乌鸦传媒

NATIONAL HARBOR, Md. -- Should the American Medical Association (AMA) support a national ban on corporate control of practices by non-physicians? For some delegates at the interim meeting of the AMA's House of Delegates, the answer was a definitive "yes."

Matthew Gold, MD, introduced the on the corporate practice of medicine (CPOM) doctrine, on behalf of the Organized Medical Staff Section and its co-sponsor, the Private Practice Physicians Section, on Saturday.

For context, the CPOM doctrine "prohibits the ownership and operation of medical groups or practices by laypersons," to prevent such interests from interfering with the physician-patient relationship.

Joseph Wood, MD, JD, speaking on behalf of the the American Academy of Emergency Medicine, said private equity firms began buying out emergency medicine practices more than two decades ago. Physician leaders would sell their practices, take the "lion's share" of the profits, and leave other emergency physicians to cope with the whims of their new employers.

Deborah Fletcher, MD, an alternate delegate from Louisiana, speaking on behalf of her delegation, said she has experienced the harms of private equity firsthand.

Her part-time emergency physician position was eliminated after a contract management group took over the practice where she worked, replacing all part-time physicians with "non-physician practitioners," she explained.

"It's all about the money ... corporations and insurance companies want to pay the least they have to pay, and as physicians, we need to vote against that corporate, institutional control of medicine," she said.

Christopher Gribbin, MD, of the Medical Society of New Jersey, also favored the resolution.

"This resolution asks the AMA to really work on attacking this" at the national level, he said. "We need to move quickly and we need to move forcefully against the barbarians at the gates who are just decimating our profession."

Christine Bishof, MD, a delegate for the Illinois State Medical Society, speaking on her own behalf, noted that approximately 74% of all physicians are currently employed, citing the resolution.

"These physicians are totally at risk of being labeled as 'disruptive' and potentially fired without due process for speaking out on behalf of their patients," she said, adding that employed physicians are also at risk of being "bullied" into seeing more patients in shorter amounts of time, with fewer resources, and without any additional compensation, "because they're the professionals."

Richard Geline, MD, an alternate delegate for the Illinois State Medical Society, called for the proposed policy to be referred back to the board for more study -- not out of opposition, but because he sought a "more expansive and aggressive" response.

However, there were some vocal critics of the draft policy statement.

Michael Brisman, MD, a delegate from New York who was speaking for himself, argued that physicians entering into private equity arrangements have done so "voluntarily."

"People are choosing private equity because they don't want to be controlled by the hospitals or the insurance companies, which are these other big employers," he noted. "If they have to be employed by someone, they should be allowed to choose which [group that is]."

Gary Floyd, MD, speaking on behalf of the Council on Legislation, pointed out that "state law, not federal law, addresses the kinds of ownership and control issues" that the resolution aims to enact. Many states also have "strict parameters" regarding who can have an ownership interest in a physician practice and how much of an interest they are allowed to have.

For all these reasons, Floyd stated that the council recommended the policy proposal not be adopted.

Following the discussion Saturday, an AMA reference committee recommended that the proposed resolution be referred to the association's Board of Trustees for further study.

Delegates opposing that recommendation testified to the harms they and their colleagues have incurred at the hands of private equity firms from the house floor Tuesday. However, by a vote of 315-211, the resolution was ultimately referred.