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In 1932 a committee on the costs of medical care reported that quality would be improved, and care would be made more widely available, if doctors practiced as groups in hospitals—an idea not unlike incoming President Larson's. "Savors of Communism!" cried Dr. Fishbein in the Journal, though the committee chairman was no less stalwart a Republican than Physician Ray Lyman Wilbur, then Herbert Hoover's Secretary of the Interior. Such bluntness cost Fishbein his job in 1949, but not until this year did the A.M.A. Journal admit that the criticism of Wilbur had been false.
Membership & Budget. In its 114th year, the A.M.A. is an organization that enrolls 177,337 of the country's 253,233 doctors (149,086 pay dues), and sets its cap to 1) make them better physicians by spreading medical-scientific news, 2) police ethics and uphold standards, and 3) protect their economic interests as doggedly as any trade union does.
Toward the goal of information, A.M.A. publishes eleven professional journals, a monthly magazine for laymen and a weekly newspaper. Most notable: the big (averaging 240 pages, 180,000 circulation) weekly Journal of the American Medical Association. Toward the goal of ethics, President Larson only last week promised a renewed drive to scourge from A.M.A. ranks the abortionists, drug addicts, mental and professional incompetents, over-chargers, fee splitters and rebaters. To protect its interests, A.M.A. runs an effective propaganda plant and Washington lobby. Member doctors pay dues of $25 a year, but the bulk of A.M.A.'s annual income of $16 million comes from advertising in its publications, mainly by drug and medical appliance makers.
Federacy. "It is unfortunate," says Dr. Richard L. Meiling, dean of Ohio State University's College of Medicine, "that many people don't realize that A.M.A. is probably the most democratic organization in the U.S." A.M.A. defines itself as "a federacy of its constituent associations"—the state medical societies that in turn are associations of county and district societies. For the U.S.'s 3,131 counties and equivalent divisions, there are 1,901 county or district societies, many covering two or more counties with few doctors.
Nearly all physicians in private practice belong to county societies; they must, to qualify for their most important prerogatives, notably putting their patients into hospitals and treating them there. All members may vote for county officers, in eluding delegates to state conventions. These delegates elect state society officers, plus a quota of delegates to sit in the A.M.A. House of Delegates. The House elects the national board of trustees, the president and all top officers. Thus the individual doctor's influence is two removes from national headquarters and national policy.
It is a special breed of physician who works his way up the county-state-A.M.A. ladder. He gladly pays his own expenses to attend meetings. In most cases he is old enough to have his practice so organized that he can arrange time off. This is easiest if he is a specialist in a small town. "Medical organization is less efficient in the larger cities," says a top A.M.A. official. "There is greater participation in the rural societies, and they furnish us relatively more delegates."