The Answer to the AMA's Feckless Disregard for its Physician Members.
Julio Gonzalez, M.D., J.D.
Yesterday, in an open letter to the American Medical Association, I called out the organization for its cavalier embrace of critical race theory, which it declared in a white paper entitled "Organization Strategic Plan to Embed Racial Justice and Advance Health Equity." As I mentioned then, seldom have I come across a more destructive, divisive, and inflammatory document by a professional organization than the one published by the AMA earlier this month. Truth be told, however, the "Organization Strategic Plan' is only the latest in a long series of Leftist forays undertaken by the AMA, but this one is different, as this is the first time the AMA has embraced a Leftist propaganda item absent any meaningful tether to healthcare.
The AMA's Origins
It should be noted that the AMA began as a conservative, problem solving organization bent on improving the nation's quality of care and of the physicians who provided it. Organized in response to the nation's first medical malpractice crisis in the nineteenth century, the American Medical Association made significant strides in the development of medical education standards and licensure requirements so that those holding themselves out to be physicians could be differentiated from the quacks, potion makers, and charmers passing themselves off as healers. Later, when America's socialists attempted to implement a near-universal government run healthcare insurance scheme, it was the AMA that defeated it, calling it communism. In 1965, the AMA also opposed the implementation of Medicare, correctly foreseeing that eventually, the government behemoth would control physician earnings and the practice of medicine.
But things changed in the AMA after the passage of Medicare. There began an incestuous relationship between itself and government that would slowly erode the organization's allegiance to its members.
The key lay in medical billing codes. As it waded into the healthcare delivery business, the government needed a communication device that would define the services performed by providers and the conditions for which those services were administered. The AMA became the point organization on the project adopting the International Classification of Diseases (ICD codes) and creating the Current Procedural Terminology codes (CPT codes).
As the AMA's partnership with government increased, its unbridled fiduciary role to its members shrank. Predictably, the AMA became more dependent on government-generated income while its negotiating abilities against it weakened.
A Sharp Left Turn on a Slippery Slope
Things took a turn for the worse when the AMA openly endorsed elective abortions as a contraceptive procedure. Prior to the 1960s, the AMA vehemently opposed abortions. Largely because of the overwhelming consensus in opposition to the issue, abortion on demand was not one of the AMA's central priorities. In fact, in 1969, a resolution from its left flank calling for the support of abortion as a contraceptive method was vehemently opposed by its House of Delegates and described as "extreme." Just six months later, however, the AMA reversed its position despite the constancy of the anti-abortion opinion of its members. In 1970, the AMA did not switch position on abortion because its members' opinions had radically shifted. Rather, it openly did so for political and economic expediency.
Whether it recognized it or not, abandoning the protection of the most vulnerable members of our society caused a seismic shift in the organization's psyche. On the one hand, the AMA convinced itself that it was appropriate to act against its members' wills in order to protect its political and economic positions. On the other, the AMA found it acceptable to abandon the zealous protection of all human life. For the AMA, despite the language in the Hippocratic Oath ("I will not give a legal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion."), it was now okay for physicians to kill the unborn.
From there, the descent into socialism and the abandonment of its members' priorities rapidly progressed. In 2009, the AMA agreed to support Obamacare, despite staunch opposition from a large swath of its members, in exchange for a mere promise by the Obama Administration of a $245 billion plan to permanently correct the formula determining how physicians were reimbursed by Medicare. What physicians got in return was something even worse: the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Then, on April 26, 2021, the AMA blindly and irresponsibly supported the practice of gender transition-related care for minor patients. Disguising its Leftist agenda with the cloak of preventing the "dangerous intrusion into the practice of medicine," the AMA told the National Governors Association that it opposed "state legislation that would prohibit medically necessary gender transition-related care for minor patients." Mind you, its message was not a call for increased funding for research and improved access to non-surgical and non-pharmacologically-transitioning treatments for children, but rather a demand that such irreversible procedures, like the lobotomies of old, were not to be opposed.
To this point, whether it was abortion, medical economics, healthcare policy, or the treatment of gender identity, Leftist as they may have been, the AMA's positions were closely tethered to issues directly related to healthcare policy or the practice of medicine. But that has now changed.
Just three weeks following its support of a controversial field lacking overwhelming consensus within the House of Medicine, the AMA now ventures into an increasingly radical position by embracing critical race theory and the contention that the United States is inherently and systemically racist. This time it does this under the guise of improving healthcare access. Make no mistake; there isn't a respectable physician in the United States who does not wish for the improved accessibility and affordability of healthcare. There is no caring physician who doesn't want minorities and the poor to get the care they need in as easy a manner as possible. But these sentiments are a far cry from an embrace of the assumptions contained in critical race theory.
Interestingly, in its "Organization Strategic Plan," the AMA claims that "[t]he origins of this strategic plan date back to the AMA's Annual House of Delegates meeting in June of 2018 where a time-limited Health Equity Task Force [was created to address] inequities in health care." Despite this claim none of the AMA delegates with whom I have spoken this week recall there being a debate to consider embracing critical race theory or repaying previously oppressed groups for injustices committed against them in the distant past. If there had been such a resolution, it would have never been adopted. Yes, I am saying that the body creating this document acted without the authorization of AMA membership, as the AMA itself has done in the past.
What to Do?
It is clear that the AMA has become a Leftist organization driven by its affinity for socialism and the centralization of healthcare delivery away from the hands of the physicians it claims to represent. It has recurrently and with increasing ease broken away from the desires of its members in pursuit of its own self-serving, protective agenda. As a result, physicians are left without reliable representation. In the meantime, the practice of medicine continues to slide into a corporate abyss far distant from its origins and its intended ends.
So what is one to do? There really is only one answer.
America's physicians, and their patients, are in desperate need of a medical organization designed to represent them; one that will protect physician independence and that will pursue medical education without government interference or meddling; and although there is the Association for American Physicians and Surgeons, which nobly provides a libertarian voice for some of America's doctors, the alternative needs to be broader. Medicine needs an organization that will lobby government for physician practices and for improvements in healthcare delivery and not advocate for vogue and misguided social causes outside the medical profession's sphere. It needs a team that will promote legislation prohibiting the co-mingling of professional advocacy efforts and the provision of paid services to government. Such an organization must serve as the umbrella for its various state chapters and subspecialty societies and a haven for like-minded medical organizations seeking shelter from the hostile and reckless actions of the AMA.
Until such time, all of America's physicians sit at the mercy of the next feckless act the AMA decides to undertake.
The FMA did support a bill opposing late term abortions that year sponsored by then Congressman and now Florida Supreme Court Justice, Charles T. Canady, but the bill specifically addressed late term abortions. The AMA appears to still oppose late-term abortions.
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Dr. Julio Gonzalez is an orthopaedic surgeon and lawyer living in Venice, Florida. He served in the Florida House of Representatives. He is the author of numerous books including The Federalist Pages, The Case for Free Market Healthcare, and Coronalessons. He is available for appearances and book signings, and can be reached through www.thefederalistpages.com.