American Medical Association

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. 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. 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. 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.

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.

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.

Politics and lobbying

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.

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". The intersection of race and health in the U.S. has long been a disputed topic relating to many factors. 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.

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." 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."

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.

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.

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.

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.

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. 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. 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.

Membership

Published membership figures as reported by the AMA include:

Charitable activities