You can say that all you want. And I get that you believe that. But the facts are that they are being relied on in a major way in Washington to make legislation and represent doctors’ interests. You may not like it. Hell, I don’t like it, but it’s a fact.

“As for your “the public thinks AMA=physicians, so perception=reality” argument, most people also think attorneys are bottom-feeding scum. You can make that argument if you want…”

I’m not saying perception=reality. I’m saying that people are looking to and believe that the AMA represents most physicians, and if you want to claim they don’t, you better improve your own lobbying techniques to get the message out.

“so an accredited school could easily bump up their enrollment to produce more students.”

No, they can’t. Because there are a limited number of slots. What’s more, the same entities control accrediting process. If you want to start a medical school today, where would you go first? Probably to get accredited. Who would you go to for that? Your COMPETITORS? Let’s say you pass that hurdle. Now you need students. So can you admit anyone with X GPA and X exam scores, you know something objective? No, you can’t. You have to go to a professional lobbying organization and again, your competitors, to fight for an arbitrary number of openings which you can allot to your school. Only a physician thinks this is ordinary.

“What you really DON’T want is to make a free-for-all situation where anyone can hang up a shingle and call themselves a “medical school” Not even the ABA allows that, unless you’re arguing that anybody should be able to sit for the bar exam after graduation from “Joe’s VOTECH and unaccredited Law School.””

The ABA doesn’t control law school slots. The AMA has a unique power among professional lobbying groups. In some states, you don’t even have to go to an accredited law school – in fact, in California you can take the bar after not going to an accredited law school, but you have to take a “baby Bar” first.

The AMA is NOT “my lobbying organization.” I want nothing to do with them. I consider myself an individual doc, and I write my legislators. As for EMTALA, that is never going away… too many people are now used to getting something for free. For hospital-based physicians, you’re at the mercy of the hospital, and they absolutely can’t live without Medicare, which is likewise never going away.

So I’ll say it again… the AMA is not “my” lobbying organization.

As for your “the public thinks AMA=physicians, so perception=reality” argument, most people also think attorneys are bottom-feeding scum. You can make that argument if you want…

With regards to accrediting schools, the AMA appoints a half-dozen physician members to a panel (along with the AAMC) to help accredit medical schools (I suspect the ABA has a similar arrangement) There are also non-physician members to that panel… so the AMA doesn’t have majority control. They also don’t control how many students a given school can take… so an accredited school could easily bump up their enrollment to produce more students.

HOWEVER, that’s not enough. Those students need GME (residency) to have a license… and THAT is controlled by CMS. You could increase residency slots (which are govt. funded) and bring in foreign medical grads (being done). You could also increase the clinical capabilities of extenders (being done). The AMA controls none of those things.

About 30 years ago many states opened up new “primary care” focused medical schools, but they couldn’t force students to rank/match primary care residencies. Many students correctly determined that primary care was a lower-paying specialty full of paperwork and long hours, and went with something else. Again… not the AMA. The government controls reimbursement through the price controls instituted by CMS.

Why don’t you set up your own medical school if it’s such a piece of cake, Matt? Unlike setting up a law school, where you only really need a library, a lecture hall, a couple of attorneys, and a mock courtroom, medical schools require a lot of hard-science disciplines to support their education. That’s micro labs, anatomy labs, surgical labs, hospitals, expensive equipment… What you really DON’T want is to make a free-for-all situation where anyone can hang up a shingle and call themselves a “medical school” Not even the ABA allows that, unless you’re arguing that anybody should be able to sit for the bar exam after graduation from “Joe’s VOTECH and unaccredited Law School.”

You really don’t understand this process nearly as well as you think you do.

“Hospital-based physicians like ER docs don’t get to choose many of our working conditions, including little things like whether we accept Medicare or not… or whether to have malpractice insurance or not.”

Think about this post. WHY DO YOU HAVE LOBBYING ORGANIZATIONS if not to allow you more power over your working conditions? You can cite me chapter and verse on every bogus “statistic” on tort reform and extol the benefits of myriad legislative proposals on the subject, yet you can point to nothing moving you towards a free market, much less empowering you in your working conditions. What do your lobbyists do for YOU? Not your liability carriers and drug companies, but YOU? Incidentally, your hospital accepts Medicare because it probably can’t survive financially without it. Thus it is subject to EMTALA.

“As for the AMA, they have been losing power for years, as physicians have fled the organization, correctly determining that it doesn’t really serve their needs.”

This may be true, but that’s not how the public sees it. Kind of like you probably think the ABA is a huge force in the daily lives of attorneys. Still, fully 20% of all physicians are members – is there any other physician group even close to that size?

“And the AMA does NOT control medical school enrollment. They have a partial role in accrediting schools (along with the AAMC, which is made up of the schools themselves), but where do you get that they control enrollment? ”

So a group whose members benefit by restricting competition, and a group of medical schools, who aren’t all that interested in adding competitors either control it. I stand corrected! But you do realize this only proves my point though, don’t you? There is no free market to it. Your statement about the cost of developing a medical school sounds like it’s straight from a medical school/AMA lobbyist justifying this. Maybe it IS cost prohibitive, but how would anyone know since if they did build one they have to get with the existing cartel to be allowed to fill the spaces for students!

Either way, are you actually claiming that a group which has at least 50% of the control of how many physicians there are isn’t a pretty damn powerful lobbyist?

Maybe it’s the AMA’s fault there aren’t enough physicians doing primary care, but when you arbitrarily restrict the number overall through medical school admissions, haven’t you lessened the chances regardless?

I actually feel bad for you, even if you don’t believe it. Your profession has limited its options severely in exchange for being money whipped by the government. Maybe that gravy train will continue so at least the tradeoffs will be worth it. If I were you though, I wouldn’t be that confident that it will, particularly when you look at pay in other nations with single payer. You know – those countries whose legal systems you’re always raving about and wanting us to adopt. Of course, if our government can gut trial by jury, taking control of medicine is nothing.

Hospital-based physicians like ER docs don’t get to choose many of our working conditions, including little things like whether we accept Medicare or not… or whether to have malpractice insurance or not. The hospital will mandated that we have those things… or we don’t work. Period.

As for the AMA, they have been losing power for years, as physicians have fled the organization, correctly determining that it doesn’t really serve their needs. And the AMA does NOT control medical school enrollment. They have a partial role in accrediting schools (along with the AAMC, which is made up of the schools themselves), but where do you get that they control enrollment? Do you think the AMA simply calls the school and tells the Dean how many slots he can have that year?

Alternatively, you can try to open more schools… but you have to build the physical plant, set up teaching programs at nearby hospitals, recruit faculty, get accredited, get funding… we’re talking years, and about a Billion dollars a pop in startup costs.

The AMA also doesn’t control residency slots, and it’s not their fault that there’s a primary care shortage. Those things are controlled by the government via CMS… and the “shortage” is simple economics; primary care is a grind, it’s reimbursed poorly, thus fewer students are attracted to it.

As to the AMA, you may not like it, but the public sees them as the voice of doctors, and they still are the largest by far of your lobbying organizations. And after all, your profession has empowered them to choose how many people get into medical school each year.

That’s not shit, that’s facts. Don’t get mad at me, be mad at your representatives. Be mad at yourself and your colleagues. I don’t want you to get paid that way. I don’t want single payer. I want you to have maximum individual freedom, I want you to act like a professional and be paid like one – and I don’t want you stifling others’ freedom by going to the govt. for damage caps, either.

As for the AMA being my lobbying arm, you stick that in your ear as well. I’m not a member, and never have been. In fact, most physicians aren’t members… but you already knew that.

Stop throwing sh*t.

Physicians weren’t on board with it then? More BS. They were, and frankly they were probably looking after their own interest. Payment scales were good, you didn’t have to worry about solvency, and you made a buttload of money. But you lost your profession for subsequent generations of physicians.

Nonsense. Have you read the statements of your main lobbying arm, the AMA? You guys are the same ones who keep signing these same third party payer contracts, avoiding the free market.

Look at your industry. The AMA decides how many people even get into medical school, based on vague standards mostly related to limiting supply. 50% of the money in your industry is paid by the taxpayer. You’re asking the government to arbitrarily decide how much your mistakes are worth. You get your clients funneled to you from insurers who care more about your cost than your skill. You spend the bulk of your political dollars either trying to get the government, not the public, to protect you from liability or to throw a few more dollars at you. And you don’t even differentiate your value based on skill. You guys are so far removed from a “free market” it’s not even funny. And it doesn’t appear there is some great movement toward changing. Your lobbyists have no concerted effort to get away from the third party payment system, and the AMA is cautiously signing on with Obama.

“As far as “something for nothing,” it isn’t the medical profession whose TV commercials advertise “no cost if no recovery.”

Except for the fact you generally need an injury to have a case. You know, like those “lotto winners” with their million dollar malpractice verdicts. Who wants to trade places with them if they got something for nothing? You want their injury in exchange for their $1M? Anyone?

I want you to go back to the market like the rest of us professionals as much as anyone. But it’s clear that the vast majority of you have no interest in changing because you keep doing the same things expecting different results.

You are mistaken, and probably deliberately so, but I’ll let that go. We are the ones arguing for more market forces, more cost transparency, and less cost-shifting. What the federal government chose to do 40-odd years ago with Medicare isn’t our doing… so I’ll thank you to lay the blame where it belongs.

As far as “something for nothing,” it isn’t the medical profession whose TV commercials advertise “no cost if no recovery.”