AMA Journal of Ethics^®

For watchers of the NBC series West Wing, much of the show's appeal lies in the depiction of life inside the world's biggest fishbowl, a fictional presidential administration with hardworking and dedicated individuals, making daily decisions that in real life affect each of us. Yet, the growing popularity of this show belies the fact that the majority of eligible adults in the United States do not vote. This environment of civic apathy, in which so many of our fellow Americans fail to exercise their responsibilities as citizens cannot but weaken the vitality and strength of our democracy.

This depiction of working at the White House is eerily familiar to someone who has worked at the American Medical Association (AMA) for nearly 5 years. Like the characters on West Wing, the AMA staff includes many dedicated and hardworking individuals who oftentimes have to perform under challenging and complicated circumstances. Like the White House, decisions and positions taken by the AMA are continuously examined and scrutinized by the public. The "fishbowl" reality reflects, in part, the fact that the public considers the AMA the voice of organized medicine—many patients believe that every physician is or must be an AMA member. However, in much the same way that many of our fellow citizens do not vote, most physicians are not members of the nation's largest medical professional association. To those people who do not vote, I say, don't complain about the state of our union. Of physicians who do not belong to the AMA I ask, are you fulfilling your obligations as members of the medical profession?

In considering this question, it is important to note that physicians do have many options when choosing which professional organizations To join. As medicine became increasingly specialized during the latter half of the 20th century, physicians focused more on aspects of care in their respective specialties, and as a result identified more with their medical specialty societies. The specialization in medicine, which reflects the advances in medical science, has contributed to a dramatic decline in membership in the AMA and, in turn, created a zero sum game in the minds of some, a game in which all medical societies are competing for pieces of the same membership revenue pie.

It is in this environment that the AMA's policy making body took important steps towards the potential restructuring of the AMA. To most physician-citizens outside organized medicine's "beltway," the specifics of the restructuring plan are neither interesting nor relevant. But what is important to every member of the medical profession, I contend, is the ultimate mission of the redesigned national, professional organization that represents physicians independent of geography and specialty. Whether they realize it or not, each physician has a critical stake in the transformation of the AMA because it will have a direct impact on whether society continues to see medicine as a trusted profession.

Democracy is resilient, but that does not give us permission to ignore our duty to vote. Society's trust in the medical profession is more fragile than democracy; physicians cannot neglect the duty to protect and strengthen that trust. Therefore, vote and voice your critique of our government; get invested in the institutions of medicine that help shape its future.