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AMA Chief Has Internal Divisions to Stitch Up

In a speech last week marking his ascension to the presidency of the American Medical Association, Cecil Wilson, an avid sailor and former Navy doctor, couldn’t resist tossing out some precautionary sea tales.

The Florida internist described two sailing trips with fellow doctors that went awry to illustrate how physicians faced unforeseen challenges that required vigilance to overcome.

Wilson, who is expected to travel to Washington, D.C., this week, has assumed the leadership of the medical association at a particularly tempest-tossed time.

The group has been waging a massive campaign to prod Congress to fix a Medicare formula that has resulted in a 21 percent cut in payments to physicians starting this month. And once-friendly relations with Republicans have soured, in part, because GOP lawmakers were annoyed at the AMA for endorsing the Democratic health care reform plan.

Meanwhile, the doctors group is still reeling from internal rifts over that endorsement.

In a phone interview, Wilson admitted that the situation facing the doctors is challenging.

But he also characterized the times as historic and exhilarating, and he said the AMA would not shy away from making its views known.

“We relish being involved,” Wilson said.

He added that the group will continue lobbying hard on the Medicare legislation, known as the “doc fix,” even though a recent AMA ad campaign on the issue is over.

“We’re going to keep up the pressure,” he said, adding that doctors will be contacting Members and urging their patients to call as well.

He also was dismissive of the six-month fix that was approved last week by the Senate.

“The time for patches and temporary fixes, we are beyond that,” Wilson said. He noted that “the House had stepped up to the plate” by approving a permanent Medicare solution last November.

Despite the difficulty in pushing AMA’s priorities on Capitol Hill, Wilson indicated that no major shake-ups are planned for the group’s large Washington, D.C., operation, which he called “superb.”

From the beginning of 2009 through the first quarter of this year, AMA spent $26 million on lobbying, according to disclosure reports filed with Congress. The organization ranks in the top 10 among companies and groups in terms of lobbying expenditures.

Wilson sidestepped questions about tensions with Republicans and said that both political parties were responsible for the failure to revamp the Medicare formula.

As with many other industries and groups, campaign giving by the AMA has tilted more toward Democrats since the party assumed control of Congress in 2006.

So far, in the current election cycle the AMA political action committee gave 67 percent of its contributions to Democratic candidates. In the 2006, cycle it gave 70 percent of its contributions to Republicans. The AMA’s political giving, Wilson said, is based on how supportive lawmakers are on medical issues.

Son of a Preacher Man

Wilson’s backers say the 75-year-old former naval surgeon, who grew up in south Georgia as the son of a Methodist minister, possesses the even temperament needed to lead the organization in this fractious period.

“One thing about him, he always keeps his cool,” said Russ Jackson, senior vice president of Florida Medical Association, where Wilson once served as president.

Jackson also said that Wilson, who had previously served as chairman of AMA’s board of trustees, is well-prepared to guide the organization on Capitol Hill.

“He’s politically savvy and understands how Congress works,” he said. Jackson added that Wilson has closed his practice in Winter Park, Fla., near Orlando, while he serves as president.

Despite the considerable resources it pours into influencing Congress and the executive branch, some health care experts say AMA’s clout has waned.

Robert Moffit, a health care specialist at the conservative Heritage Foundation, said at one time “the AMA was not only respected, it was feared.”

But he said over the years the proliferation of specialist groups has diluted the group’s influence.

Many of these specialists, particularly surgeons, were among the most critical of the Democratic health care reform proposals. Among AMA members, there was vocal dissent when the group threw its support behind the House and Senate bills, endorsements that were viewed as crucial in swaying some undecided Democratic lawmakers.

Former AMA President J. James Rohack, who led the organization during the health care debate, referred to the heated sentiments on his final AMA blog entry on June 15.

“As I have read some vitriolic emails and letters — some suggesting that I inflect self harm — I have thought how difficult it is at times to practice the Golden Rule,” wrote Rohack, a Texas cardiologist.

Wilson said there were political differences over the health care plan across the country.

“Physicians are not immune to those divisions,” Wilson said.

Intensive Care

But in his address at the AMA convention in Chicago last week, Wilson promised to mend those divisions and hold regular conference calls to reach out to the group’s members.

The tensions over the direction of the organization were reflected in a rare three-way race to become the group’s next president-elect, which was held at their Chicago meeting.

Peter Carmel, a pediatric neurosurgeon from New Jersey, won that race, and he will take the helm of the organization in June 2011.

Carmel vowed to take a tougher stand toward Washington.

“The AMA is going to be more insistent and little edgier with its relationships with Congress and the administration in demanding some of the things we doctors need,” Carmel told the Chicago Tribune.

But for the time being, even one of the more outspoken AMA members said he was willing to give the new leadership a chance.

Donald Palmisano, a New Orleans physician who was active in the conservative faction opposing health care reform, called Wilson “a fine gentleman.”

But Palmisano, a former AMA president, noted that the group’s leaders are bound by policies set by its board of delegates. The test for Wilson, he said, is whether he will be able to effectively communicate those policies on issues such as Medicare physician payment formula.

“I’m going to give Dr. Wilson the benefit of the doubt,” he said.

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