Alabama figures prominently in the efforts of the American Medical Association (AMA) to promote the interests of physicians, patients, and the public. Founded in 1847, the AMA generally sought to promote scientific advancements in medicine, public health efforts, medical education, and to establish ethical guidelines for physicians. But by the beginning of the Progressive Era in the early 1900s, physicians as a professional group saw their fortunes reversing. Inflation, a constant stream of newly trained practitioners — sometimes in the loosest sense of the word — entering the field, and a lack of interest in both private and public sectors to encourage medical advances and disease prevention efforts caused the association to rethink its organizational approach and incorporate into its focus the achievement of political goals. In doing so, the association looked with favor at the organizing efforts of physician Jerome Cochran, who had transformed "the Alabama profession into a strong political force," according to James G. Burrow in "Organized Medicine in the Progressive Era: The Move Toward Monopoly." Burrow said Cochran took a five point approach to building a strong and influential medical society in Alabama: physician unity, frequent membership meetings that focused on scientific advancements, promoting high standards for medical practice, creating public health programs, and establishing professional courts with jurisdiction over medical ethics. Burrow wrote of that period: "The Alabama profession had elected a majority of physicians to both houses of the state Legislature in 1873, written the medical practice act four years later, secured passage of effective health legislation in the 1880s, and made each county society an integral part of the state government. Through Cochran's efforts state and local societies had become the state and local boards of health with authority over public health problems and control over admission into the profession." A history of the Medical Association of the State of Alabama (MASA) notes that the boards of health system Cochran introduced provided for a president, two vice presidents, a secretary, a treasurer, and 10 censors. "A distinctive feature of the organization was the board of censors, who were chosen from the members of the College of Counselors. This College of Counselors consisted of prominent members of the profession throughout the state," Burrow writes. County societies were designed along lines similar to the state association. Today, at both the national and state levels, the AMA continues to advocate on behalf of its members and the public. Of particular concern are medical liability reform, Medicare physician payment reform, and expanding coverage for the country's growing number of uninsured, estimated to be as many as 45 million people, and improving access to care. In order to promote these and other issues of concern to physicians, the AMA and its state organizations maintain legislative affairs divisions, whose goals are to prevail upon legislators to be receptive to the organization's concerns and initiatives on behalf of its members. With regard to Medicare physician payment reform, the AMA recently experienced a setback. The Centers for Medicare & Medicaid Services (CMS) announced in November that the Medicare physician payment rule to take effect in 2007 would cut payment for services rendered to Medicare patients. The CMS "will pay approximately $61.5 billion to over 900,000 physicians and other healthcare professionals in 2007 as a result of the payment rates and policies adopted in this rule. This new spending figure reflects current law requirements to reduce payment by 5 percent to account for the combined growth in volume and intensity of physician services." The AMA said the release of the payment rule "serves as a harsh reminder of the need for congressional action to stop next year's Medicare physician payment cut due to the flawed payment formula." Even though the payment rule allows for increased payment to doctors for office visits, payments to physicians during the past five years "have failed to reflect the government's own measure of annual increases in medical practice costs, with current payments about what they were in 2001." The AMA indicated that the payment cut will force physicians to make harsh decisions about the number of Medicare patients they accept and the treatment provided to those patients. Military families will also be negatively impacted by the new payment rule through reduced access to care as TRICARE rates are tied to Medicare rates. For physicians and Medicare, patients' time is running out on this issue; the cuts are due to go into effect January 1. It is imperative, the AMA said, that current congressional leadership take action before then to prevent the rule from being implemented. December 2006