AMA's position on coverage expansion was inconsistent with the views of most physicians

reported by Terry A. Rondberg, DC, CEO, World Chiropractic Alliance

In chiropractic, we often hear complaints that the professional organizations don't truly reflect the ideas and principles of the members they are supposed to represent.

It may be small consolation, but this situation occurs in other fields as well, including medicine.

Researchers at Mount Sinai School of Medicine have found that the majority of physicians and members of the American Medical Association (AMA) opposed the AMA's position on coverage expansions -- the most contentious issue in the recent health care reform debate. The data was published in a letter in the June 9th issue of the New England Journal of Medicine.

In the 2009 health care reform debate, the AMA opposed Medicare expansions and proposed coverage of the uninsured primarily through private means. The researchers found that only 12.5% of all physicians and 14.2% of AMA members who participated in the survey supported the AMA's position on insurance coverage expansions. Salomeh Keyhani, MD, MPH, assistant professor of health policy; and Alex Federman, MD, MPH, assistant professor, medicine, Mount Sinai School of Medicine, co-authored the study.

"Our survey indicates that most physicians and AMA members oppose the AMA's views on coverage expansions," said Dr. Keyhani. "The AMA is a highly visible organization that is presumed by many to represent physicians' opinions on various issues. However, there appears to be a discrepancy between the AMA's platform, the beliefs of its members and the views of physicians nationwide."

Mount Sinai researchers used the AMA Physician Masterfile to survey 5,157 physicians. The researchers secured a 43.2% response rate. There were no significant differences in response based on specialty, practice type, or geography. Physicians who were most supportive of the AMA's position were doctors of osteopathy (16.5%), physicians whose income was based on billing (16.1%), and physicians in rural areas (16%). The lowest level of support came from female physicians, with just 7.9% supporting the AMA's platform. Physicians who back the AMA's position were more likely to be younger, male practice owners in non-medical or non-surgical specialties such as anesthesiology, pathology, or radiology, fields that typically involve less patient interaction.

Respondents to the survey were asked to indicate their support on key issues, including the public option, expansion of health insurance through private means, and support for a proposal that would allow adults 55- to 64-years-old to buy into Medicare. Physicians were considered to be in support of the AMA's position if they agreed with private expansions only and opposed the expansion of Medicare.

It's the same quandary we face with our elected public officials. While we want them to act in accordance with their constituents' desires, we also expect them to use their best judgment as to what's best for the greater good. Organizations have to be given some leeway to do likewise.

Still, they can go too far and begin acting in ways that fundamentally differ from our own principles. Politicians can always be voted out at the next election. When it comes to chiropractic organizations, our "vote" is our membership dues and we have to vote wisely.

(Dr. Terry A. Rondberg is founder and CEO of the World Chiropractic Alliance and publisher of The Chiropractic Journal. His reports on other health and wellness news appear on www.terryarondberg.com, www.terryrondberg.com.)