Madam Chair, We Propose that ‘Happy Hour’ begin 30 minutes Earlier Today by Pat Conrad MD

Over the years I’ve spilled more than a little electronic ink describing how the AMA is an unofficial extension of the federal government that furthers and encourages CMS’ whims and abuses.  But to give the AMA its due, it has successfully adopted the rhythms and reflexes of its benefactor.  Rather than tackling the really tough problems, the federal government wants to go after peripheral issues that are none if its business, that it has no chance of solving.

Likewise, the AMA – long a recipient of hundreds of millions of dollars in ICD/CPT extortion – just can’t find time during its annual self-congratulation pageants to deal with actual problems that face actual doctors.  Where is the call from these sell-outs to reverse mandatory EHR’s?  Where is the principled leadership to phase out Medicare, or to move for a reversal of the federal crony corporatism with Big Insurance, or reinforce practice restrictions against non-physicians?  We here have already covered the giant pass these functionaries (again) gave the ABIM and its MOC shakedown racket.

No, unable to tackle any issue that actually affects real physicians, the brave and oh so relevant AMA again comes out in strongly worded terms against … guns.

At the 2018 AMA Annual Meeting, delegates adopted policies that inserted themselves into domestic relationships, favored no-evidence suspension of civil rights, called for further infringements on states’ rights, recognized the role of firearms in suicides (that actually made me laugh), reaffirmed schools as “gun-free zones”, opposed teachers carrying guns, and called to eliminate certain classes of firearms and ammunition.

The point of this column is not to argue the gun issue.  If you are pro-Second Amendment, go turn on Fox; if you are anti-gun ownership, go watch CNN.  I don’t care.

What I care about here is that a thoroughly deceitful organization, representing less than a quarter of U.S. physicians, is trying to make PR hay – whose members always hope will translate into more money and power– by getting into areas which are none of its business.  What is the AMA position on global warming, or North Korea?  Does the AMA favor the latest interest rate increase by the Fed?  Will the AMA oppose paying for medical insurance with BitCoin, since it represents financial prejudice against developing world economies?  Where does the AMA come down on so-called transgender bathrooms?  The AMA knows very well that its blather will not take one gun out of the wrong hands, and will not prevent a single gun-related death.  Those are law enforcement concerns.

The delegates of the vaunted “House of Medicine” won’t take on the tough issues like CMS punishing mis-coding doctors out of existence, or hospitals not being paid for readmissions of chronically ill, elderly patients because of arbitrary violations of unproven “quality” standards.  The AMA will not call for the repeal of the ACA that jacked up premiums for the majority of productive citizens while providing a financial windfall for Blue Cross, Aetna, et al.  No, the delegates will pose for photos, congratulate themselves on “making a difference,” perform cocktail colonoscopies on each other, and otherwise not accomplish a damn thing.


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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Madam Chair, We Propose that ‘Happy Hour’ begin 30 minutes Earlier Today by Pat Conrad MD

  1. James Tinsley
    June 21, 2018 at 9:25 pm

    And yet they are eerily silent on home pools that kill more kids than guns. It’s not about guns.

  2. Kurt
    June 20, 2018 at 6:50 pm

    I dropped out of the AMA years ago and am leaving the AAFP after this dues cycle.
    None of these groups act in members best interests and I encourage anyone who is
    in either or both organizations to leave. It will leave more $$$$ for CME one feels
    actually benefits their style of practice.

  3. Fern lentini
    June 18, 2018 at 3:58 pm

    I’m not so clear on your points that you bring out. I was with the ama for almost 6 years in late 90’s and early 2000, so am not that knowledgeable about its history. However, it sounds as though your remarks are astute. We were hemmoraging membership when I was there. And ceo’s Changed like the Chicago weather. When membership numbers were given out, they counted students and other memberships “given away”. I believe it’s dying a slow death.

    • Terry Nugent
      June 20, 2018 at 11:29 am

      Slow is the key word in your comment. While they are continuing a long pivot from a dues to non-dues revenue mode, the latter is sufficiently robust to maintain viability indefinitely.

  4. Terry Nugent
    June 18, 2018 at 2:45 pm

    This sort of thing is why I’m not in charge of AMA membership marketing anymore, which Iu was in the 1980s. The job was akin to being General Westmoreland in Vietnam.

    However, from of habit allow me to respond to Dr. Conrad in an uncensored manner from the perspective of a former staffer who has kept a distant eye on the machinations of the Association.

    There is merit in the observation that the AMA bears a chilling resemblance to the Federal behemoth it lobbies. Just as a pet tends to resemble its owner, or perhaps vice versa, AMA tends to look a lot like the top of the Federal pyramid. That of course includes its unicameral House of Delegates (HOD), the AMA equivalent of Congress. Perhaps a better analogy is that in football, the defense tends to mirror the offense. This is inevitable and comes with the territory.

    As to AMA’s “non-dues revenue “: Once upon a time, the AMA funded its activities strictly through dues and ad revenue. The ad revenue succumbed to competition, forcing a greater reliance on dues. The dues model was torpedoed by the Justice Department when it decoupled county society membership from hospital privileges in the 60s. This may have had something to do with the AMA’s fight to the death over Medicare, which was enacted over their dead body as it were.

    Once Medicare was given to the voters, it became nearly politically impossible to take away. Since private insurers piggyback on Medicare’s political cover, all the reasons AMA opposed Medicare have proven to be sound. But there’s no going back, as we saw with the GOP inability to repeal and replace Obamacare. So realistically the AMA just has to make the best of it, which it does. Which by the way is why AMA’s control of CPT codes is a bonus. It is the AMA’s most powerful vehicle to get the best deal for physicians from 3rd party payers. The fact that ads and dues wont pay the bills means that AMA has to operate as a quasi business to fund operations, and the coding product line is a part of that business model.

    As to MOC, AMA lost control of the specialties almost a century ago and doesn’t make a dime from this much-reviled enterprise. Perhaps it could be more aggressive in advocating reform, but there’s very little in it for them in my calculus. One can’t imagine a surge of membership in return for undertaking an internecine war. In fact, AMA opposition might have a boomerang effect of ralying specialists against AMA meddling in their affairs (stranger things have happened).

    Re EHR/EMR, AMA is working, albeit rather quietly, to advocate Federal reform, with some modest success. For example, the Feds recently cracked the whip on the software players to get serious about interoperability.

    Finally, in regard to non-physician provider scope of practice, the first week I was at AMA , we lost the Wilk case in the Supreme Court, which severely constrained the AMA’s scope in seeking to limit scope of practice for other professions on antitrust grounds. As a result, payers reimburse all manner of non-allopathic care based on little to no credible scientific evidence.

    Most of the issues Dr. Conrad raises stem from major lobbying battles lost iretriveably lost decades ago. The Great Society was not so great or physicians who want professional autonomy.

    So it goes. But life goes on. The AMA staff does what it can to respond to the directives of the membership as expressed by the HOD, which is a truly democratic body, within the constraints of law. Many were the tasks we staff had to undertake which we would have greatly preferred not to at the behest of the HOD. Many staff heads have rolled at the insistence of the Board of Trustees, duly elected by the HOD. The power of the members over the AMA is real.

    The bottom line: All in all, physicians are probably on balance better off having the AMA than not, especially since they don’t generally pay for it through dues. But as in all things, remembert you get what you pay for.

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