Medpagetoday.com reports in a series of articles from the AMA delegates convention some of the decisions of the medical physicians' trade association.  

HERE a report notes that for the first time in 26 years a sitting president of the United States will address the AMA delegates convention.  Says the report "It's been a long, long time since a sitting president of the U.S. talked face-to-face with the American Medical Association -- so it's not surprising that the more than 500 AMA delegates, friends, and relatives assembled here are focusing all their energies on President Barack Obama's appearance on the podium.  Obama's speech will end a 26-year long drought for presidential speeches at the AMA -- Ronald Reagan addressed the delegates in 1983, the same year he proposed to freeze Medicare payments to physicians while his administration worked to cobble together a Medicare overhaul."

"When President Barack Obama delivers a speech tomorrow in front of the American Medical Association House of Delegates, it will be a poignant occasion for the divisive doctors' group for a number of reasons. The years since the Reagan speech have been tough ones for the AMA, which has seen both its membership rolls and its revenues shrink. While membership has shrunk since the 1980s, the group still describes itself as the "house of medicine" with a membership of about 236,000 physicians from a wide swath of specialties-- but 30% of them are students, who don't pay dues, and only about 50% are practicing physicians.  Moreover, the AMA has a struggled with its image. Last year it issued a formal apology for its past history of racial discrimination."

"Second, it's no secret that the group has vocally opposed many healthcare legislation and overhaul efforts in the past 40 years, from the creation of Medicare to the failed reform efforts of the 1990s. In March, Nancy Nielsen, M.D., Ph.D, the AMA's outgoing president, told MedPage Today that the AMA felt spurned during the Clinton administration when it wasn't invited to a single healthcare reform discussion. Rather than sitting out the battle over the Clinton plan, the AMA, along with insurers, launched a major offensive that some say was the main reason the reform efforts failed."

"Dr. Nielsen called the current climate, where healthcare reform may soon be a reality, "our profession's D-Day."

"To prove the AMA's clout, Dr. Nielsen outlined in her speech some successes the group has under its belt -- such as suing United Healthcare and its database subsidiary Ingenix for understated out-of-network payments. United settled with the AMA for $350 million."

"In her speech, Dr. Nielsen appeared to be hinting at a new, less adversarial role for the AMA. 'We can't keep on hating everyone all the time -- government, health plans, and sometimes even each other,' she said. 'It's our responsibility to try some new things and innovate in healthcare delivery.'"

"Still, perceptions are slow to change....some colleagues in Wisconsin won't join the AMA because of hardline stances taken by the group on a number of major issues..."

"Regardless of its image problems, the AMA is riding high this week because Obama is coming to the "house of medicine" to talk turkey with doctors." 'I think it's important that he is recognizing the AMA as representative of the physicians of the country,'" said one medical physician.  "Obama will address the AMA House of Delegates Monday at 11:15 CDT, which will be 12:15 EDT."

An article HERE reports on the opening day of the medical physicians' trade association.  Says the report "There was not a lot of good news to cheer the assembled delegates at the opening of the American Medical Association's annual meeting-doctors are still facing a 21% cut in Medicare pay, tort reform is nowhere on the national agenda, and membership continues to shrink."

"...AMA's executive vice president in a speech to the delegates...put the net decline in membership at 5% to 7%."

"...Nine states decided against participating in a joint program between state medical societies and the AMA.....giving added benefits to doctors who agree to become dues-paying members of both the state and national organizations.....When states opt out of the partnership deal, membership in those states has historically declined by 12% to 13%, a factor that he said combined with discontent over the AMA's backing of the Patient Protection and Affordable Care Act."

"The atmosphere during the opening session was markedly less than celebratory and, as a measure of the discontent, the delegates demanded that the house be cleared of press and non-delegates at 5 p.m. so that it could go into a closed-door session.  Several delegates told MedPage Today that the closed-door session would allow for a more frank discussion of "problems" with both membership numbers and AMA leadership during the healthcare reform debate."

THIS REPORT continues the reporting on the AMA's membership woes.  "After a brief upward spike," medpagetoday.com reports,  "the AMA's membership is shrinking again. Although the group boasts close to 240,000 members, 29% are students or residents, who pay sharply discounted dues. Still more of the members are retirees, whose dues are also cut."

"Even more ominous for the AMA's coffers, not all of the 120,000-odd practicing physicians on the membership rolls pay the full $420 annual dues. That's because about 25% belong to group practices, which win discount dues for signing up en masse.  The 5,000 or so members gone from last year are primarily from the ranks of actively practicing physicians, it emerged during a committee hearing at the AMA House of Delegates meeting here."

"The AMA's Council on Long Range Planning and Development had more specificity. It reported that there are 1,060,333 physicians and medical students in the United States and 238,977 of them AMA members.  Of those members, 20.5% are medical students, 9% are residents, and 36.5% are 56 or older. As one delegate put it, "we have a lot of students and a lot of old docs, but not a lot of practicing physicians."

"...membership dues brought in $48 million in 2006, down $1.6 million from 2005. About a quarter of the decline -- $400,000 -- could be laid to the AMA's decision to waive dues for physicians practicing in areas affected by Hurricane Katrina..."

"Just a year ago, the AMA was touting a 2.5% increase in members that marked the first rise after more than 10 years....Slashing the $420 dues by 50% or more could attract doctors reluctant to pay full price, he said. He pointed out that the ranks of students, who pay $20 a year, and residents, who are charged $45, has remained steady, while full-dues paying members have declined."

"In related news, Gary C. Epstein, the AMA's chief marketing officer, who created a glitzy $60-million "branding" campaign that Dr. Maves cited last year as a major factor behind the membership bump, will leave the AMA on Friday....Epstein, who came to the AMA from Proctor & Gamble, spearheaded a number of initiatives designed to boost membership including updating the AMA logo, a switch in the organization's color scheme from aqua and white to purple and white, a series of "member-connects" roundtables hosted by AMA leaders, and ongoing radio, television, and print ads that pushed a "together we're stronger" message.  Despite the drop in members, 2006 saw a 2.1% increase in revenues and the "seventh consecutive year of operating profits," said Joseph M. Heyman, M.D., an obstetrician-gynecologist from Amesbury, Mass., who chairs the board of trustees' finance committee."

"The biggest gains came from sale of data and credentialing products, which was up by $2.6 million, increases in book and products sales of $1.8 million, and a $1 million increase in publishing revenues pegged mainly to higher reprint sales and an increase in online subscriptions."

In a related story FOUND HERE medpagetoday.com reports that two states have "lost more than 20% of their AMA members over the past year, and [26 states] have seen a decline of 3.6% to 9.9%."  Four states are "facing membership declines of 10% to 19.9%. A dozen states, mostly in the Northeast, have lost less than 3.5%, and six states...are claiming more members now than a year ago."

Alabama and Mississippi "are rumored to have lost as many as 40% of their AMA members."

The numbers, however, may not accurately reflect AMA membership "until August, when the AMA closes its membership books." The AMA board "feels that 215,000 members is a conservative estimate" of where the membership will stand in August.

In 2007, the AMA reported that its membership stood at 240,000.

Surprisingly AMA leadership says "that the AMA is actively reevaluating its definition of membership.  For example...in the current digital age a better approach to membership might be traffic, so if a physician accesses a certain number of AMA digital services -- CME, electronic journals, practice management programs -- that physician would automatically be considered a member."