Introduction to “Recontextualizing Physician Associations: Revisiting Context, Scope, Methodology”

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.

Exploring how Professional Associations Influence Health System Transformation: The Case of Ontario Health Teams

“…From the literature, it is known that PAs represent the interests of their membership and play key roles in influencing health policy which impact health care planning and delivery [7]; however, there is no 'playbook' to guide their strategies or actions when interacting with other stakeholders, government, and the public [8]. Although most PAs have clear mandates to advance the interests of their members, PAs must also enact strategic thinking to strike the 'right' balance to satisfy the interests of many stakeholders [9].…”

“…In cases where member needs and system needs are not aligned, PAs face difficult decisions when choosing a formal position and a corresponding tactic. There is limited scholarly research on the role and activities of PAs, perhaps due to the broad diversity in their structures and functions; and the private nature of their operations [7]. It is important to understand how PAs function, due to their high degree of influence in the health policy domain, which often shapes health care systems.…”

Associations, unions and everything in between: contextualising the role of representative health worker organisations in policy

“…Associations, unions and other organised groups representing health workers play a significant role in the development, adoption and implementation of health policy 1. These representative organisations are a key interface between employers, governments and the members they represent.…”

“…RHWOs may also advocate for broader aspects of health reform (ie, availability, financing, quality of care, access)3 and partner with governments to expand access to particular health services and health as a human right 4 5. Such advocacy aligns with the interests of RHWOs both insofar as it advances a vision of health reform that protects the professional status and scope of practice of members and because such actions justify or reinforce the status of RHWOs as important policy actors 1 6. Examples of interest-oriented action on the part of RHWOs include well-documented actions on the part of physicians associations, such as the consequential, longstanding opposition of the American Medical Association (AMA) to single-payer financing of healthcare in the USA,7 and the influence of the British Medical Association in expanding access to abortion in the United Kingdom on the grounds of protecting clinical autonomy for physicians 8.…”

“…In this article, we seek to expand and complicate conceptualisations of RHWOs as key actors in global health by unpacking the heterogeneity of RHWOs and their roles and responsibilities in policy processes, and by situating RHWOs in political, historical, social and labour relations contexts. Our analysis is drawn from completed and ongoing research on RHWOs by the authors1 9 16 20 21 as well as a review of existing research in LMICs and HICs. Our goal is to contribute to a deeper understanding of these organisations in global health scholarship and to stimulate further research on a largely neglected, yet important, set of actors in health policy analysis regarding LMICs and transnational contexts.…”