Who Speaks For Physicians?

AMA and Sermo have parted ways only two years after the AMA lent its name and credibility to the startup company in return for gaining access to its social networking site. The well-publicized breakup has a couple of interesting subtexts.

Let's start with the double standard of Sermo founder and CEO Daniel Palestrant, MD. While assailing the AMA for selling its CPT codes to insurance companies, as well as other parties, Palestrant is well aware that his own firm is selling access to its members' discussions to pharmaceutical companies that want to know physicians' opinions of their latest drugs. Neither the AMA nor Sermo has tried to conceal how it makes money; but to attack the AMA for doing business with health plans is like the pot calling the kettle black.

Sermo does protect the identities of individual physicians when it provides access to drug companies. But it's notable that when the firm asked Arthur Caplan, chair of the medical ethics department at the University of Pennsylvania, to evaluate the ethics of its business model, he declined to provide an endorsement. "It's a new arena of ethics for sure. It made me nervous enough that we backed away," he was quoted as saying.

The red meat of Palestrant's complaint about the AMA is that he doesn't believe the organization any longer represents U.S. physicians. (A poll of Sermo members showed that 89 percent felt the same way.) According to Fierce Healthcare, "Palestrant and Sermo members say they're frustrated with the AMA's failure to address issues such as limiting insurance companies' ability to deny care; tort reform and settlement caps; and changing the law to allow doctors to negotiate collectively with insurers. Also, Sermo members strongly support a 'public option' health plan, while the AMA opposes it."

The AMA has lost a great deal of physician support. Only 25 percent of Sermo's 100,000-plus members belong to the AMA, and the association itself claims only 250,000 members, or about a third of practicing physicians. Its declining membership is certainly one reason why the AMA has had scant success in limiting denials of coverage, achieving tort reform, or changing antitrust law. The biggest reason, however, is the strength of the interest groups on the other side of these issues: insurance companies, trial attorneys and patient advocates, and employers and health plans, respectively.

What's more interesting is the report that physician users of Sermo, unlike the AMA, back the idea of a public plan that would compete with private insurers in the proposed health insurance exchanges. In light of the fact that the version of the public option favored by House Democrats would probably result in significant payment cuts to physicians, these doctors must either be very civic-minded or unaware of the consequences of the public option. I find it hard to believe that 100,000 doctors fall in either category.

One thing is clear, as blogger KevinMD points out: unless the AMA and its physician detractors can find common ground, doctors will not have much ability to influence the shape of healthcare reform.