The American Medical Association, which drew flak from some of its members for endorsing the House health care bill, is taking a more cautious approach to the Senate counterpart.

The large doctors group sent a letter to Senate Majority Leader Harry Reid (D-Nev.) this week that outlined both support and reservations about various provisions in the bill now being considered on the Senate floor.

“We anticipate a lengthy debate, multiple amendments, and modifications of the bill during the floor debate, and we will work for changes in the Senate bill to improve the health system for patients and the physicians who care for them,— AMA President J. James Rohack said in a written statement.

The letter was from Michael Maves, executive vice president of the AMA, and it took issue with a number of items in the Senate bill, including the proposed 5 percent excise tax on cosmetic surgery, provisions regarding Medicare payments to doctors and restrictions on physician-owned hospitals.

The letter stated that “the AMA strongly opposes taxes on physician services to fund health care programs or to accomplish health system reform.—

It also faults the bill for not offering permanent solutions to problems with Medicare’s physician payment system and advocates a permanent repeal of what is known as the sustainable growth rate formula.

The medical group also opposes allowing an independent Medicare advisory board to mandate payment cuts for physicians and the imposition of Medicare provider enrollment fees on physicians.

The AMA also said restrictions on physician-owned hospitals would “effectively shut down many physician-owned hospitals currently under development.—

At the same time, the AMA praised other provisions including the reform of the health insurance market, tax credits to help low-income individuals buy insurance, expanding Medicaid and excluding co-payments and deductibles for prevention and wellness initiatives. The doctors group also said it supports the creation of an independent comparative effectiveness research entity to develop information to help patients and physicians make decisions about treatment options.

The letter makes reference to the controversial public health insurance option that has sparked dissent both among doctors and within the Senate only in an addendum to the letter. The addendum, which includes additional comments and suggestions, says that while “the AMA does not believe a new public health insurance plan is essential to ensuring competition in a reformed insurance market,— it adds that the group was pleased that the bill included provisions that maintained “a level playing field among public and private options.—

While the AMA has the best-funded lobbying operation on behalf of doctors in Washington, D.C., it increasingly has had to compete with the proliferation of specialists groups, some of which have been more vocal in their opposition to the health care legislation.

This week, a coalition of 19 surgical and anesthesiologists organizations sent a letter to Reid opposing the Senate health care bill as currently written. The letter listed a number of the same reservations as the AMA, including the tax on cosmetic surgery and Medicare payment rates.

The surgeons said the bill’s call for the redistribution of unused residency slots for general surgery positions “is a positive step in addressing the predicted shortage in the surgical workforce.—

However, they added, “the Senate should look more broadly at the issue of limits on residency positions for all specialties that work in surgical setting that are also facing severe workforce problems.—