Why Organized Medicine is Dying (And What We Can Do to Save It)

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By Sarah Michael

Sarah Michael Photo

When I arrived at the University of Michigan Medical School a year and a half ago, I was inundated by numerous student organizations with lofty goals and big ideas. Most eye-catching to me was our Medical Student chapter of the AMA. Ambitious and idealistic, I had just finished a year of service in AmeriCorps where I cultivated a rich appreciation and passion for patient advocacy. I knew I could make a difference in the care of people through advocacy and health policy. I signed up, paid my dues, found myself in an Advocacy Chair position. I finally spent the past year as our External Vice President. In this position, I served as the liaison between our chapter and our larger community of organized medicine.

In this short time, I have sat around many tables at many meetings when we progress to the next item on the agenda: membership in our organization, and more specifically, our dissatisfaction with the numbers. We ask ourselves questions like “What purpose are we serving our members?” and “How can we make membership more appealing?” I must admit that my focus in this past year has also shifted from my original desire to advocate for patients towards these questions that delve into the meaning and purpose of organized medicine. The question I ask of myself is how I went from being so optimistic to my now more cynical self in regards to organized medicine? I have a few ideas.

I believe it’s inherently difficult to obtain positions of leadership without schmoozing and attempting to please those who will influence your vote. I observed this first-hand at the House of Delegates last April, where even at the level of the Medical Student Section, alliances were formed between schools to vote for whoever had lobbied to them the best. The general interest in physician advocacy and patient care is lost when one must fight through the jungle of politics, weeded with self-serving individuals out to make a name for themselves. In these situations, people find the easier option is to the leave the job of advocacy up to those who are most political, not necessarily the person most qualified for the job. For if one is not aggressive enough, it is easy to be trampled in what has become a race for power and status. Like any group project, only 15% of the people will end up doing 85% of the work. The opportunity to be involved in organized medicine is tainted with political rituals that simply turns people off.

The year 2014 has been called the “digital tipping point.” At this point, the majority of health care providers will be digitally native, which means they have relied on digital interactions for their entire career. With the implementation of electronic health records and swift advancements in medical technology, there is a need to remain current and up to date in regard to these progressions. Many organizations desire a relevant technological presence in the form of websites and social media, but they struggle with uncertainty as to how to connect with those who come from a different generation of physicians. In this day and age where information abounds, organized medicine has yet to find its niche in regard to the technology that pervades medicine today.

In light of the increasing burdens on the practice of medicine, many physicians have what I like to think of as a “wish list” for reducing these burdens and optimizing care. I think we can all agree most physicians desire at least some of the following: autonomy in one’s practice, fair compensation for one’s work and years of training, to have a voice with legislators regarding healthcare issues, to direct and influence quality care issues, and tort reform (just to name a few).

Addressing these issues is difficult, especially given the trend toward increased specialization within the profession, leading many to belong to their respective specialty organizations in lieu of their local, state, and national medical societies. Challenges such as healthcare reform and the continuous use of Medicare’s SGR formula for physician reimbursement are two examples of issues affecting a variety of physicians. Collective action from members of all specialties is essential to tackling these problems. In isolation, no one specialty organization can address these issues as well as one larger organization can. The same concerns that motivate someone to join their respective specialty society should be the foundation for joining their larger community of organized medicine, as well.

The field of medicine and delivery of healthcare is a continuously changing landscape. The day and age where someone graduates from medical school, finishes their residency, and hangs a sign with their name on it to open their own practice is a fading dream for many. I am well aware that I will most likely be employed by a physician group when all is said and done. Physicians in these groups, especially those in academic medicine, may not necessarily be compelled to belong to organized medicine, as they feel they are already part of an organization of physicians. However, the issues and items on our “perfect practice wish list” are not within our reach unless we have strength in numbers. We cannot afford the luxury of un-involvement if we wish to seek change in the practice and delivery of medicine.

So, why am I still here you ask? Why have I taken the time to scrutinize my professional organization to pieces? Because that is how we move forward and progress. We must take a look within ourselves to remember who we are advocating for to avoid the political environment that dissuades many from becoming involved. Also, we need to assess our ever-changing field to remain current and useful. Finally, we must adapt by asking our members what it is they would like from us rather than assuming what we’ve done in the past is enough. There is no doubt that we need local, state, and national medical societies to organize and unify our profession in this time of rapid growth and change in health care.

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