The American Medical Association likes to call itself the voice of medicine. But lately it seems to be getting laryngitis.

Long one of the lobbying titans in the halls of Congress, the AMA is now just another voice in the cacophony of medical interest groups. And while it's still the largest physician group, the AMA represents an increasingly smaller percentage of the nation's practicing physicians — about one-third, by most counts.

Yet President Obama still considered the group important enough to pay a house call to its annual House of Delegates meeting in Chicago, in recognition of the fact that while the AMA may not be able to dictate the terms of what type of health overhaul can pass Congress, it could still help gum up the process.

The AMA "may not be what it once was," says Rep. Michael Burgess (R-TX), a physician and former member of the AMA's policymaking body. But at the same time, Burgess says, "anytime you talk to a member [of Congress] about something in regards to health care, they will ultimately ask you, 'Well, where's the AMA on this?' So they do have considerable clout."

Historically, the AMA has been largely white, male and Republican. But the rest of the medical profession is more diverse, and doctors differ on what they want to see in a changed health care system.

"Medicine isn't monolithic anymore," says health care consultant Robert Laszewski. "About the only thing every physician in America can agree on is, 'Don't cut my pay.' "

In fact, one of the key issues in a health care overhaul is threatening to touch off a civil war within the medical profession, Laszewski says. It's the fact that there's widespread agreement that primary care doctors — for example, those who practice family medicine and pediatrics — are today underpaid and need to be paid more.

"But the only way primary care physicians get more money is if certain specialties get less money," he says. "So it really gets down to a contest between the various specialty groups as to who gives up and who doesn't."

But while doctors may end up bickering among themselves, those who want to get a health care overhaul passed want to make sure that doctors don't become opponents. The AMA is legendary for having helped defeat efforts to create national health insurance in the 1930s and 1950s, and almost prevented the passage of Medicare.

Even in its weaker state, says Laszewski, "if the physician community stands up and says, 'This would be bad for you,' a lot of consumers are going to believe and accept that."

That makes keeping doctors happy and on board a key goal of President Obama and his allies.


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