President’s Messages 

Richard T. Scholz, M.D. 

As president of the BCMA, I attended the AMA Interim Meeting in New Orleans in November. This was the first time that I had ever attended an AMA meeting.  Although the AMA may have only about 17 percent of American physicians as members, it remains the largest single national medical organization and is recognized by the public and the Federal Government as the major voice of American medical practice.  The Journal of the American Medical Association (JAMA) is the most widely circulated medical journal in the world (over 600 thousand copies a week).  

One would wonder how an organization that has lost membership in droves over a lack of interest (Generation X) and controversy (too conservative, too liberal, allied with the current administration, not enough pro Obamacare, etc.) survives. I am told that the contract for CPT coding with the federal government is one of the major sources of income for the AMA.  This has been disputed by others who point out that the AMA provides many services and publications from which they receive income.  

The AMA has been criticized over the years as being a guild and trade union for physicians.  It fought vigorously against early health maintenance organizations in the 1930’s, a fight that led to the Supreme Court convicting the AMA of violating the Sherman Anti-trust Act.  It sponsored a vigorous campaign against Medicare, which famously featured Ronald Reagan on a record that was circulated in “Operation Coffee Cup” a grass roots campaign to derail any public support that there would be for Medicare.   

On the positive side, the organization has also been instrumental in elevating the quality of medical education and practice in the United States.  In 1847 the first code of medical ethics in the modern world was promulgated by the AMA.  The council on medical education was formed in 1904 and commissioned the landmark Flexner report that reformed medical education in the United States.  It provides $1,000,000 in scholarship money to medical students, promotes health education, and provides research funding for students and fellows.   

In addition to CPT coding, it is also involved in helping to set the RVS (relative value scale) used to determine a portion of Medicare reimbursement.  In recent years the AMA has become (in my opinion) more of an advocate for patients, physicians and those in medical training as the complex dance between private insurers, government sponsored healthcare and other healthcare “providers” has dramatically changed the playing field for all.  The AMA is attempting to preserve funding for postgraduate medical education, which is threatened by current federal proposals. 

It is said by some that the rise of specialties and subspecialties during the 1960’s and beyond is one of the reasons that there is less interest and cohesiveness in a national medical organization like the AMA.  It is this aspect of the meeting that made the biggest impression on me.  The first meeting that I attended was a caucus of ophthalmologists and lobbyists for ophthalmic subspecialty groups (retinal surgeons, cataract surgeons, physician owned outpatient surgical centers and others) which was in preparation for the “triple s” meeting.  The SSS is the Specialty and Service Society which is the group representing all specialty societies.  I also attended meetings of the Maryland/DC caucus, which is part of the Southeastern Regional Delegation also with separate meetings, receptions, etc.  

Hence, I attended two caucuses that were to prepare for attending another caucus before attending the House of Delegates.  When sitting in the portion of the main meeting room reserved for non-delegates and others, I could not help but notice the myriad of other organizations represented at the tables in front of me; various groups that were non-voting but in attendance.  The AMA encompasses 175 state and specialty societies.   

One of the last sessions that I attended was the one where those who formulate the AMA’s code of ethics hear testimony from members on a variety of issues.  I did not attend the entire session, as it went on for hours, but I found it to be one of the most interesting.  Numerous individuals spoke about issues and situations that they felt affected the practice of medicine and were concerned enough about it to take the time to address it in an official forum.  

I enjoyed my time at the meeting immensely.  Those who participate in organized medicine come from all walks of medicine and devote considerable resources in time, money and effort to further the role of the American physician in caring for the individual patient and for the American public.