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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Whats the new spelling for the AMA? S-E-R-M-O

Spelling (spĕl’ĭng) n.

  1. The forming of words with letters in an accepted order; orthography.
  2. The art or study of orthography or the way in which a word is spelled.

Whoa . . . just ahead of a 21% cut in physician salaries we have an epic battle shaping up within the physician community. The AMA, long the Godfather and voice of physicians around the country, apparently is feeling the heat from a younger, more svelt upstart from across (cyber)town. I have just received back to back emails from Sermo CEO Daniel Palestrant essentially declaring his succession from the physician union. This comes at a critical time when further fracturing of physician leadership and political strength put in jeopardy the opportunity for the physicians to have a unified voice (or is it because the stakes are so high that this group is compelled to speak up?):

The leading missive from 7/1/09 (might require log in):

Dear Dr. Shreeve,

As physicians, our first step in the healthcare debate needs to be clearing the air about who speaks for us on what topics. Today, I am joining the increasing waves of physicians who believe that the AMA no longer speaks for us. As the founder and CEO of Sermo, this is a considerable change of heart, given the high hopes that I had when we first partnered with the AMA over two years ago. The sad fact is that the AMA membership has now shrunk to the point where the organization should no longer claim that it represents physicians in this country.

The AMA has drawn its power from the support of the physician community. The waning membership reflects our objection as the AMA has failed us consistently for over 50 years. Make no mistake, the debate within the AMA about how to stop their membership decline is not new.  What is new is the lengths to which the AMA appears willing to go to deceive the public on this topic.  The AMA routinely claims that their membership is 250,000 practicing physicians.  At best, this is 25-40% of practicing US physicians and even that claim is based on some stretching of the truth.  The 250,000 total includes a number of non-practicing constituencies, including medical students, residents, and subscribers of the AMA’s journals.  Paying membership is generally accepted to be far lower.  How much lower?  Actual numbers are remarkably difficult to come by.

At this critical moment in history, we cannot watch the AMA fail physicians so completely yet again.  Nor can we stand by and let false perceptions about who speaks for physicians persist. At the very least, all parties should understand the intrinsic conflicts of interest that are in play, and the AMA should be held accountable to these truths.  Better yet, physicians should call for sweeping changes within the AMA.   In the best-case scenario, the AMA will shed its relationships with insurers and abandon tactics that take advantage of physicans to generate millions of dollars in revenue.  It is an inherent conflict of interest to claim advocacy for physicians while profiting from a reimbursement system that makes it increasingly difficult for physicians to practice medicine.

The flight from the AMA signals that physicians don’t believe the AMA is willing to make these changes. The longer that the public and our lawmakers cling to the perception that the AMA represents the voice of US physicians (and the AMA succeeds in perpetuating this), the more imperiled the medical profession will be and with it the broader US healthcare system.  It’s time to turn to entities like Sermo where physicians are establishing a new voice to collectively discuss the future of our profession.

There can be no healthcare reforms that have any chance of succeeding without buy-in from physicians.  As a country, we cannot risk another failed reform effort.  As physicians, we cannot risk letting the AMA represent our interests.  This is our time to educate the public about which voices truly represent us and our commitment to our patients.

Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.

The follow on upper cut (From 7/2/9):

Dear Dr. Shreeve,

Yesterday I posted on Sermo about the need for a new voice to represent physicians. The Sermo community’s response was clear. 2,400+ physicians voting in less than 24 hours. 90% say that the AMA does not represent them. That is a bold statement and the general public will take note.

The need for physicians in this country to have a strong voice has never been greater. And Sermo, a community of well over 100,000 US Physicians, needs to make its voice heard. Yesterday’s posting was the beginning of a regular series that will make your voice heard on issues critical to our profession. Results from these postings will be publicized to the media.

Believe it or not, we are already making dramatic progress. I have been contacted by major media outlets who are interested in what physicians on Sermo have to say. Beginning next week our voice will be heard.

Add your voice to the first topic:

The Biggest Risk to US Physicians Today: The AMA


Daniel Palestrant, MD
CEO & Founder
Sermo Inc.

I have commented about Sermo before (here and here). I think it can be a useful tool – the virtual lounge if you will – which I totally get. Some of the hallway conversations were useful, but I had other settings in which to engage to my clinical and personal satisfaction. And just like the real thing, I never felt comfortable hanging out in the posh lounge with slightly better food when all my patients, colleagues, and fellow health care workers were sent somewhere else. It is the same discomfort I feel on the rare occasions I have flown first class and sat uncomfortably watching all the “regular” people pass pass on the way to the back of the plane.

Obviously a Sermo style virtual lounge has alot of potential and possibilities. While some of my previous comments can be taken as somewhat down on the platform, I am generally very much in favor and supportive of what Sermo is doing. In fact, I believe the collective intelligence within the network is a wonderful place to harness the cognitive surplus of physicians. Moreover, online communities of experts who can share real medical knowledge in real time, discuss and comment in warp speed peer review, and allow a business commodity to be created from voyeurism certainly has earned my respect.

The breakthrough is not in the message nor even the messenger, it is the manner in which I am getting this message that is most impressive. 100,000 physicians strong (and growing), online and interactive, and now muscling up for the biggest fight of their life. Perhaps most useful of all, is the ability to aggregate the physician voice into a common unified message. My articles above highlight the role of aggregators, and this specific type of network effect grows in influence and power to the point of being a  political force to reckon with. Perhaps the 100,000 member barrier represents the political tipping point to take on the slothful big brother?

Should be interesting to follow – looking forward to seeing if the new kingpin has the staying power to dislodge the king. Looks like he has certainly swiped the scepter.

6 comments on “Whats the new spelling for the AMA? S-E-R-M-O

  1. Great comments, your thoughts are right on.

    Will be interesting to see what develops, and how intense the battle becomes. He makes very valid points about the AMA, yet surely there’s enough time and equity for a behemoth like AMA to retrench and regroup. Not easy to change with that much history and legacy, though.

    What I find most intriguing about SERMO is that it’s not necessarily just a lounge. Clearly dialogue happens there that impacts clinical practice, be it collective dialogue or person-to-person. In the daily life of a physiciansm that’s a more powerful value proposition than AMA offers at this point — never mind the big-picture issues that physicians battle the AMA on.

  2. The following comment was posted from the AMA in response to Dr. Palestrant’s Sermo post:

    We need to set the record straight on the information in Dr. Palestrant’s post. The truth is that AMA membership numbers are public information, and there has been no precipitous decline in AMA membership over the last two years, as Dr. Palestrant suggests. With about a quarter million members, the AMA is the largest physician organization in the country, and through the AMA House of Delegates, comprised of elected physician and medical student representatives from all state and national medical specialty societies, it is the only physician organization that gives all physicians a voice in the future of medicine.

    Twice a year the AMA House of Delegates meets to debate and vote on in public the most important policy matters facing medicine today. Last month, for example, the AMA House of Delegates met to vote on key elements of health system reform. It was a vigorous debate that ended with the following declaration of commitment: AMA supports health system reform alternatives consistent with principles of pluralism, freedom of choice, freedom of practice and universal access for patients.

    At that same meeting, President Obama chose to give his major health reform speech to AMA physicians. Not only has President Obama shown that AMA physicians are integral to the health reform process, but a recent Kaiser Family Foundation poll shows that the American people trust physician groups like the AMA to do the right thing on health reform as well.

    Our advocacy on behalf of physicians is well documented and unfailing. We are actively engaged to permanently fix the broken Medicare physician payment system and have a big victory on that this week. We also continue to advocate for antitrust reform, medical liability reforms, a streamlined insurance claims processing system, and so much more to safeguard the patient-physician relationship. As for relationships with insurers, we continue our high-profile fight against insurer abuses that hurt physicians and patients. More details on AMA’s advocacy on the behalf of physicians and patients is easily found at the links above and on our Web site:

    As for Dr. Palestrant’s sudden “change of heart” regarding the AMA, one can only speculate. He ardently courted the AMA when launching his business two years ago, and now he expresses scorn immediately following the end of that business relationship. The AMA door is always open to Dr. Palestrant and all physicians who would like to join with us to make a positive difference in medicine – especially those who feel their views differ from the policies set by the physicians of the House of Delegates. We urge you to join with us to make a positive difference in the lives of physicians and patients in our nation.

    1. Brenda,

      Thanks for your response. I believe the AMA needs to continue to demonstrate the commitment you describe, continue to be inclusive to new voices and now models, and ensure complete transparency in all of its activities in order to garner the trust and respect of the other 500K practicing physicians in the country. I think Dr. Palestrant’s recent CPT argument is much stronger than the original rant against AMA. I would be interested in your response to his CPT viewpoint . . . looking forward to actively contributing and following along in the conversation.

  3. The foregoing debate over whom to trust as the voice of American physicians seems to have descended into potentially endless bickering and recriminations. This is a poor use of time and resources for both Sermo and the AMA, as well as readers of this blog. Sermo may have created excellent new forums for professional purposes, but as a privately owned for-profit business corporation, in my experience in Washington, it does not and probably cannot achieve the same political clout that a broad-based, nonprofit membership organization like the AMA has, primarily because it does not operate or govern by the same principles, does not have a duly elected House of Delegates, and can be slanted to the selfish private interests of its owners, regardless of what its forum participants may think, collectively. While I carry no brief for the AMA, a series of accusations and gripes against a professional association is worthless without supporting facts and figures, and in any event such disputation does not advance the interests of the medical community. If physicians want to restore the founding principles of American free enterprise to the world of healthcare in the United States, you had better stop quarreling amongst yourselves and get active in both Washington and local political decision-making. Soon we will all be watching the socialists redistribute your time and your efforts and your compensation and your roles in ways you will not like. Your ox is about to be gored! Whether it is through Sermo or the AMA, physicians everywhere had better get organized, join forces, and take a leading role in stopping what is about to be crammed down the throats of all Americans. If your two groups still represent only 40% or 50% of the 500,000 physicians in America, your first step must be to rouse the remainder to EFFECTIVE ACTION against the impending nationalization of healthcare. The government has never run any business well for any constituency, apart perhaps from enhancing the power of incumbent politicians themselves. Healthcare administration is tough enough without the vagaries of politics. For the next six months, at least, and maybe the next 8 years, medical America had better join the battle where it counts, or forever be vanquished and left wondering what happened. If not you, who? If not now, when? Who can we trust?

    1. Ed,

      You loquaciously summarize, accurately surmise, and as always surprise me with the clarity of your thought, crispness of your argument, and the playful candor of your words. You also happen to be 100% correct about the failure of the house of medicine to align and engage in the political process at the local, regional, and national level.

      See you at a Cafe soon.

  4. ghr1000 says:

    I’m glad to find this posting! Very useful for me, thanks for sharing. I recommend this post to my friends.

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