Who speaks for physicians? Not the AMA please! We need another voice.

Dr. David Palestrant - the founder and CEO of Sermo - is stirring up his 107K+ physician community by calling out the AMA.  He points out that the AMA's membership numbers appear to be inflated by counting medical students, trainees, retirees and doctors who merely subscribe to JAMA. 

This is an important issue since policy folks who want physicians input on health issues turn to the AMA as representing physicians, but the AMA consistently works against reform.  As Dr. Palestrant points out, the AMA represents only a fraction of physicians and appears to have a significant conflict of interest due to the bulk of its revenue coming from industry relationships and not the physicians.

Dr. Palestrant polled Sermo physician members, 89% of whom (myself among them) said that the AMA does not speak for them.

This begs the question - who does speak for physicians?  I suggest we create a voice specific to primary care.

At this point one of the biggest problems in US health care is the structural incapacity of primary care.  This is NOT due to lack of intellect, energy, professionalism or caring on the part of the primary care work force.  This IS due to policy and payment that directly impede the work of effective primary care.  To solve the quality/cost problems in US health care we must address these structural issues.

If we had adequately funded primary care that lived up to the four cornerstone principles, we'd have better health care outcomes at much reduced costs.

Engaging in the full scope of effective primary care requires getting off the "visit" hamster wheel (pushing patients through our offices like cattle, if you'll pardon the mixed metaphor), learning new processes and skills and using new tools that improve population health outcome.  Every one of these interventions pushes primary care further into financial ruin in the current payment paradigm.

We can step up to the full scope of work only when there is a legitimate course of action that includes resources adequate to the work.  This includes adequate funding for the work as well as eliminating the crushing burden of administrative trivia dictated by the insurance industry. 

Some fully integrated delivery systems are able and willing to increase their primary care funding internally and achieve improved results, but we're leaving the majority of Americans and primary care clinicians out in the cold if all Congress does is suggest that everyone join integrated delivery systems.

To achieve improved population health, improved experience of care, and dramatically cut the total costs of health care we need three things:

1. Primary care must learn to engage in the full scope of work of effective primary care
2. Primary care must have resources that adequately fund this work (tools, team, time)
3. We must eliminate the patient-harming mind-numbing administrative trivial pursuits

I suggest that at this point we need a voice for primary care.  This voice should be inclusive - including specialists and others who support effective primary care.  Let's start here and build a primary care voice that supports the ethical practice of medicine, one that moves us from glorified billing clerks back to the professionals we imagined when we entered the field.

Join me in creating a voice that speaks of the dignity and caring that are the bedrock of our profession.

L Gordon Moore MD

Comments

[Kevin Richter, MD]

Gordon,

I agree with your sentiments wholeheartedly. As they used to say,"It's hard to fight City Hall" in regard to established relationships, politics, revenue, etc. But, I did when I went into Solo Practice and have thoroughly enjoyed it!

If this New Voice is to be one to speak for primary care, our choices are limited, given our limited time. Certain organizations come to mind, such as AAFP,ACP,AAP that could form a triune voice, so to speak. Another that may not strictly be primary care focused, however, is the Association of American Physicians and Surgeons. They seem to have a very ethically-minded set of principles that are on their website.
I applaud your tenacity!

[Sandra Barton MD]

OK. So, agreed, primary care needs a better voice. No doubt about that. Most of the public isn't even aware of what "primary care" means. Perhaps the AMA could divide into a reformed AMA, with primary care and specialty care branches, with a tribunal or council in charge of each division, including Gordon Moore, Chuck Kilo, Tom Bodenheimer and some female leadership voices too. The AMA, while it no longer represents doctors, does have name recognition both with politicians and with the public. It would be great to see public service ads on TV from the "AMA" (that everyone has heard of), educating the public about some basic primary care issues, like how half of all medical needs don't require an appt with the MD but rather can be resolved by another medical team member, and how simple musculoskeletal issues can be handled directly by physical therapists and not the MD, and how "the sniffles" can be handled by PAs/NPs/RNs and not the MD -- simple, pointed messages aimed at educating the public. I've come to believe that so much chaos is out there re: "health care reform", and that educating the public to be more like "the public" in Sweden etc is a key piece.

[Susan A Miller MD]

Gordon, You are right, the AMA has never been my voice. As a family physician I do feel that the AAFP is my voice. AAFP has supported universal health care for years, was early into redesign with TransForMed and the Future of Family Medicine. The four groups AAP, AAFP, The general internists and the DOs who have signed onto the Medical home movement are headed in the right direction. Then there is Chuck Kilo's The Trust for Better Healthcare or Gov. Kizhauber's Archemeides movement. Both movements working long term for redesign of helthcare system. It worries me to fragment us more. I would rather see an umbrella organization of all the above come together to work on the financing side of redesign. That is the one area in which the AAFP does not represent me because they have been cautious in aligning themselves with any political solution. That is why I also belong the PNHP, Physicians for a National Health Program, which has worked for 20 years to build the research base for the movement for single payer. As much as I appreciate all you have done for primary care, Gordon, I do not feel we need another organization unless it is the umbrella. The forces against us are much too powerful.

[Gordon Moore]

Excellent comments.

I agree that fracturing clinical professionals does not serve the goals of reform. I'm eager to lend my support to organizations and movements that help us become the professionals we imagined at the start of our careers.

Do these other groups have coherence around primary care and the issues we confront? If not I see a potential for a primary care voice that works in collaboration with others - we could work with other groups if they had only some overlap with an agenda around effective primary care.

Gordon

[Sofia]

Gordon:

Such an organization is needed an it seems that movements are converging.
Let me remind everyone of the Human Genome Project. Can you imagine the potential when all of us work together and collaborate? Imagine the brainpower alone!

Perhaps it is necessary to organize individual specialty groups under one umbrella. Open levels of communication, whether via sermo or other social media. Unfortunately, or FORTUNATELY, our individual specialty organizations are also misguided. While the AAFP has the best of intentions, their "ideas for change" create more bureaucracy than solvency.