Critics of the American Medical Association argue that the organization's ranks have shrunk to the point where it can no longer claim to be the voice of the nation's doctors. Now new demographic information suggests that, not only might the AMA no longer represent doctors, but its membership and leadership may not be representative of the U.S. physician population.
According to two newly released reports on the U.S. physician population and the AMA's leadership and membership demographics, the country's oldest and still-largest physician organization is doing OK in some respects at matching the changing gender demographics of the nation's physician workforce. But the age distribution of AMA members and leaders doesn't come close to mirroring the age range of physicians currently in practice.
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With Mayor Rahm Emanuel's controversial plan to close 54 underused or underperforming schools, Chicago's educational institutions are once again the focus of negative national publicity. But the system has shown itself to be capable of educating national leaders, as evidenced by the fact that the current presidents of two prominent physician organizations are alumni of Chicago public high schools.
Dr. Jeremy Lazarus, who graduated from Senn High School on Chicago's Northeast side in 1961, was sworn in last June as president of the American Medical Association. Dr. Joshua Jacobs, a 1973 graduate of Taft High School on the city's Northwest side, was sworn in last month as president of the American Academy of Orthopaedic Surgeons.
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More and more news articles and news releases are decrying how economic pressures are increasing the drudgery of healthcare work. But there are also rays of hope and inspiration.
Typical of the drudgery reports is this passage from a recent news release heralding a new white paper from the National Patient Safety Foundation: “Healthcare workers are experiencing an epidemic of demoralization, fatigue, and risk of injury that threatens not only their safety, but the safety of the patients under their care.”
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A doctor who died 12 years ago is having an influence on healthcare debates all across the country.
Some 200 bills relating to certificate-of-need laws have been introduced in state legislatures this year. According to Kara Hinkley with the National Conference of State Legislatures, the trend is toward limiting CON by repealing pieces or including moratoriums on CON requirements.
Despite this opposition to the CON process, a new study concluded that certificate of need has done what it set out to do: Control healthcare costs.
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Membership in many physician associations had been flat or declining in recent years, but now appears to be on the upswing. This could be the result of better times, better marketing or the fear generated by the regularly repeated threats of precipitous Medicare pay cuts.
Membership dues are often the first things to be sacrificed when the economy stalls. Docs rejoining groups like the American Medical Association or state medical societies could be a sign that better financial times lie ahead. It could also be a sign of a growing interest among physicians to advocate for their profession. Or, according to a theory put forth by Princeton University economist Uwe Reinhardt, it may not be a positive development at all.
According to a California Medical Association news release, there are between 60,000 and 70,000 physicians in the state of California, and 37,222 are CMA members—which represents a more than 4% increase from the year before. The growth is significant, according to the release, because membership had been “relatively flat” for nine years.
“The increase in membership is due to outreach to medical groups and more targeted recruitment and retention activities,” the release said. (The release didn’t mention that CMA dues for medical student, resident and fellow members were eliminated last year and that the CMA asked county medical societies to do the same.)
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Everyone, it seems, wants in on the medical home business, but the medical home practice implementation consulting service TransforMED got in on the ground floor.
A subsidiary of the American Academy of Family of Physicians, TransforMED was launched in June 2006 as part of the AAFP’s two-year, 36-practice national demonstration project. Eighteen of the demonstration practices were on their own, and 18 received help from TransforMED—which has since gone on to help guide almost 700 practices in adopting the medical home model. The model calls for coordinated care, a “whole-person orientation,” and increased patient access, which includes providing secure electronic doctor-patient messaging and offering same-day scheduling options.
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No one doubts Edward Hospital CEO Pam Davis' credentials as a tough customer.
In 2003, she wore an FBI wire while meeting with thugs affiliated with the Illinois Health Facilities Planning Board so the feds could get dirt on corrupt officials seeking kickbacks from the state's “certificate of need” healthcare construction-approval process.
Former Bear Stearns & Co. Managing Director Nicholas Hurtgen pleaded guilty to a role in the scheme, and the trail of corruption led all the way up to then-Gov. Rod Blagojevich. While Hurtgen eventually withdrew his plea and all charges against him were quietly dropped, Blagojevich is now serving a 14-year prison term after being convicted on 18 charges.
The Facilities Planning Board was dissolved and replaced with an entity hoped to be harder to buy off. And, for reporters, Davis became a go-to source when seeking a critical voice against the certificate-of-need process. She also went on to become an ABC person of the week and Naperville American Legion Post No. 43's Citizen of the Year.
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Here's an interesting statistic from the American Academy of Family Physicians: In areas where there are few physicians, there are still usually more doctors than nurse practitioners.
I was sent that stat and more after writing a blog post responding to the AAFP's and the American Medical Association's (PDF) insistence that in the drive toward team-based healthcare, physician leadership is an absolute requirement for any healthcare team.
While physicians have presented a unified front, they stand in isolation.
Nurse practitioners criticized the AAFP and called it "misdirected and out of step” on the issue. With a nod to the idea that the care-coordination-focused medical-home practice model is the new foundation of team-based care in the U.S., the NPs noted that none of the organizations that recognize practices as medical homes requires practices to be physician-led to earn the organization's seal of approval. (I had trouble believing that last part, so I called the National Committee for Quality Assurance, the Joint Commission and the Accreditation Association for Ambulatory Health Care, and they all confirmed it was true.)
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The brave new worlds of healthcare and healthcare economics got me thinking about legendary University of Alabama football coach Paul "Bear" Bryant.
First I was assigned to write an article on voters' approval of a local ballot measure in California that capped executive pay at the public healthcare institution in Google's hometown, El Camino Hospital in Mountain View, Calif., at twice that of the state's governor.
The El Camino Hospital pays CEO Tomi Ryba a $695,000 base salary to run its 361-bed, two-campus institution, and—eight days after the election—its board approved a $137,815 performance bonus (PDF) for her.
In contrast, Gov. Jerry Brown makes almost $174,000 as the state's CEO, but the California Citizens Compensation Commission—as part of state austerity measures—has knocked that down to $165,000 starting next month.
The hospital board has authorized taking legal action to challenge the ballot measure's directive, which would reduce Ryba's salary to $330,000.
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Go team! Or, more accurately, “Go physician-led team” was one of the battle cries of the American Medical Association House of Delegates interim meeting.
But what if there are no physicians around to lead the team? Would the AMA be willing to call for a draft where doctors are pulled from comfortable suburban practices and dragged to the rural hinterlands like a professional athlete picked by a new team in an expansion draft?
OK. No more sports analogies. But there is a definite trend of physicians calling for physician-led teams without addressing the realities of the projected physician shortage and the existing “maldistribution” of doctors.
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Go team! Or, more accurately, “Go physician-led team” was one of the battle cries of the American Medical Association House of Delegates interim meeting.
But what if there are no physicians around to lead the team? Would the AMA be willing to call for a draft where doctors are pulled from comfortable suburban practices and dragged to the rural hinterlands like a professional athlete picked by a new team in an expansion draft?
OK. No more sports analogies. But there is a definite trend of physicians calling for physician-led teams without addressing the realities of the projected physician shortage and the existing “maldistribution” of doctors.
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