In part 1 of this article [March digital issue], I discussed the new "woke" American Medical Association (AMA) and its current health care policy declarations. These have included issues such as voting equity, critical race theory and climate change, for example.
I mention these policies only to emphasize that the younger AMA has more "modern" concerns, and might be bored with bad-mouthing the chiropractic profession and the natural healing arts. Recall that its long and loathsome attempt to "contain and eliminate" chiropractic partially stalled in 1987 when the Wilk antitrust case was decided in favor of the chiropractic profession.
In part 1, I noted that the AMA has a history of attacking anything that could harm physicians, especially competition. It has used a nasty, scorched-earth approach against its rivals and any legislation that has even faintly smelled of losing control of the Divine Right of MDs. Now let's examine the AMA's anemic membership, its rich sources of income,and what might all this mean to the future of chiropractic.
Losing Members (Both Literally and Figuratively)
The AMA's membership numbers are deceiving. Kevin Campbell MD, medical columnist, writes, "22.5% of members are students and 24.7% are residents" and the others are mostly retired, fellows in training, and so called "sponsored memberships." He calculated that practicing physicians make up only about 12.1 percent of AMA members.
Why the low membership? Annual dues are $420, which should not be a major deterrent. Campbell says, "The majority of U.S. physicians DO NOT believe that the AMA represents their interests ... or the interests of their patients."1
Many practicing docs know the AMA has been on the wrong side of history numerous times, like pro-tobacco policies, opposing child labor laws and Medicare. The AMA promoted the discredited pharm company Purdue, which pushed the opiate OxyContin, a drug that has addicted, killed or ruined an unknown number of lives. The AMA Foundation received more than $3 million from Purdue from 2002-2018.2 Is it any wonder many physicians have said, "I'll pass," when it comes to membership?
But Still Making Tons of Money
The AMA is a rich organization. According to medical writer Julia Luria, the AMA has about $430 million in annual revenues. It has a few sources of income that pay off very nicely. One is its "seal of acceptance" or AMA approval, that has been for sale to the highest bidder. Tobacco companies were one of the first recipients in the early 1930s.
But a more lucrative source of money is the infamous Current Procedural Terminology (CPT), which is owned by the AMA. All firms and vendors have to pay the AMA to be licensed to use it. The organization makes about $245 million a year from royalties.2
Virtually every part of medicine depends on the use of these codes, especially the federal government. Lobbying the government is important if an organization wants largess and more importantly, authority. Luria states, "Over the past two decades, the AMA has been the third-largest spender on political lobbying, topped only by the US Chamber of Commerce and the National Association of Realtors."2
A third money bag is called the Physician Masterfile, a database the AMA has kept on every practicing physician, even non-members. It is a dossier that matches up prescribing histories of every doctor in the country, showing those providers who are the most prolific drug prescribers.
This information is then sold to pharmaceutical companies. There is an "opt-out" exemption, but only 4 percent of physicians have ever applied for it. In 2019, Julia Luria reported that AMA sales of Masterfile brought in $60 million.2
The next money train comes out of the Big Pharma depot. The financial relationship between the AMA and Pharma may be almost impossible to measure from the outside. It is immense. Lurie again: "Just last year, the AMA hosted a discussion with its new top corporate donor (Pharmaceutical Research and Manufacturers of America) titled, "Stronger together: A conversation with PhRMA".
Membership dues are only 8 percent of AMA's revenue. The AMA may be one of the only organizations I have ever heard of that doesn't really need any members!2
Why Nothing Will Change
What does all this have to do with chiropractic? The "kinder and gentler" AMA will get treacherous immediately if the chiropractic profession tries to expand its scope of practice. Just ask the DCs in Texas.3 Organized medicine there tried to take the right to diagnose disease out of the chiropractic law! They failed, but not due to lack of trying.
It's not just chiropractic, by the way. Just ask the nurse practitioners (NPs), who want basically all the privileges of the MDs and DOs. Ask the physician assistants (PAs), who have decided to call themselves "physician associates."4
The AMA has boasted that since 2019, it has shut down over 100 state legislative moves by "non-physicians" to expand their scope of practice. Most of these were fights with the NPs and PAs, but in Maryland, the AMA opposed podiatrists being able to use the term "podiatric physician."5
An Interesting Scenario That Makes a Point
If the chiropractic profession would ever show serious interest in obtaining the right to prescribe drugs, the AMA would become apoplectic, mustering all its resources, media friends, government bureaucrats, etc., in the effort to stop it.
But there might be one exception: Big Pharma. The pharmaceutical companies would love it if they had a new prescription writing team. They have supported the prescription rights of NPs, PAs, podiatrists, advanced-practice nurses, and anyone who can lift a pen and scribble out an Rx. I can envision a scenario whereby the AMA is ready to smash "DCs-want-to-prescribe" legislation, when they get a call from Big Pharma saying, "Lay off the chiros; you're going to cost us money!"
Would the AMA want to lose one of its biggest sources of income? Would it back off? I personally am not advocating chiropractors giving drugs, but wouldn't this be an interesting dilemma for the American Medical Association.
References
- Campbell K. "Don't Believe AMA's Hype, Membership Still Declining: Group Focuses More on Its Own Finances Than Physicians' Real Concerns." Medpage Today, June 19, 2019.
- Lurie J. "The Untold Story of Purdue Pharma's Cozy Relationship With the American Medical Association." Mother Jones.com, Aug. 5, 2021.
- Hanks J. "Think Scope of Practice Is Finally Safe? Think Again." Dynamic Chiropractic, March-1-18.
- Rau J. "Physician Assistants Want to Be Called Physician Associates, But Doctors Cry Foul." NPR, Dec. 3, 2021.
- "AMA Successfully Fights Scope of Practice Expansions That Threaten Patient Safety."American Medical Association.
