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The AMA Equation

Nov. 12, 2011

AMA Interim Meeting
Hilton New Orleans, Riverside
New Orleans, La.

James L. Madara, MD
Executive Vice President and CEO
American Medical Association

Mister Speaker, Mister President, members of the Board of Trustees, distinguished delegates – thank you for the opportunity to address you this afternoon.

It is a great pleasure to be attending my first House of Delegates Interim Meeting.

I am particularly excited to be here because the HOD is the heart of our AMA.

Since it first convened in 1901, this body has crafted our policies.  Here physicians from many different backgrounds, specialties and geographic locations come together to focus, not on our differences, but on what we hold in common.

Today, more than a year and a half after the Affordable Care Act was passed, we've come together once again to seek common ground in helping patients and physicians navigate our changing health care system.

Amid the unfolding discussion of delivery models, Health Information Technology and other critical issues, the AMA and this House of Delegates must provide its clear voice and strong leadership in shaping health care change in this country optimally.

Doing all we can to ensure that the sacred core of our profession – the relationship between physicians and patients – is protected.

Yet even as we work toward realistic change in our health care system we recognize that we are also part of a transformation in the way medicine will be practiced in the future.

And to fit into our new world of health system reform, the AMA also faces change. So we must sharpen our focus and direct our attention and resources toward those issues that matter most to physicians.  Areas where AMA engagement can make a difference . . . have impact  . . . and is truly valued by physicians. 


As you know, I have been with the AMA only a few months. But I do believe that no other physician group has the resources, expertise and opportunity to influence the future of health care in this country more than the AMA.

As your Executive Vice President and CEO, I will do everything within my power to strengthen our AMA's voice, and to help steer America's physicians through this challenging time.

Toward that end, I have spent my first months focused on three primary objectives:

  • First, maintaining our strong voice in Washington.
  • Second, listening to physician concerns and taking action guided by House policy, 
  • And third, bringing a sharper focus to our work – to enhance the power and clarity of your voice.

Since joining our senior management team I have been impressed by the breadth and depth of AMA contributions to American medicine. And the impact that the AMA has on our nation's physicians.

At the same time, I have noted that, while polls show the public has great respect for the AMA, that same public has little appreciation of the totality of the AMA.  Even many physicians are not familiar with all that we do.

The shorthand definition is that we are the nation's largest physician member organization. That is certainly true, but it fails to capture the entire essence of our AMA.

So what is the AMA? 

It is not simply membership numbers, though critical they may be. Just look around you – in this hall, 175 state and specialty societies are assembled, representing the vast majority of all American physicians – this too is the AMA.

We are proud to be the nation's largest physician organization. And I assure you we will keep working to attract and maintain members.

But the essence of the AMA is more than that.

I believe the essence of our AMA –– the way we should be defined –– lies within the answer to the following question:  "How many times, in how many ways, does our AMA touch American physicians each year?"

The AMA is engaged in a rich array of activities that impact patients and physicians every day. In fact, earlier this year, our Membership team took an inventory of our collective work at the AMA. They came up with 423 separate projects.

I think the totality – the essence – of our AMA is better captured by something that might be called the "AMA Equation."  That is . . . the AMA equals the sum of many components. Let me share 5 of these components with you:

  • First the AMA is the Voice of physician organizations.  That voice is yours, the House of Delegates.
  • Second, we are also a forum for direct personal engagement among physicians. That is our membership.
  • Third we provide expertise in managing their practices –– valuable resources like CPT, our Practice Management Center and Health IT information and resources.
  • Fourth, the AMA is a source of research and education, career support and practice enhancement. This includes JAMA and other AMA publications, ethics and education, and our work to define and improve quality measures. For example the AMA-convened Physician Consortium for Performance Improvement has contributed more than 70% of the quality measures now embedded in the federal government. And with a circulation of 315,000 – JAMA is the most highly circulated  medical journal in the world.
  • Fifth, the AMA is the authoritative advocate for physicians in Washington, in the Courts and to the public through our Advocacy efforts.

Taken together, this forms the AMA equation:  the activities of this House composed of 175 societies which together represent nearly the entire body of American physicians, PLUS more than 200,000 direct members, PLUS the thousands of physician users of our practice management tools, PLUS physicians who read our journals, PLUS the American physicians we support through advocacy, direct members or not. 

That is the AMA Equation.

And it touches the vast majority of physicians in this country – in powerful, significant ways.

Why am I so concerned with defining the totality of our AMA?  Partly, as I said, because I don't believe that the AMA is widely recognized for the variety of ways that it touches and supports today's physicians.

The other reason: we must be clear about what we are. Amid this time of great change – our self-awareness is essential.

Because if the experts agree on anything, it's that, going forward, the only constant in American health care will be change.

This means we must be able to focus intensely on our most essential elements: things like advocacy and public policy, quality, research and education.

The AMA must be a leader in helping physicians create and navigate new payment and delivery models. Be an authoritative, but reasonable voice, in creating a sustainable health care system for our country – finding solutions that reduce waste and unnecessary expenditures, while enhancing quality and ensuring access.

And we must do so with a firm commitment that if physicians are playing an active role in these efforts, they should be rewarded.

We must constantly look for ways we can improve our engagement with these areas that physicians share in common. So we can continue to carry out our mission to promote the art and science of medicine and the betterment of public health.

Because that is the essence –  the totality – of the AMA.

My commitment toward a sharpened focus is such that I recently created a new senior level staff position to help with this effort.

Let me introduce to you Ken Sharigan, who joined the AMA this September as Senior Vice President for Development and Integration.

Ken will play a key role in helping us develop a strategy to ensure we deliver an integrated and cohesive portfolio of products and services across the entire AMA to maximize our value to physicians.
Ken has a distinguished career in healthcare and extensive experience as a senior executive working directly with physicians, and in the area of integrative business development. Most recently, Ken served as Executive Vice President for Organizational Strategy and Planning at the University of Chicago Medical Center.
Prior to his tenure at U of C, Ken served in a variety of positions at Stanford, including: Vice President, Physician Organization and Business Planning and CFO of Stanford University Medical Center. Earlier in his career, Ken served as an executive in the Kaiser Permanente system.
Please join me in welcoming Ken to the AMA. (LEAD APPLAUSE)

During my first weeks on the job, I thought about how my work here at the AMA differed from that of the other posts I have held – center director, department chair, medical school dean, and health system CEO.

For the first time in several years, I was not directly surrounded by patients; not responsible in real time for events in the operating rooms or the outpatient clinics.

To be honest, I didn't know how to feel about that missing patient element.

Now, a little more than four months on the job, I've been able to resolve this issue.

The direct patient responsibility that made me want to be a doctor in the first place is very much at the heart of my work here at the AMA.

It's at the heart of what you do in this House of Delegates.

The policies we shape here - at our AMA - touch our citizens in a very real way each and every day.

And the best and most powerful way to serve the health needs of our patients is to ensure that the environments in which our physicians practice are thriving, sustainable, and attractive to future generations.  

And that's a problem the AMA Equation can help solve.

The atmosphere of uncertainty hanging over our nation makes this task feel all the more daunting. But we must remember tough challenges are not new to the AMA.   We've pursued our mission through the Civil War, two world wars, the Great Depression, the biomedical revolution of the 20th century, and the dramatic coverage changes of the 1960's. 

The challenge of an uncertain environment is not new to us and we will rise to the occasion once more. Because the AMA is the place where physicians with differing expertise and practice experiences from all corners of our country can come together and chart a future course, through consensus - tolerant of disagreement.

Adapting continually over the next 150 years as we have done over the last.

I'm delighted to join you in the latest segment of this journey. Good luck in your deliberations. All the best for a productive meeting.