American Medical Association

American Medical Association
Formation May 7, 1847 (1847-05-07)
Type Professional association
Purpose "To Promote the art and science of medicine and the betterment of public health"
Headquarters Chicago, Illinois, U.S.
Location
  • United States
Membership
224,503 as of 2012[1]
Official language
English
President
 Barbara L. McAneny[2]
Key people
 James Madara, CEO & EVP; Jack Resneck, Jr., Board Chair

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 mission is "to promote the art and science of medicine and the betterment of public health."[5] The Association also publishes the Journal of the American Medical Association (JAMA).[6] 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, American physicians met in Philadelphia and formed the AMA 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.

2000-present

In 2002, the American Medical Association released a report that found a medical liability insurance crisis in at least a dozen states forcing physicians to either close practices or limit services. The association called for Congress to take action and campaigned for national reform.[7] The American Medical Association launched the "Voice for the Uninsured" campaign in 2007 to promote coverage for uninsured citizens.[8]

In 2007, AMA called for state and federal agencies to investigate potential conflicts of interest between the retail clinics and pharmacy chains.[9] The American Medical Association issued a formal apology for previous policies that excluded African-Americans from the organization and announced increased efforts to increase minority physician participation in the AMA in 2008.[10]

In 2009, the American Medical Association released a public letter to the United States Congress and President Barack Obama endorsing his proposed overhaul to the public health care system, including universal health coverage.[11] The following year, it offered "qualified support" for the Patient Protection and Affordable Care Act.[12]

The AMA officially recognized obesity as a disease in 2013 in an attempt to change how the medical community approaches the issue.[13] In 2014, the Association created the AMA Opioid Task Force to evaluate prescription opioid use and abuse.[14] The American Medical Association supported the Medicare Access and CHIP Reauthorization Act of 2015 which introduced Medicare reforms and replaced the SGR formula with increased Medicare physician reimbursement.[15]

In 2015, the AMA declared there is no medically valid reason to exclude transgender individuals from serving in the U.S. military. The Human Rights Campaign lauded the decision.[16] The Association announced its opposition to replacing the federal health care law in March 2017, claiming millions of Americans would lose health care coverage.[17]

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.[18] 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-style organization 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.[19] 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.[20] 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.[21]

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.[22]

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.[23][24]

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.[25]

  • 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.[18]
  • 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.[26] 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.[19] 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.[27] 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.[28] 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.[29]
    • 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 attacks, and may become more restrictive after the attempted terrorist bombings June 2005 in Britain, still under investigation, linked to foreign doctors.[30][31]
  • 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."[32]
  • 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.
  • In June 2018, the AMA discussed its support of gun control and presented nearly a dozen proposals at its annual policymaking meeting in support of stricter regulations.[33]

Criticism

In historical terms, the American Medical Association's policy of allowing its constituent 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 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".[34] The intersection of race and health in the U.S. has long been a disputed topic relating to many factors.[35] 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.[36]

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."[36] 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."[37]

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.[38]

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.[39]

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.[40]

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.[41]

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.[42] 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.[43] 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.[44]

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 four years of negative amortization during residency[45] medical student debt has increased by 7% each successive year.[46] By the time debt is paid off, it is sometimes almost half a million dollars.[47]

See also

Notes and references

  1. ↑ "American Medical Association Implements New Policies to Combat Opioid Abuse - Drug and Alcohol Treatment Centers (855)-638-9268". Gettreatment.com. 20 July 2016. Archived from the original on 8 February 2017. Retrieved 19 April 2018.
  2. ↑ "Barbara L. McAneny, M.D., Inaugurated as 173rd President of the AMA - American Medical Association". Ama-assn.org. Retrieved 15 June 2018.
  3. ↑ "AMA (AMA History) 1847 to 1899". American Medical Association. Archived from the original on 9 February 2009. Retrieved 2009-02-16.
  4. ↑ Pollack, Andrew (2013-06-18). "AMA Recognizes Obesity as a Disease". New York Times. Retrieved 2013-07-21.
  5. ↑ "About the American Medical Association - AMA". Ama-assn.org. Retrieved 19 April 2018.
  6. ↑ "About JAMA: JAMA website". Jama.ama-assn.org. Retrieved 19 April 2018.
  7. ↑ "AMA: States are in crisis of liability and of costs". Relias. August 1, 2002.
  8. ↑ "AMA campaign to psuh coverage for uninsured". Modern Healthcare. August 23, 2007.
  9. ↑ "In-store clinics". Archived from the original on 2007-09-29. Retrieved 2007-07-22.
  10. ↑ "Group Apologizes for Its Racial Bias". The New York Times. July 11, 2008.
  11. ↑ David D. Kirkpatrick (September 9, 2009). "A.M.A. Endorses a Health Care Overhaul". The New York Times.
  12. ↑ David M. Herzenhorn (March 19, 2010). "A.M.A. Offers 'Qualified Support' for Health Bill". The New York Times.
  13. ↑ Andrew Pollack (June 18, 2013). "A.M.A. Recognizes Obesity as a Disease". The New York Times.
  14. ↑ Cindy Sanders (September 22, 2017). "Addressing Opioid Addiction in America". Birmingham Medical News.
  15. ↑ Joyce Frieden (April 14, 2015). "Senate Passes Historic SGR Repeal Bill By Vote of 92-8". Medpage Today.
  16. ↑ Campaign, Human Rights. "Voters Reject Cruz's False Scare Tactics Against Trans Americans - Human Rights Campaign". Human Rights Campaign. Retrieved 19 April 2018.
  17. ↑ Reed Abelson (March 8, 2017). "American Medical Association Opposes Republican Health Plan". The New York Times.
  18. 1 2 American Medical Ass'n. v. United States, 317 U.S. 519 (1943)
  19. 1 2 "The doctors are leaving". The Chicago Tribune. April 18, 2004.
  20. ↑ "Weiss Ratings - Weiss Ratings". Weissratings.com. Retrieved 19 April 2018.
  21. ↑ "Medical Liability Claim Frequency: A 2007-2008 Snapshot of Physicians" (PDF). Ama-assn.org. Retrieved 19 April 2018.
  22. ↑
  23. ↑ "American Medical Association annual meetings collection 1866-1890". National Library of Medicine.
  24. ↑ "AMA Deceased Physicians Masterfile 1906-1969". National Library of Medicine.
  25. ↑ Klein, Ezra (22 Mar 2012). "Our Corrupt Politics: It's Not All Money". The New York Review of Books. Retrieved 2013-06-30.
  26. ↑ Steven A. Schroeder (April 2011). "Personal reflections on the high cost of American medical care: Many causes but few politically sustainable solutions". Archives of Internal Medicine. 171 (8): 722–727. doi:10.1001/archinternmed.2011.149. PMID 21518938.
  27. ↑ "AMA (Public Health) Eliminating health disparities". Ama-assn.org. Archived from the original on 14 January 2009. Retrieved 19 April 2018.
  28. ↑ "AMA (GLBT) News release from the Gay and Lesbian Medical Association". Ama-assn.org. Retrieved 19 April 2018.
  29. ↑ "AMA (GLBT) AMA policy regarding sexual orientation". Ama-assn.org. Retrieved 19 April 2018.
  30. ↑ Justin Donathan. "Physician Shortages, Gone Country". eQuoteMD. Retrieved 2014-04-14.
  31. ↑ "Short supply of foreign doctors". Archived from the original on 2007-09-29. Retrieved 2007-07-22.
  32. ↑ "AMA policy statement on climate change". Ama-assn.org. Retrieved 19 April 2018.
  33. ↑ "Frustrated AMA adopts sweeping policies aimed at gun violence". NBC News. Retrieved 2018-06-13.
  34. ↑ "The Medical Committee for Human Rights". Virtual Mentor. American Medical Association. 16 (Number 9): 745–748. September 2014. Retrieved May 13, 2016.
  35. ↑ "Health Disparities By Race And Class: Why Both Matter". Content.healthaffairs.org. Retrieved 19 April 2018.
  36. 1 2 Friedman, Milton; Friedman, Rose (1990). Free to Choose: A Personal Statement. Mariner Books. pp. 238–241. ISBN 9780156334600.
  37. ↑ Wilson, M.D., Cecil B. (April 12, 2012). "AMA Supports Training More M.D.s". Wall Street Journal. Retrieved May 13, 2016.
  38. ↑ Berlant, Jeffrey (1975). Profession and Monopoly: a study of medicine in the United States and Great Britain. University of California Press. ISBN 0-520-02734-5.
  39. ↑ Cauchon, Dennis (2005-03-02). "Medical miscalculation creates doctor shortage". USA Today.
  40. ↑ Scherz H. (2010-05-07). "Why the AMA wants to muzzle your doctor". Wall Street Journal. Archived from the original on 10 May 2010. Retrieved 2010-05-10.
  41. ↑ "U.S. judge finds medical group conspired against chiropractors". The New York Times. Associated Press. 29 August 1987. Retrieved October 23, 2016.
  42. ↑ "Meeting Dates". www.ama-assn.org. Retrieved 2015-09-23.
  43. ↑ "Physician Leadership Opportunities at the AMA". www.ama-assn.org. Retrieved 2015-09-23.
  44. ↑ "Member Organizations". www.ama-assn.org. Retrieved 2015-09-23.
  45. ↑ "House passes partial forgiveness for medical student loans".
  46. ↑ "Medical Student Debt". Archived from the original on 30 October 2010. Retrieved 2010-11-07.
  47. ↑ "$1 million mistake: Becoming a doctor". www.cbsnews.com. Retrieved 2015-09-23.

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.
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