The American Medical Association once expelled doctors who took jobs with health maintenance organizations.
But the nation's largest physicians' group this week sought a truce with HMOs, a move that experts say reflects the shifting balance of power in the nation's health care establishment."If this stuff doesn't happen, we'll find AMA listed next to dinosaur," said Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota.
The 289,000-member AMA has been a staunch defender of traditional pay-as-you-go, free-market health care. It has argued that doctors are encouraged to skimp on care to save money for HMOs, which charge a set fee for unlimited care from a group of doctors.
HMOs have argued that private doctors' fees are inflationary and lead to excessive care.
The two groups made an attempt at peace in 1978, when the AMA House of Delegates approved a report that said HMOs delivered the same quality care as fee-for-service doctors.
But AMA officials never publicly embraced HMOs until Monday, when a top official voiced support for HMOs and admitted that they have some advantages over traditional health care.
"While the AMA has long recognized the existence of HMOs, we have been slow in recognizing and accepting the benefits of HMOs," Dr. James Todd, AMA's executive vice president, said Monday in a speech to the annual meeting in Minneapolis of the Group Health Association of America.
"This failure was based on traditional beliefs and conventional wisdom, which . . . is often more conventional than wise. I believe the old ways of doing things need to change."
Todd said HMOs are leaders in educating patients, help hold down health costs, and give patients more health care options.
Todd's declaration, especially before the nation's largest and oldest HMO trade group, surprised doctors and HMO officials. It took a 1943 U.S. Supreme Court decision to stop the AMA's practice of expelling doctors who worked for HMOs.
"It's unprecedented," said James Doherty, president of the Group Health Association. "It's a huge change for that organization. It's a recognition that it (managed care) is no longer the second-class medicine that it used to be perceived as."
Critics believe the AMA is trying to change its image as an uncompromising defender of the status quo and mend its relationship with the rapidly growing HMOs. The number of Americans enrolled in HMOs have grown from 6 million in 1976 to 38.6 million last year.
The AMA "was making a concession to the reality that managed care is here and it's here to stay," Caplan said. "You can't adopt a General Custer ethic and say you're going to fight it to the last internist."