The Ama Isn't Feeling So Hot

Many doctors are asking what's in it for them

It was like routine surgery gone horribly wrong. A small group of staffers and board members at the American Medical Assn. crafted a plan to give a variety of Sunbeam Corp. consumer products the AMA seal of approval in exchange for royalty payments to support education and research. But the reaction by AMA members and medical experts alike to the Aug. 13 deal--the AMA's first step into the commercial arena--was swift and angry. A week later, AMA leaders were beating a retreat. "We have zero tolerance for our image being tarnished," says Dr. Thomas R. Reardon, chairman of the AMA's board of trustees.

On Aug. 21, the AMA was expected to seek a radically restructured arrangement with Sunbeam. Out would go the royalty stream, the exclusivity agreement, and the seal of approval. Now, the AMA plans to take only enough money to cover the cost of printing educational materials to accompany the products.

DWINDLING NUMBERS. Can the damage be undone? Perhaps, but only if the AMA makes clear that any future corporate ties are extremely limited in nature. Says Dr. John Tooker, a senior official of the American College of Physicians and an AMA member: "This should not be a means of generating income for the AMA." Otherwise, such deals "look like the kind of arrangement that movie stars and sports figures make."

What's clear is that anything that riles AMA members is the last thing the 300,000-doctor organization needs as it tries in this, its 150th year, to bolster its image and rebuild membership. The AMA now represents only about 40% of all doctors, down from more than 80% in the mid-1960s, as physicians have drifted to specialty groups deemed better able to represent the narrower interests of surgeons, say, or pediatricians. And while the AMA's financial condition has improved in recent years thanks to the stock market's rise, it has spent heavily on public-service campaigns against underage smoking and domestic violence, and it needs to establish new revenue sources.

Worse, the group's mission--to speak for all doctors on matters of public health and their professional interests--is becoming increasingly difficult as health care undergoes fundamental changes. For example, the AMA found itself in the middle of a fractious debate between general practitioners and surgeons over changes in Medicare reimbursement in the federal budget legislation. Some doctors now question whether the AMA does anything to benefit them. Says Dr. Robert Beatty, a Hinsdale (Ill.) neurosurgeon and a member: "Doctors are getting whipsawed between HMOs, quality-of-care issues, and the malpractice climate, and the AMA isn't helping much."

Some doctors also worry that despite its lavish lobbying, the AMA is losing its influence in the court of public opinion. One reason: The group is seldom seen going to bat for patients, but frequently lobbies on physician pocket-book issues such as Medicare fees. "The choice the AMA has made is to tell the public that health care is a private product, not a public good, and that makes them skeptical of our pronouncements," says Dr. Robert Graham, executive vice-president of the American Academy of Family Physicians.

The AMA also alienated some doctors earlier this year when it abandoned its longstanding opposition to government interference in the doctor-patient relationship and supported a congressional effort to severely restrict late-term abortions. The move stirred up trouble with the American College of Obstetricians and Gynecologists.

The AMA's sheer size still carries clout in Washington and in the states. And it is still highly influential on issues of public health. The AMA has been a forceful player in the tobacco talks, for example, and has won plaudits from consumer groups by opposing "gag" provisions in HMO contracts that prevent doctors from mentioning alternative treatments.

But more controversy may not be far away. There's the plan to consider more corporate tie-ins and a new accreditation scheme under which the AMA plans to establish a database verifying doctor credentials and grading doctor performance. The rating system may be a laudable reform, but it's sure to raise the hackles of many doctors. That suggests a long recovery period for the AMA.

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