CATEGORY: HTH Health
HED:Tupelo doctor targets AMA rebirth
By Marty Russell
Membership in the American Medical Association, the nation’s pre-eminent physicians’ advocacy group, has been declining since the 1970s. Only about a third of the nation’s doctors are card-carrying members.
Although AMA officials say that hasn’t hurt the organization’s clout, turning the trend around has fallen to a Tupelo physician, Dr. J. Edward Hill, who’s the state’s only representative on the AMA Board of Directors.
Hill serves as chairman of the AMA’s national Membership Committee and is director of the Family Medicine Residency Program at North Mississippi Medical Center.
Membership cost, a perceived lack of representation for grassroots, practicing physicians and the growth of lobbying organizations for medical speciality groups are cited as reasons for the decline.
Hill cites a perception among physicians of not getting an adequate return for their dues dollars as well as the high cost of those dues as primary reasons for declining membership.
Recent scandals involving selling the group’s endorsement to the Sunbeam Corp. and the firing of a controversial Journal of the American Medical Association editor actually may have helped membership, Hill said.
To turn the trend around, Hill hopes to implement changes in dues structures and offer more grassroots support for members with local and state concerns.
He also thinks the organization can do a better job of communicating with its rank and file members.
In the 1960s, 65.2 percent of all physicians in the nation belonged to the AMA. Currently, only 34.3 percent or 285,560 are members.
“Dues were $25,” Hill said of the ’60s when membership hit its peak. “Membership held steady until 1970 when dues went to $100 and then it began to decline.”
The decline was fairly steady until just recently, he said.
“The level went down less last year than previously,” Hill said. “It’s truly been leveling off for the last two years now.”
Mississippi is the exception in the national decline. Almost 75 percent of the state’s physicians belong to the AMA but that figure may be misleading. Mississippi is one of four “unified” states where members of the county and state medical associations are required to pay AMA dues also.
“It may be the highest (membership rate) in the country,” Hill said of the state’s AMA membership. “If it’s not, it’s close. … Mississippi has always been highly organized. It’s more tradition than anything else. Most feel a duty to join.”
Bill Roberts, executive director of the Mississippi State Medical Association, agrees but also credits visible activity by the state group for keeping membership up.
“We were unified in 1985 and since that time, with only one exception, it’s increased every year,” Roberts said of membership. “It’s the direct result of the efforts the association’s leadership have made to ensure (the organization) is relevant to physicians in their practice.”
Hill hopes to carry that philosophy to the national level but both he and Roberts said they realize the importance of the bottom line to many physicians, particularly now that many are employed and salaried instead of independent operators as in the past.
“Some feel $420 (a year) in dues is too much for what they feel they get for it,” Hill said. “You figure they pay the state $375 and the county $50 to $75. Then the specialty groups can charge another $300 to $500.”
Roberts said even though Mississippi doesn’t have a lot of managed care programs, that trend hurts.
“More are employed now than ever before under those kinds of arrangements where physicians have a fixed income and are limited in the amount of money they can pay,” Roberts said.
The AMA is beginning to realize that, Hill said.
“I don’t think we ever appreciated that until two years ago,” Hill said of the cost of membership.
Changes in the works
As a result, the AMA is changing its dues structure.
“We’ve started a dues rebate and three levels of membership,” Hill said. “The unified states will get a rebate. Mississippi doctors should get a rebate check this year that will amount to about $120.”
Besides Mississippi, Oklahoma, Illinois and Delaware are unified states.
Hill said he wants to lower dues, which account for only 30 percent of the AMA’s income, while growing membership to replace the lost revenue.
“My goal as membership chairman is to see dues at $200 or as low as $100 but see membership increase to where it was in the 1960s,” he said. “Our goal now is a 1 to 2 percent increase (in membership) starting in 2000 and every year for up to five years.”
But both Hill and Roberts said it’s not just the cost of belonging to the group, it’s the perception many doctors have of what they get for their money.
The recent scandal over selling the group’s endorsement to Sunbeam and the firing of a controversial journal editor resulted in almost a complete shakeup of the AMA’s top brass, a move Hill said has improved the group’s integrity in the eyes of its members.
“It was a wakeup call,” he said. “It was the best thing to happen to the AMA in the last 20 years.”
In spite of the scandal and declining membership, Hill said the AMA is still a force to be reckoned with in Washington and in state capitals.
“We’re considered one of the three top lobbying groups in the country,” Hill said. “We have been successful in spite of declining membership.”
Hill said most doctors don’t realize the benefits AMA creates for all physicians as a result of lobbying efforts. An example, he said, is the organization’s successful defeat three times in the last five years of a federal plan to charge doctors a user fee for participating in Medicare.
“They don’t realize what we’re saving them,” Hill said. “We must change that perception.”
The organization also must reconnect with its member physicians where they live and work, he said, and remind them that they do have a voice in policy.
“They tell me they don’t have any input but that’s because they don’t take the initiative,” Hill said.
As an example he cites a county medical society in Mississippi that became concerned about door-to-door sales of chair lifts that were covered by Medicare. The group passed a resolution on the county level and then the state level expressing concern and the measure approved by the AMA on a national level. As a result of the group’s lobbying efforts, the federal government changed Medicare policy.
“(The Health Care Finance Administration) saw the enormous amount of money it was costing to buy unneeded medical care and changed the regulations so they would only pay for the mechanism for the lift, not the furniture,” Hill said. “It saved millions of tax dollars. … The mechanism is there for any physician to have input into health policy, they just have to demonstrate responsibility and initiative.”
But the AMA still plans to step up its grassroots efforts to demonstrate its willingness to work with physicians on the local level.
“If a group of physicians or a physician are having a big problem with an insurance company or managed care organization, we are now willing to send a rapid response team to the local community, if invited, to correct the problem or negotiate,” Hill said. “We’ve been in 12 states in the last three months.”
Other changes include better communications by reducing bulky newsletters detailing AMA stances on issues to just one page aimed at specific physician demographics and specialties.
“It should be something they can read in the elevator,” Hill said.
But the AMA still faces the dilemma of the growing number of specialty groups that are becoming influential in shaping government policy.
“A lot of physicians have decided to pay their dues dollars to specialty and state associations,” said Roberts of the Mississippi medical association.
A longtime dream of unifying all the groups into one voice on the national level is likely to remain a dream, the officials said.
“You have differing interests and different types of practices,” Roberts said.
Hill said in order for the AMA to continue to attract physicians and wield influence in government it must remain committed to the physicians’ ultimate client.
“As long as we keep the patient uppermost in everything we do, we’re going to win,” he said. “If we make our own self-interests and profiteering first, we’re going to lose.”