stated that membership was stable, avoiding commenting on the low overall numbers (2005 AMSA annual meeting, AMA vs. PNHP healthcare debate, Arlington, Virginia). This has been seen as a major reason why physicians, on the whole, are less successful in lobbying for their positions than other professional and paraprofessional societies.

See also

• AMA Foundation Leadership Award
• AMA Scientific Achievement Award
• American Association of Physicians and Surgeons
• American College of Physicians
• American Dental Association
• American Medical Student Association
• American Osteopathic 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

• AMA home page
• AMA Foundation
• AMA Political Contributions (Opensecrets.org)
• AMA Archives