Doctor Organization and Political Action

There are more than a million doctors in the United States, and yet the country’s largest professional organization, the American Medical Association, has only about two hundred thousand members. Most doctors belong to multiple societies or associations that represent a particular subspecialty. These organizations often have a strong, identifiable brand that is easily recognizable by patients. They can also promote shared interests, such as advocating for increased access to affordable medications and a higher quality of care for low-income patients.

In many countries, doctors are organized through national federations or public law corporations. The corporations are able to contract with health maintenance organizations and other payers of health care benefits, which can help them keep prices down. Physician organization is also a critical factor in promoting physician participation in management decisions in the delivery of health care services.

The success of integrated delivery systems, large multispecialty medical groups and other forms of doctor organization is closely linked to the strength of leadership, organizational culture and clear, shared aims. It is believed that these attributes, in turn, create a causal link between physician organization and improved performance, including the ability to provide high-quality patient care.

Nevertheless, there are many examples of physicians acting in their own self-interest. The Endocrine Society railed against the price hikes in insulin that have caused patients to ration their medication; and the American Academy of Pediatrics has condemned immigration policies that separate children from parents. However, most of these actions are limited to statements in medical journals and positions declared at press conferences.

Even so, it is unlikely that doctors will ever organize on the scale of workers in other industries. With private sector union density at about five percent, it would take a very long time to gain the power necessary to affect change.

Doctors may be frustrated with the state of their profession, but it is difficult to see them engaging in the kind of political activism that might lead them to organize collectively. For example, they are less likely than other workers to join a protest against the treatment of migrant farmworkers.

This article examines the problems faced by national federations and associations of doctors in their attempt to build an effective system for organizing doctors. It describes the variety of experiences in different countries: centralization or decentralization of the registry; type of membership (obligatory versus voluntary); and level of autonomy of local councils. The analysis is based on a comparison of the data available from websites and official documents. In addition, it compares the degree of decentralization with the types of competences and activities entrusted to each of the local councils. The resulting analysis identifies some important issues for future research. The findings have practical implications for a new paradigm for doctor organization. This includes a stronger emphasis on fostering the development of organizational identity among doctors and a more flexible approach to managing them in a way that enables their involvement in strategic committees that can influence the direction of an entire organization.