The AMA vs. Sermo: Who Really Speaks for Physicians?

Claiming that American physicians are being ill-served by the AMA, Sermo’s CEO recently dramatically announced that his organization will soon take on a larger advocacy role. Is Sermo ready for this, and is the AMA really becoming as irrelevant as its most vocal critics contend?

HCPLive.com network member KevinMD on Friday posted a blog entry about the dissolution of the Sermo-AMA partnership.

Noting that the relationship between the two organizations had once been quite congenial (at least publicly), KevinMD dredged up an old quote from Sermo CEO Daniel Palestrant’s rationalizing why his company wanted to partner with the AMA in the first place: “As a company, we had to take a very rational perspective on that by saying we’re a small software company, not an advocacy organization. Who is the best entity to turn voice into action? Without a doubt that’s the AMA.” The AMA, too, was enthusiastic at first, claiming to be eager to engage with Sermo’s community of users and “add to the resources the AMA can call upon to rapidly assess and respond to the issues and concerns of physicians across the United States.”

And yet, as of Monday, that partnership is no more. The AMA responded to KevinMD’s request for a comment by stating “The AMA has decided not to continue its business relationship with Sermo. The AMA is always looking for effective ways to communicate with physicians. After an evaluation of the initial relationship with Sermo, we have decided that the value was not there to justify the investment of AMA members’ dues dollars. We continue to explore ways to communicate more effectively with all physicians.”

Why the sudden change? Probably because of the bombshell post Daniel Palestrant sent out to the Sermo community late last week. Scott Shreeve, MD, at CrossOver Health shared some details in a blog post titled “What’s the new spelling for the AMA? S-E-R-M-O."

The post reprints Palestrant’s post, which beings “As physicians, our first step in the healthcare debate needs to be clearing the air about who speaks for us on what topics. Today, I am joining the increasing waves of physicians who believe that the AMA no longer speaks for us.” Palestrant goes on to point out the AMA’s declining membership, challenge the AMA’s claim that 250,000 practicing physicians are members, and decry the AMA’s “relationships with insurers… that take advantage of physicians to generate millions of dollars in revenue.”

Palestrant said that “The longer that the public and our lawmakers cling to the perception that the AMA represents the voice of US physicians (and the AMA succeeds in perpetuating this), the more imperiled the medical profession will be and with it the broader US healthcare system. It’s time to turn to entities like Sermo where physicians are establishing a new voice to collectively discuss the future of our profession.” (emphasis added)

Shreeve also posted a follow-up announcement from Palestrant claiming that within 24 hours following his first proclamation, more than 2,400 physicians had voted on Sermo, with 90% saying that the AMA does not represent them or their interests.

Palestrant’s second post concluded with this: “The need for physicians in this country to have a strong voice has never been greater. And Sermo, a community of well over 100,000 US Physicians, needs to make its voice heard. Yesterday’s posting was the beginning of a regular series that will make your voice heard on issues critical to our profession. Results from these postings will be publicized to the media. Believe it or not, we are already making dramatic progress. I have been contacted by major media outlets who are interested in what physicians on Sermo have to say. Beginning next week our voice will be heard.”

Is Sermo positioning itself for bigger things, preparing to make the leap from online communications network for physicians to a player in the national healthcare reform debate? Would such a move even be productive for physicians at a time when many docs feel their voices are not being heard by a government that seems intent on enacting several far-reaching changes to the healthcare delivery system?

KevinMD isn’t sure it would be, saying that although he can “understand the sentiment within the physician community that the AMA may not represent the majority of doctor’s interests,” he thinks the AMA is “the best advocacy organization we have, like them or not, which is important in the current health reform environment. As such, perhaps it’s not the best time for physicians to bicker among themselves.”

This lukewarm endorsement (if you can call it that) of the AMA got us to wondering if we could find anybody willing to mount an independent, full-throated defense of the organization. A bit of Googling turned up an army of angry physicians who are fed up with the AMA and feel it doesn’t represent them. A sample:

Dr. Margaret Flowers and Dr. Carol Paris, members of Physicians for a National Health Program, say that it is “a common misconception that [the AMA] speaks on behalf of most American physicians but that is a misconception with very serious consequences at such a critical time in the health care reform debate.”

Peter Klatsky, MD, says that “AMA membership has dwindled to less than 20% of practicing physicians” and “most of their members no longer represent the views of most American physicians.”

Rahul Parikh, MD, writing recently at The Health Care Blog asked “Is the AMA still relevant?” The answer, according to Dr. Parikh, is that “Only time will tell, but given it sinking numbers and traditional resistance to change and innovation in the delivery of health care in the wake of a groundswell of support for change, it's hard not to see this grand old institution of American medicine slowing getting sick and slipping into critical condition.”

Rahul Rajkumar, MD, a physician at Brigham and Women's Hospital in Boston, and Harold Pollack, chair of the Center for Health Administration Studies at the University of Chicago, wrote in an editorial for the Miami Herald that “The AMA does not speak for all physicians. In the battle for the soul of American medicine, the AMA is often on the wrong side.”

Granted, many of these detractors anti-AMA views stem from the fact that the AMA does not support whatever their personal version of healthcare reform happens to be, but still there seems to be a strong sense among a growing number of physicians that the AMA does not truly serve their interests.

Do you share this view? Do you think the AMA is doing a poor job of defending the greater interests of US physicians and patients? Are there better alternatives for physicians who want to make their voices heard?