Physician Associations and the Politics of Health Care

Physicians’ expertise and relationship with their patients give them a point of difference in the health care marketplace. This gives physicians market leverage to use in seeking joint ventures that reduce their overhead and improve the efficiency of the system. Physicians are increasingly exercising this leverage through a variety of contracting and affiliation strategies which allow them to speak with one voice. These initiatives are often called physician networks.

The New York Medical Society is a good example of the role that physician associations can play in shaping policy. In its heyday in the eighteen-forties, it played a major role in setting a code of ethics for the profession, in creating a national pharmacopeia, and in organizing the American Medical Association. In addition to its purely professional duties, the society also promoted the interests of its members in legal matters and in public opinion. The society was a key player in influencing the development of health care policy in the United States, but its influence has waned as other policy actors have emerged in the marketplace (Peterson 2001; Stevens 1998) and the medical profession has become less dominant in the world of healthcare.

Today, the New York Medical Society (NYMS) is an organization of doctors that operates like a trade association. Its membership is made up of physicians from a wide range of specialties who are members of their state medical societies and the AMA. It disseminates medical and scientific information, carries out a wide variety of health education programs, and advocates for its own views before Congress and other governmental bodies. The NYMS also acts as a gatekeeper to the profession, vetting students and other applicants for membership in the medical profession. It has a long history of opposing socialized medicine and is the strongest national opponent of a government-backed, single-payer health insurance system.

In June, Joy Lee and Dan Pfeifle arrived early at the American Medical Association’s annual meeting of its governing body, the House of Delegates. The House was considering a measure that would end the AMA’s explicit opposition to single-payer health insurance. The meeting was crowded, and the delegates were staking their positions.

The AMA is the most influential association of physicians in the country, but its influence has diminished as other players have emerged in the market for health care services. Its members have substantial market leverage through the formation of a variety of physician networks, allowing them to negotiate with hospitals, pharmaceutical companies and insurance providers for favorable contracts.

The AMA’s policies are set at meetings of the House of Delegates, which are typically attended by delegates from state and specialty societies. The AMA’s policy statements are based on the medical profession’s professional principles, scientific standards, and experience of practicing physicians. They can be accessed on PolicyFinder, the AMA’s online repository of AMA positions and policies since its founding. This tool is particularly useful to researchers interested in understanding the evolving role of the AMA.