June 2019 President’s Message

AMA represents a wide range of interests and points of view

by Michael Lievens, MD

For the past two years, as MSSC president-elect and now as president, I have attended the annual AMA meeting in Chicago in early June.

The AMA is a large organization that must represent a wide range of interests and points of view, even though it represents only physicians. It has surprised me just how different the interests and opinions have become amongst a group of professionals that I would have predicted would be more homogeneous.

Developing AMA policy and positions is messy, painstaking work, which seems to crawl along at a snail’s pace. The delegates work surprisingly long and difficult hours in committee work, wrestling with those divergent points of view.

In addition, numerous special-interest groups, corporations and political entities desire to obtain the AMA’s endorsement, or to influence its policy and position on numerous issues. All of this seems to pull the attention of the AMA in many directions, sometimes good, sometimes not so beneficial.

The most contentious issue this year seemed to be the AMA’s long-standing opposition to a single-payer health system. The issue generated a loud protest at the outset of the meeting, which reportedly included medical students and nurses.

The AMA voted to maintain its opposition to a single-payer system (e.g. Medicare for all) by a 53% to 47% margin. The voting reportedly largely followed a “young vs. experienced/old” dividing line. It might be interesting to see how this develops over the next few years.

For the third year in a row, the delegates elected a female president-elect. The AMA also has spent a lot of time and energy on diversity issues of all kinds. This is a good thing, for which the organization deserves credit.

I find it sad, however, that the AMA has had to spend so much effort on this issue. There are so many topics affecting practicing doctors every day, which are demanding urgent attention, such as prior authorizations, EHR, augmented intelligence, workforce shortages and more. I look forward to the time when there is an equal-opportunity playing field for all, so the issues that all of us face can be addressed with the full resources of the organization.

On another topic: Many of you likely read the recent New York Times article by Dr. Danielle Ofri, which has been widely shared on social media by doctors and nurses. It discusses how the business of health care depends upon exploiting the dedication and professionalism of doctors, nurses and health care workers of all kinds. It is a good read, and I encourage you to read it if you haven’t already.

I was struck by the timing of the article and wondered if the publication during the AMA meeting was intentional or coincidental. The work that physicians bear – in patient care, record keeping, research, addressing health care policy and so on – is massive. It seems that we are bearing a bigger burden than ever before. Yet, we are ever more subservient to payers, investors, hospitals … to “corporate medicine.”

This makes me quite concerned about the future of our profession. We seem to be working harder than ever, yet we have less power and influence over the system than ever. As more of us become employees of corporate medicine, our ability to shape our future seems to diminish.

I completely understand why physicians choose to be employees. There are many reasons it may be a wise choice for any of us. The corporate nature and size that medicine has become often makes it essential to be an employed physician just to survive.

As a profession as a whole, however, we need to be in control of patient care as much as possible. Physicians need to take “ownership” of their practice and their patients, whether they “own it” or not. It is a mind-set, or a paradigm. By “owning” patient care and decision making, we can control at least a part of the health care system.

If doctors don’t control this piece of the pie, who can be trusted to do it in our place?

Lastly, I urge all of you to be a member of the AMA. Kansas is at risk of losing a delegate to the AMA assembly. Delegate numbers are a representation of the number of members from any given state, just like the U.S. House of Representatives. If you are already a member, thank you. If not, please sign up and be counted.