Special Interest Groups: What's their role in the reform?

Hey guys.

I'm going to respond to Patrick's post, and then pose a couple (somewhat-rhetorical) questions. I found it very interesting that while the AMA's position is one against the public option, the majority of physicians belonging to AMA are in favor of the public option, in some shape or form. Off the bat, I just have to throw the fact out there that the majority of physicians sign up for the AMA because it's "what you do", you get your little purple ID card, keep it in your wallet (or the back of your desk drawer), and conspicuously arrange your free subscription to JAMA on your desk as to assure your patients will see it. Somewhat of a cynical exagerration, but you catch my drift. That being said, I guess it's not too hard to conceptualize how the majority of the group's members feel one way, yet the official position of the group fails to reflect the majority vote. The average doc out there, "working 75+ hours per week, trying to please a million masters, attempting to keep his head above water in the sharktank" is about as invested in the AMA as schoolchildren are in classwork on the day before Christmas vacation. In fact, this lack of leadership and interest has been a topic of concern for the AMA for decades. And it's sad, because as much as the reform (in whatever form it eventually takes) is going to effect patients, insurers, etc...it's going to rock the worlds of physicians.

As Patrick mentioned, the medical community is widely split on the reform issues. So much so, in fact, medical schools host debates (tactfully-advertised around campus as "expert panel discussions on health reform") between physicians from the two camps: mainly the AMA and PNHP (Physicians for a National Health Plan.) Med students pile into auditoriums to listen to middle-aged docs battle it out over reimbursement, treatment of the uninsured, and how there are more billers in their office than physicians due to the headaches involved with billing several different insurance companies. In general, primary care physicians side with PNHP, and specialists side with AMA--but this is a gross overgeneralization (as the statistics in Pat's article illustrate.) I guess I'm having a hard time reconciling how the AMA, whose vision is to "help doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues", can publicly take a stance on such a massive issue as national reform, with an opinion that does such a mediocre job of capturing the best interests and feelings of so many (the majority!) of its constituents. Sure, there will always be a few dissidents in every interest group...but this is more than that. In this case, with so much on the line, and such a massive discrepancy of opinion amongst its constituents, is the AMA justified in publishing any official stance on health reform? That's what an "interest group" is supposed to do, right? Attempt to influence policy, in some way, by at least taking some official stance on the issue. Or is this a classic example of the squeaky wheel speaking inappropriately on behalf of the silent majority?