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American Medical Association
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The American Medical Association (AMA), founded in 1847 and incorporated 1897, is the largest association of physicians and medical students in the United States. The AMA's 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.
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The American Medical Association (AMA), founded in 1847 and incorporated 1897, is the largest association of physicians and medical students in the United States. The AMA's 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. The AMA also publishes a list of Physician Specialty Codes which are a 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.
History
Charitable activities
- The AMA Foundation provides approximately $1,000,000 annually in tuition assistance to financially constrained students (who now graduate medical school with an average debt load of well over $100,000 each).
- Funds awareness projects about health literacy.
- 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 program has a goal of providing over 100,000 stethoscopes to third world countries, donated by physicians and students.
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.
- For most of the twentieth century, the AMA opposed publicly-funded health care because of concerns physicians have had over the financial implications of such plans and the worries that a prominent government role in coordinating medical financing would inappropriately interfere with the doctor-patient relationship. When Progressive Era advocates proposed compulsory health insurance in the second decade of the twentieth century, the AMA initially took a cooperative and moderately open position to the idea, but by 1918 the Association had moved to a strongly oppositional position regarding compulsory health insurance. Ronald Numbers' 1978 book, Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920, provides what is probably the best account of the AMA's policy positions during this early period.
- 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, .
- 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. 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. 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. 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.
- 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 foreigndoctors.
- 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.
- 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."
- 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,H-460.991, and resolution 506-2007 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 activites.
Criticisms
Critics of the American Medical Association, including economist Milton Friedman, have asserted that the organization acts as a government-sanctioned 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 osteopaths 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.
The AMA is also criticized because it derives a significant portion of its income by selling physician licensure data to pharmaceutical companies, which those entities use to track physician prescribing. It continues to do this despite complaints by some physicians and others, claiming approximately $33 million in revenue in 2005 from this practice. However, the AMA does allow physicians to "opt-out" of having their information shared through the Physician Data Restriction Program (PDRP).
Physician membership in the group has decreased to lower than 19% of practicing physicians. In 2004, 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. 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). 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).
See also
Further reading
- Burrow, James G. AMA: Voice of American Medicine. Baltimore: Johns Hopkins 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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