W

hen 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.

advertisement

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.

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.

America’s Essential Hospitals lauded Price’s health care background. The Advanced Medical Technology Association said “we look forward” to his confirmation.

Newsletters

Sign up for our hospitals newsletter, On Call

Please enter a valid email address.

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.

Leave a Comment

Please enter your name.
Please enter a comment.

  • I suppose prospective isn’t required. “Anger from over 500 doctors that have signed a petition. Wow! There are over 800000 doctors practicing medicine in this country.

  • Seriously? 500 doctors out of 855,000 signed a petition, and that’s newsworthy? For a site called STAT, they’re remarkably bad at interpreting the importance of statistics.

  • The article is not an even handed evaluation of the situation. Certainly, the AMA’s support of Price will anger physicians who are left leaning. What you do not report is that after the AMA signed on to Obamacare and mandated insurance, many physicians left the AMA in protest. The leadership at the time was perceived as being out of touch with the majority of the membership. And, as was blindingly obvious at the time, the ACA has indeed crashed, and needs to be replaced. Those of us in the trenches, who see the inner workings of the system daily, knew that the theoretical constructs of the architects of the ACA who never see what real life in a hospital is like, would fail.
    Price knows what is actually going on in Medicine, and I have hope that he can construct a system that will more effectively deal with the problems we face.

  • While endorsing the choice of someone who is so clearly against the views the organisation has espoused – and someone who propagates dangerous and damaging information – seems to be hypocritical and self-serving, there is an argument to be made that getting on good terms with an administration which wants to repeal Obamacare and who’s VP is strongly anti-abortion could yield dividends for patients down the line. It’s a new world now, a Trump world, and perhaps the AMA have just adjusted faster to the new reality

  • Perhaps it is time for physicians to look across the aisle with a discerning eye at the American Dental Association. Founded to promote dental amalgam over 155 years ago, the ADA has a long history of endorsing products and with affiliates holding patents on dental amalgam, and put a gag order of sorts in its Code of Ethics after 60 Minutes ran a special questioning the safety of dental amalgam in 1990. The evidence has further mounted with four studies published by James S. Woods et al 2011-2014 finding genetic susceptibility to mercury toxicity after reanalyzing the Children’s Amalgam Trial data by gender and gene type, and many others in PubMed. The AMA avoids endorsing products to avoid potential conflicts of interest. Mixing professional practice and commercial interests, along with regulatory capture of the FDA and deference by doctors, is a recipe for patient harm that has been perpetuated over decades.

    • Quit bloviating. There isn’t enough silver and mercury in a mouth full of fillings to poison a goldfish.

  • It seems as though the AMAZON is reverting to its decades old conservative stances, against most govt paid health care for the public…
    Eg, the AMA was against the original Medicare under the Social Security program for years after it was finally passed into effect in the 1960s!!

  • The AMA has not been an advocate for patient care for decades. Had they been we would not be in the mess we are in now. I appreciated that as a medical student and am proud to say that I have never been a member.

    • Agreed. I would stay away from a doctor who belonged to AMSA. As you know the saying is “eat when you can, s**t when you can and sleep when you can”. There is no time for anything else, really.

  • Not really interested in one percenters arguing. Not much difference between a liberal or conservative one percenter except the conservative is probably less of a hypocrite

  • Of course the AMA is for Price, they care most about the bottom line, their pocketbooks. Price could care less about universal access but does want increased reimbursement and limiting amounts in law suits to under 100,000 $. The poorest among us are going to lose the most when the ACA is dismantled and Medicaid is block granted. Studies in Kentucky showed increases in overall health and longevity with the ACA, I guess Price has forgotten about the Hippocratic Oath

    • Could you give a reference for these studies? I would like to see how the authors might extrapolate increased longevity from 6 years experience.

    • Phil Shaffer, we’d all like to see how anyone could extrapolate longevity from 6 years. By which I of course mean that whatever they used was obviously complete garbage, and thus any other conclusions they drew can also be discarded as complete garbage. But fools will still quote it.

    • Phil Shaffer, Bob Nix: I don’t know anything about the study referenced, but 6 years of data is more than sufficient to show a trend in longevity at the population level for many, though not all, medical covariates to longevity. Here’s a thought exercise for you: imagine you had a population in a civil war. People of all age groups are being killed randomly in the fighting. You end the civil war. The age adjusted life expectency, and the overall population longevity, for every age group would go up immediately, and this would apparent in even short term surveys.

Sign up for our Morning Rounds newsletter

Your daily dose of news in health and medicine.

X