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The AMA and America's Doctors: Opinion by D4PC Member, Adam F Dorin, MD, MBA

Wednesday, June 23, 2010



The AMA and America's Doctors--Betrayal From the Board Room to the Bedside 
by Adam Frederic Dorin, M.D., MBA
 
The old medical establishment meets an increasingly frustrated, resentful and emboldened chorus of dissent in the physician community. The silent majority of America's doctors find their voice to speak out.
 
An overwhelming majority of America's private practice physicians were behind the President when he took on the challenge to provide health care insurance to all Americans.  The goal was noble: improve access to preventative medicine, stop using emergency rooms as substitutes for a doctors' office visits, and remove the uninsured from the burden of unexpected and financially crippling health conditions. Doctors earnestly endorsed health insurance portability and competition across state lines, the elimination of pre-existing condition clauses, and ramped up efforts to fight fraud--these are intelligent and worthy pursuits that should have been incorporated into law. Unfortunately, however, the new health care reform law--commonly referred to as Obamacare--is not the panacea it has been portrayed by some politicians to be; it will have real world, possibly devastating, implications for the physicians upon whom we all rely to deliver America's medical care.
 
At the heart of the disconnect between a nation's shared vision to give health care to all, and the realities of actually delivering that care in a fashion that is cost-effective and preserves access and quality, is the behind-the-scenes battle between the American Medical Association (AMA) and the majority of community doctors across America.
 
The American Medical Association (AMA) has a membership of, at best, 18 percent of the full practicing physician population in the United States. The AMA has an exclusive contract with the federal government to own, distribute and charge for the coding books that all medical specialties must use to bill for insurance cases (regardless of whether that insurance is government or private in nature). The AMA, whose dwindling membership consists of mostly primary care doctors and medical students, does not need the support of the majority of the nation's physicians to carry on the work of its choosing. It has had more than enough money to comfortably position itself as the stalwart defender of physician and patient rights, but instead decided to stake out a decidedly left-of-center agenda in the arena of legislative affairs. Long considered unfriendly to more highly-reimbursed medical specialists, whose training is understandably more lengthy and rigorous that than of general practitioners, the AMA Board abandoned its true national constituency to 'level the playing field' in terms of physician compensation. Intrinsic to the Obamacare law are provisions to increase pay to primary care medicine, which has experienced shortages in manpower. It also puts into effect drastic decreases in pay to surgical specialties and some medical specialties such as cardiology.
 
The AMA, it seems, needed only the money it receives from its exclusive coding book contract with the Feds (valued at hundreds of millions per year), and the perception in the mainstream media that it is the primary mouthpiece for doctors nationwide, to disregard the majority dissent within its ranks. At the heart of the AMA's power are the community doctors who rise up through the ranks of county and state medical societies as AMA 'delegates'. Some may call these doctors 'enablers' as they help to promote an agenda that is out of touch with America's mainstream doctors. These individuals are charged with writing policy, voting on member resolutions, and meeting local and national politicians; some are paid as lobbyists to campaign on behalf of the AMA and its state feeder societies (or, at least, given compensation for their non-clinical time and expenses). The position of AMA delegate and 'doctor lobbyist' can be highly coveted.  Sadly, the urge to put one's own perceived sense of importance above the requests and needs of the greater physician community was just too great to overcome for some medical leaders. Despite internal tensions, and with full knowledge of the dissent within the ranks of doctors nationwide, the AMA elite betrayed their own. Multiple polls, grassroots doctor organizations, and physician forums across the nation (such as the Association of American Physicians and Surgeons, Docs4PatientCare, and Sermo) have demonstrated the concern and consternation of doctors at being sold out by their traditional medical associations.
 
It is because of this betrayal that many medical practitioners have already opted-out of participation in the Medicare and Medicaid programs; many more will follow, will restrict their practice hours, and will consider retiring early. The reality behind the grand vision of Obamacare is that this legislation will cut reimbursement to specialist doctors, impose onerous new regulations and restrictions, and squeeze the life out of thousands of medical practices in America. In September of 2009, months before the March 2010 passage of HR 3590 (the multi-thousand page health care reform legislation), Investors Business Daily published a study (The IBD/TIPP poll) showing that 45% of doctors would likely quit or retire early if the bill passed. 72% of the doctors polled disagreed with the White House's claim that forty-seven million more people could get quality health care without decreasing the quality of care for everyone else (and increasing costs). The AMA was hoping to show that it can 'play ball' and be seen as a willing partner to historic legislation. Instead, its leadership fell victim to a dangerous game of politics that may ultimately lead to a vastly diminished pool of qualified physicians and a decreased quality of medical care for all Americans.
 
We are witnessing an ever-increasing chorus of Americans--from think tanks to tea partiers to accountants--who are decrying the underhanded tactics used by the Democrats and the Administration in getting the health care reform legislation passed. The AMA signed on to promises that all doctors would receive some sort of permanent fix to the way doctors are paid by the government, commonly known as the SGR (sustainable growth formula). Seven years of 'fixes' to the SGR were abandoned on April 1, 2010. The Obamacare law provides no such permanent fix to the SGR, and doctors' practices are limping along with temporary delays of the impending 21% across-the-board cut that is looming on the horizon. So much money was spent on Obamacare that Congress lacks the stomach to add more spending to the federal deficit. Obamacare was not fully thought out, and was sold disingenuously to the American people. The AMA was complicit to this act. Assuming no changes to the law, every American, starting in 2013, will be able to tout a medical insurance card (unless a penalty is paid to opt out). The real question, however, is what that 'card' will actually represent in terms of quality and access to care.
 
The President's ultimate goal, it seems, has been to force the expansion of physician extenders, minimize the role of doctors to mere 'health care personnel' and slowly but surely edge the nation toward a single-payer medical system. Corporations will be inclined to drop their health plans to counter the overwhelming burden of increased costs, fees and taxes, and the workforce will stagnate with zero-growth employment numbers. Washington will then have to resort to some form of 'value added tax' to tackle the exponential national debt and handicapped economy. And all of this in the absence of any meaningful tort reform for physicians. Isn't it odd (and sad) that the White House would favor the Trials Lawyers lobby over the interests of America's health care providers and America's patients? The end result of all of this will likely be a European-style social democracy here at home--a far cry from the vision of America's founding fathers.
 
If the AMA had done its job of representing its physician constituents, then the American people, Congressmen and Senators would have known better what doctors really thought about Obamacare before the final vote was taken. The people and doctors of America have been betrayed by a faulty political process and self-serving medical leaders. Isn't it time the press take notice and allow the truth to come out. Doctors never liked the way the health care reform legislation was fashioned, and still don't.
Doctor Dorin is an AAPS member, Delegate to the California Society of Anesthesiologists, and a medical director; he is a board-certified anesthesiologist practicing in San Diego County.
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