No abstract

Physician associations, in particular the American Medical Association (AMA), were long seen as a dominant force in health policy, using their symbolic power, access to politicians, financial resources, and collective strength to shape policy in their interest. 1 However, with the rise of other policy actors (such as the hospital, pharmaceutical, and insurance industries) and tectonic shifts in the political economy of the health sectors of many countries, researchers have argued that the power of physicians has diminished, and that they are less relevant to policy change (Peterson 2001;Stevens 2001;Stone 1998). In this special section, we caution against overstating the loss of physicians' collective power (Timmermans and Berg 2003;Timmermans and Oh 2010) and draw attention to a casualty of this assumption-the scholarly neglect of physician associations. We argue that the techniques used by physician associations to affect policy change have evolved significantly, and that it is imperative to account for the shift of physician influence to new arenas and platforms. We also reconsider the distribution of power in organized medicine, highlighting the significant power held by physician associations that have largely 1. In this article we use the term physician associations, recognizing the overlap of terms used to describe professional associations that represent medical doctors-particularly physician associations, medical associations/societies, and doctor associations. We elect to refer to physician associations rather than medical associations/societies, as the latter term suggests concern for a broad set of medical stakeholders when, in fact, these associations advance physician interests over other stakeholders. We selected the term physician over doctor because of the widespread usage of the term physician in North America. We invite further scrutiny of the use of these terms, including which stakeholders can lay claim to the oversight of medicine and the implications of using particular terms on the relative power of actors in the health sector.

In recent years, the American Academy of Family Physicians (AAFP) has debated and developed organizational stances on issues as varied as nuclear disarmament, gay marriage, policing, and climate change. This article considers the relationship of "political" policies to the ongoing maintenance of this professional association over time. The author describes transitions in the organization's policies from broad, neutral statements to more explicitly politicized social policy statements and then discusses debates around the establishment of an organizational policy on same-gender marriage. Results indicate that members use concerns about the maintenance of the organization over time as a lingua franca during debates. However, while members routinely interpret policy in terms of its relationship to the maintenance of the organization, they articulate conflicting visions of maintenance, with those in favor of the policies describing maintenance primarily in terms of external legitimacy and those in opposition describing maintenance primarily in terms of internal cohesion.

The term "orthodox" is often used to characterize religious communities who understand themselves to hold a stable set of practices or beliefs. However, as is the case with any group, orthodox communities experience ideological fragmentation and change. How then, do communities who identify as orthodox maintain the perception of orthodoxy in spite of ideological fragmentation and change? I describe activities engaged in by a conservative Protestant denomination in the service of orthodoxy. I draw on archival and field research in this denomination in order to demonstrate how the orthodox: (i) project future threats; (ii) develop strategies for obstruction; and (iii) coordinate in-group interactions.