When Donald Trump this week tapped a surgeon-turned-congressman to run the Department of Health and Human Services, the nation’s largest physicians group swiftly endorsed the choice.
The blowback started almost at once.
Liberal doctors peppered the American Medical Association with furious tweets decrying the group’s endorsement of Representative Tom Price as a betrayal of patients and physicians. And by Wednesday night, 500 doctors had signed an online open letter titled “The AMA Does Not Speak For Us” started by the Clinician Action Network, a left-leaning advocacy group.
The outpouring of anger has exposed the bitter political rifts dividing doctors these days. Price is an AMA member, but he also belongs to a conservative doctors’ group that publishes a journal which has advanced discredited theories, such as the notions that abortions cause breast cancer, vaccines cause autism, and HIV does not cause AIDS. The same group shot into the spotlight during the presidential campaign by promoting conspiracy theories about Hillary Clinton’s health, including speculation that she’d had a seizure or a stroke.
There are left-leaning alternatives to the AMA, too, including one that has long advocated for gun control, pushes physicians to cut all financial ties with drug companies — and expressed dismay that any doctors group would back Price.
The AMA remains by far the biggest and most visible lobbying force representing doctors and medical students. The group spent $15 million just in the first nine months of this year to lobby Congress and the executive branch on everything from marijuana research to opioid prescribing to telemedicine, as well as traditional issues such as reimbursement and billing, according to federal filings.
But physicians are increasingly using social media to push back against the organization.
“The AMA is generally a force for the status quo in health care, a physicians’ guild in the old-school style of wheeling, dealing, and horse-trading to keep the billing flowing like a mighty stream into MDs’ coffers,” Dr. Zackary Berger, an internist at Johns Hopkins, said in an email. Berger, who is also the founder of Doctors Against Trump, has never belonged to the AMA.
The AMA has about 250,000 members, including doctors and medical students. Roughly 15 percent of practicing doctors in the US are full dues-paying members of the AMA, according to a 2011 estimate published in the journal of the Canadian Medical Association.
The organization has a lot at stake when a new administration comes to town: Working with Congress, the executive branch can shape everything from health insurance markets to hospital ratings systems to how much money doctors receive for treating patients on Medicaid and Medicare.
Back in 2009, when President Obama first nominated Kathleen Sebelius to run HHS, the AMA put out a statement within hours praising her “leadership skills.”
Within six hours of Trump officially nominating Price, the AMA urged quick confirmation in a tweet expressing strong support for the Georgia congressman, a former orthopedic surgeon. In a statement on its website, the group praised Price as “a leader” in developing “market-based solutions” to health policy and reducing “excessive regulatory burdens.”
The AMA didn’t mention that Price has been a vocal opponent of the Affordable Care Act. Or that he’s called for restructuring and sharply cutting federal aid to Medicaid, which primarily serves poor people. Or that he’s proposed controversial changes that could cut benefits to seniors under Medicare. Or that he has a 0 percent rating from Planned Parenthood and has opposed efforts to give women free access to birth control.
The endorsement infuriated some doctors.
@AmerMedicalAssn as a Delegate to the House I am horrified to see this. He opposes much of what the AMA has fought for recently.
— Kyle P. Edmonds, MD (@kpedmonds) November 30, 2016
— Nusheen Ameenuddin (@namd4kids) November 30, 2016
I am a doctor who takes care of the underserved. My patients will lose coverage. Please justify this ghastly position, AMA. https://t.co/Ligkaqad9g
— Jonathan Golob (@golob) November 30, 2016
Other physicians said they were glad they had cut ties with the AMA before the endorsement. “I left when I realized they certainly were not speaking for me,” said Dr. Jen Gunter, a Bay area OB-GYN who was an AMA member for a few years in the 1990s.
Gunter told STAT she found the AMA too slow to speak up in defense of reproductive health, too weak on promoting primary care physicians, and too slow to promote female leaders. Even so, she said she was “stunned” that the organization endorsed Price.
The outcry among doctors didn’t escape the notice of Sebelius, who served as HHS secretary for five years during the development and implementation of Obamacare (and who took heavy criticism from anti-abortion groups after her nomination).
“I wasn’t surprised to see some pushback” from doctors on Price’s nomination, Sebelius told STAT in a phone interview. She noted that the AMA has supported Medicaid expansion and been involved in outreach around the Affordable Care Act — and “clearly, this nominee does not share those views.”
Even Dr. Steven Croft, a Texas neurologist who is a member of the same right-wing physicians group as Price, said he was “shocked” — and pleased — to see the AMA back Trump’s nominee, given the group’s support for Obamacare.
“It seems that they switched sides (for the better),” Croft said in an email.
Dr. Patrice Harris, who chairs the AMA’s board of trustees, said the group’s endorsement stems from its “relationship with Dr. Price going back decades.”
The AMA has not always agreed with Price on “important policy issues,” Harris wrote in an emailed statement, but he has “consistently recognized the many challenges facing patients and physicians, and he has been willing to listen” to the group’s concerns.
And the blowback from doctors? “We understand that our diverse membership will never agree on every position the AMA takes,” Harris wrote.
The AMA wasn’t the only medical group to back Price.
“A strong choice,” said the Association of American Medical Colleges.
“An indispensable voice,” said the American Academy of Orthopaedic Surgeons.
Meanwhile, the National Physicians Alliance, which identifies as nonpartisan but generally backs liberal policies, put out a statement taking those other groups to task: “We are dismayed that other large physician organizations have endorsed Dr. Price without consideration of the harm his policies would inflict on our collective patients.”
The group’s president, Dr. Manan Trivedi, told STAT that he believes many physicians share his sense that they have been betrayed by “organizations that they thought represented them and patients but in fact were focused on personal pocketbook issues.”
His view of Price? “No [health secretary] nominee in recent memory has been such a threat for basic health care for our patients,” Trivedi said.
Price’s congressional office did not respond to a request for comment. Neither did Trump’s transition team.
Dylan Scott contributed reporting from Washington.