As I See It

A cautionary tale

This column will be much more controversial than any I’ve ever written, but it’s important and I ask you to read it with an open mind. It was not written without a lot of thought, consideration and input from many colleagues.

The American Medical Association once stood as a powerful force in this country. According to a Canadian Medical Association Journal article by Roger Collier, 75% of doctors in the 1950s were AMA members. When the budget of the AMA became hugely dependent upon government payments for their creation of diagnostic and treatment coding, the writing was on the wall. Whenever the government wanted the AMA to support its agenda, it was ready and willing to do so. Many physicians recognized this, and membership dwindled. This made the AMA even more dependent on government largess. For example, passage of the Affordable Care Act was aided by AMA support, and while championed by some physicians, it is anathema to others. In 2011, Collier estimated membership to be close to 15%, suggesting declining confidence in the AMA on the part of U.S. physicians.


I share that as a cautionary tale for the AAO. The Academy represents the vast majority of U.S. ophthalmologists. We can’t possibly agree on everything, but one thing that binds us together is our love of eye care.

The AAO has done a good job in education and advocacy for our profession. A couple of recent events, however, have caused a greater outpouring of concern than my phone, texts and email inbox have ever experienced.

First was the March 18 declaration “that all ophthalmologists cease providing any treatment other than urgent or emergent care immediately” due to the COVID-19 pandemic. Our practice, and others I spoke with at rural practices, had determined in consultation with our local and state governments to continue operating, as at least in the state of Tennessee what we offer are “essential services.” But once this edict came out, we were in a medical-legal bind and had no choice but to comply.

I live in a county that has had one COVID-related death and in a state that has had 421 such deaths as of this writing, while Tennessee normally has about 70,000 deaths per year according to the Tennessee Department of Health. The AAO’s statement went on to say, “All other factors — business, finance, inconvenience, etc. — are remotely secondary.” As the New York Times reported ( ), our collective global response to this virus “could double the number of people facing acute hunger to 265 million by the end of this year.” While I do not minimize the seriousness of COVID-19 or appear insensitive to those affected, some areas such as New York City were hit harder than others, and the responses should have been different for regions that were not affected as significantly.

Second, the Academy recently called on “domestic law enforcement officials to immediately end the use of rubber bullets to control or disperse crowds of protesters.” Understandably, everyone is upset about what is happening in this country right now — and for some very good reasons. It is fine for the AAO to issue papers warning of the dangers of rubber bullets just as they have for fireworks. But, it is inappropriate and out of the depth of expertise for an ophthalmology society to intervene in public policy of crowd control for law enforcement.


No one had been more of a cheerleader for the Academy over the years in these pages than me. But this time I have to object.

The AAO must stay true to its core mission: education and advocacy. Stray too far, and you will become another AMA. OM

The views expressed in this article are the author’s own and do not reflect the views of Ophthalmology Management.