The Corpus Callosum

Obama's speech will end a 26-year long drought for presidential speeches at the AMA -- Ronald Reagan addressed the delegates in 1983, the same year he proposed to freeze Medicare payments to physicians while his administration worked to cobble together a Medicare overhaul.

The freeze, and a short-lived Medicare option called part C which covered catastrophic medical expenses, were both flops. When President Barack Obama delivers a speech tomorrow in front of the American Medical Association House of Delegates, it will be a poignant occasion for the divisive doctors' group for a number of reasons.

The years since the Reagan speech have been tough ones for the AMA, which has seen both its membership rolls and its revenues shrink.

While membership has shrunk since the 1980s, the group still describes itself as the "house of medicine" with a membership of about 236,000 physicians from a wide swath of specialties-- but 30% of them are students, who don't pay dues, and only about 50% are practicing physicians. [emphasis added]

Unfortunately,  I can't tell you how many physicians are in the USA.  But to put that membership number of 236,000 in perspective:

The Bureau of Labor Statistics says that there were about 633,000 physician jobs in the USA in 2006.  That includes MDs and DOs.  It does not include medical students or retired physicians.  I don't know if they include residents, but they probably do, since residents get W2s.  I don't know if they include physicians who do not see patients, such as those in research-only jobs.

American Family Physician reported that there were 936,000 physicians in the USA in 2004.  That includes MDs and DOs.  5.2% were DOs; the remaining 94.8% were MDs.  
USA Today reported that there were about 800,000 active physicians in the USA in 2004, and that medical schools produce 25,000 per year.  

Let's say there are about 1 million physicians in the USA in 2009.  The AMA has about 125,000 active physicians on its rolls.  That's about 1/8th of the total .  That does not sound right.  In an interview on Democracy Now!, Dr. Quentin Young -- an AMA member for over 50 years -- stated:

I’m a very severe critic of what AMA has done. And it’s worth noting that AMA membership has dropped from some 90 percent of doctors when I started out a half-century ago, and now about a third of America’s doctors do belong.

Perhaps the discrepancies can be accounted for be the fact that not all physicians are MDs, and some counts may or may not include medical students, residents, retirees, and research-only MDs.  Perhaps some counts merely total the numbers of licensed physicians in each State, while many physicians are licensed in more than one state. 

In any case, it is clear the the AMA is waning in influence.  They are at risk of becoming marginalized.  In a way, it is like what is happening to the RNC.  The membership is declining.  The members who are left, are those who are most extreme in their positions.  As they become relatively more extreme, they become less relevant, easier to ignore.

I've not been a member of the AMA for a long time, maybe 15 years.  I still get a lot of mailings and emails from them, exhorting me to join again.  Sometimes they offer me a special deal, half-price for a six-month membership.  Cripes, they think I'm smart enough to be a doctor, but not smart enough to do arithmetic.  But the most common pitch is that they would represent me in Washington DC.  My suspicion is that it is the political iinfluence that persuades many MDs to join.  Sometimes there are other factors, such as local medical society than require membership in the AMA in order to join the local group.  Some hospitals or insurance groups require membership in the local medical society, so this indirectly requires membership in the AMA.

I would venture to guess that many AMA members, gathered around the radical core, are fairly casual about their membership.  It gives them something to put of their CV, they are in the habit of renewing every year, and they take the expense as a tax writeoff, or charge it to their employer, or something like that.  The number who are truly active may be rather small.  I can't prove nay of this, but I think it is true.

All this is a long-winded way of saying that the AMA probably does not speak for the majority of doctors.  I would encourage politicians to keep this in mind, lest they act out of disproportionate fear of the organization's clout.  

One the the MDs that Amy Goodman interviewed on Democracy Now! has left the AMA over their position on a public option for healthcare reform.  I would do the same, if they'd let me quit twice.