CHICAGO -- The nation's largest doctors' group is meeting this week amid turmoil in U.S. medicine and efforts to maintain its membership and political clout.
Nationwide calls for malpractice insurance changes, a Medicare overhaul, and health concerns ranging from West Nile virus to bioterrorism are the backdrop for the annual meeting of the American Medical Association.
Some of these issues are sure to be raised during the six-day meeting, which opened Saturday, along with dozens of proposals seeking an AMA stand on topics ranging from cloning to car lights.
But the AMA has more pressing concerns: how to remain relevant when it continues to represent less than a third of the nation's physicians and medical students.
Data prepared for the meeting show another steep membership slide for the AMA, which counted 260,455 members as of December 2002. That's down nearly 18,000 from the previous year, and compares with 951,853 physicians and medical students nationwide.
"It's a serious concern," said Dr. William Kobler, an AMA member and president of the Illinois State Medical Society.
One reason cited for the membership decline is the growth of competing groups representing specialists. And some nonmembers view the group increasingly as a trade organization concerned more with pocketbook issues than health care practices.
The membership decline has led to belt-tightening including staff cuts, but Kobler said too much cutting could hurt the AMA's lobbying power.
Kobler blamed the falling numbers in part on "frustration that, as hard as the AMA seems to work, it's very difficult to influence the legislation the way you would like."
Dr. Donald Palmisano, AMA's incoming president, said membership is a top priority. The AMA last year launched a newsletter aimed at touting the group's success on issues it says members care about.
That includes lobbying efforts the AMA says helped win proposed legislation to limit jury awards in medical malpractice cases. The bill passed by the U.S. House earlier this year would place a $250,000 cap on noneconomic damages. Whether it survives in the Senate remains to be seen.
Reports prepared for the meeting include measures asking the AMA to endorse embryo cloning for research purposes, restrictions on sales of products containing ephedra, and a moratorium on executions nationwide.
Others ask the group to prevent drug company representatives from sitting in on doctors' visits without patients' consent, and to work to curb teens' use of bodybuilding steroid drugs.
The AMA historically has been cautious in adopting controversial topics as policy, and proposals often are withdrawn or watered down before the AMA's 541 delegates get a chance to vote on them.
Committee meetings on today and Monday will help determine which proposals are sent to the delegates, who will vote Tuesday through Thursday on which ones will become official AMA policy.
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