Founded 1847 · Chicago, IL
American Medical Association — all physicians & surgeons
Founded 1897 · Chicago, IL
American Osteopathic Association — osteopathic physicians & surgeons
Founded 1912 · Rockville, MD
American Podiatric Medical Association — podiatric physicians & surgeons
Three medical associations. Three founding philosophies. One is a 178-year-old political colossus whose very size has become its greatest liability. One is a century-old defender of a parallel medical tradition — osteopathy — that spent most of its existence proving it wasn't a cult. And one is a lean, purpose-built advocacy machine still fighting to be recognized as full physicians at all. Their parallel histories illuminate organized medicine's deepest tensions: between scale and coherence, between identity and assimilation, and between protecting a profession and actually serving its members.
Scale, scope, and structure — at a glance.
1847, Philadelphia — originally to standardize medical education and root out quackery. 178 years of continuous operation.
1897, Kirksville, Missouri — as the American Association for the Advancement of Osteopathy by students of Andrew Taylor Still. Renamed AOA in 1901.
1912 (as National Association of Chiropodists) — 65 years after the AMA, 15 years after the AOA. Renamed three times since.
~271,660 (2022) — representing roughly 25% of all U.S. physicians. Catastrophic fall from ~75% in the 1950s.
207,000+ DOs and DO students — representing a substantial majority of the ~200,000 U.S. DOs. Membership density has been harder hit as DO-to-MD residency migration has increased.
~18,000 — roughly 80% of all U.S. podiatrists. The highest membership density of the three, and the most stable over time.
One of the largest lobbying budgets of any U.S. organization — avg. $18M+/year. PAC donated to 45.6% of the 118th Congress. Enormous federal reach.
DO Day on Capitol Hill annually. Active on Medicare physician status, DO residency access, and scope-of-practice issues. Smaller than AMA but coordinated and growing, with 197,000 member voices.
APMAPAC and Center for Professional Advocacy. Highly focused on scope-of-practice expansion, DPM physician parity, and interstate licensure compacts. Small but purpose-built.
JAMA (est. 1883) — one of the world's highest-impact medical journals. Commercial powerhouse. Carries significant institutional influence.
JAOA — Journal of the American Osteopathic Association (est. 1901). Monthly peer-reviewed journal; renamed Journal of Osteopathic Medicine in 2021 to broaden appeal beyond osteopathic audiences.
JAPMA — Journal of the American Podiatric Medical Association (est. 1907) — predates the association itself by five years. Six issues per year.
House of Delegates meets twice yearly; dominated by large state and specialty societies. Individual member influence is limited.
House of Delegates with state-level component societies. 18 specialty certifying boards under AOA umbrella. Also the accrediting agency for 37 osteopathic medical schools.
53 state and territory component societies. House of Delegates sets policy. Board of Trustees governs between meetings. Proportionally stronger member voice than AMA or AOA.
330 N. Wabash Ave., Chicago, IL — with significant DC presence. Moved to current HQ in 1990.
142 E. Ontario St., Chicago, IL — same city as AMA, a proximity that has occasionally been symbolically and practically significant.
11400 Rockville Pike, Rockville, MD (as of 2024). Previous HQ: Chevy Chase Circle, Washington DC (1969); Bethesda, MD (1987).
Every institution accumulates a record. The three organizations have accumulated very different ones.
From 1868, when Black physicians from Howard University's integrated delegation were blocked from the national meeting, to 2008, when a formal written apology was issued after a three-year independent review, the AMA systematically excluded Black physicians. Since hospital privileges required AMA membership, this functionally barred Black doctors from hospitals for nearly a century. The 1910 Flexner Report — commissioned by the AMA — recommended closing nearly all Black medical schools. The AMA's own 2021 report described the organization as "rooted in white patriarchy and affluent supremacy."
● High Severity · 140-year impactIn the late 1950s, leaders of the California Osteopathic Association (COA) negotiated secretly with the California Medical Association to effectively dissolve osteopathy in California. By 1962, approximately 2,500 California DOs were converted to MDs — some for as little as $65. The AOA was vehemently opposed, revoking the COA's charter in 1960, but only one-sixth of California DOs joined the replacement society. The merger was later reversed by the California Supreme Court in 1974. Scholars describe the episode as a "devastating loss" driven by a "minority complex" — California DOs defining themselves as "not MDs" until they decided simply to become them. It remains the most existentially threatening moment in osteopathic institutional history.
● High Severity · Identity nearly dissolvedIn October 2024, the AMA posted to social media that "most patients wrongly believe that podiatrists are physicians." APMA responded forcefully, noting that the federal government recognizes podiatrists as physicians and that DPM training is equivalent to MD and DO training. The APMA Board considered formal action. The AMA has also written directly to state legislatures opposing podiatric scope expansion, prompting APMA to mobilize in states including Mississippi and Massachusetts. This is the sharpest contemporary expression of a structural tension that has defined APMA's entire existence.
● Ongoing · Structural identity disputeJAMA ran cigarette advertisements for decades. When the landmark Surgeon General's report on smoking was released in January 1964, the AMA accepted nearly $18 million from the tobacco industry over the following years rather than endorsing it — delaying full endorsement for 14 years. AMA leaders served simultaneously on tobacco industry research committees. The AMA's Members' Retirement Fund held tobacco stock in the seven figures until the mid-1980s. Critics have called this the most egregious public health failure in the AMA's history.
● High Severity · Public health betrayalIn 2016, a class of approximately 32,000 osteopathic physicians sued the AOA, alleging it had illegally tied board certification to mandatory annual AOA membership dues (~$683/year) — without which, physicians' board certifications could be cancelled. The lawsuit alleged this violated federal antitrust laws by giving the AOA a monopoly over board certification and using that power to extract membership dues unrelated to the doctors' medical practice. A federal court denied the AOA's motion to dismiss. In 2018, the AOA settled for $35 million and agreed to decouple board certification from membership — a major structural concession that effectively came from the AOA's own members suing it.
● Resolved — $35M settlement, 2018A 2025 Office of Inspector General audit found that 44 of 100 sampled podiatric E&M claims did not fully comply with Medicare requirements, with OIG estimating roughly $39.6 million in potentially improper payments out of $222.5 million audited. APMA pushed back strongly, arguing that the framing risked a "misleading narrative," that modifier-25 usage is clinically justified, and that sample-based extrapolations overstated alleged improprieties. The episode raises unresolved questions about podiatric Medicare billing at scale.
● Medium — Under active scrutinySince 1920, the AMA has fought every major universal healthcare proposal: FDR's Social Security health provisions, Truman's national health plan, Medicare and Medicaid in 1965 (branding them "un-American"), and the ACA. In 1938, the AMA was convicted by the federal government of antitrust violations for coordinating retaliation against physicians who joined early group health plans. In 2019, the AMA's own Medical Student Section narrowly failed (53-47) to strip the AMA's formal opposition to single-payer — revealing a membership deeply divided on its organization's oldest political position.
● Contested — deep internal divisionIn its earliest decades, the AOA, citing concerns about safety and efficacy, actively opposed the introduction of pharmacology into the osteopathic medical curriculum — consistent with osteopathy's founding philosophy as a drugless healing system. This delayed osteopathic physicians' ability to prescribe medication and created a significant practical divide from allopathic medicine. The AOA's board of trustees finally voted to allow the teaching of pharmacology in DO schools in 1929, more than three decades into the organization's existence. The delay contributed to the social and legal inequalities that DOs would spend the mid-20th century fighting to overcome.
● Historical · Reversed 1929The American Orthopaedic Foot and Ankle Society (AOFAS) has repeatedly contested podiatric scope expansion. In 2025, the AOFAS president published an editorial urging orthopedic colleagues to lobby against "scope creep" by podiatrists. APMA responded that the editorial was "riddled with misleading messages, exaggerations, and outright falsehoods." Two states still restrict podiatric ankle care by statute. The AMA has amplified these efforts by writing directly to state legislatures. The fight is, at its core, about market share as much as patient safety.
● Ongoing · Professional legitimacy disputeIn the early 1950s, ~75% of U.S. physicians were AMA members. By 2022, that figure had fallen to approximately 25% — even as the physician workforce has grown. Members have left over ACA support (alienating conservatives), opposition to single-payer (alienating progressives), dominance of specialist interests over primary care, and perceived political drift into paralysis. The AMA increasingly represents a shrinking, demographically older slice of American medicine — and has been unable to arrest the decline.
● Ongoing crisis · Legitimacy at stakeIn 2014, the AOA and AACOM agreed to merge postgraduate training accreditation with the ACGME — creating a single residency accreditation system for MDs and DOs by 2020. Supporters argued it expanded DO access to the full range of U.S. residencies. Critics — recalling the California Merger — feared the loss of distinctly osteopathic training environments. By 1995, nearly 60% of DO graduates were already completing MD-oriented residencies; the unified system formalized this reality. Some members felt the AOA had negotiated away a defining institutional asset. The Journal of the American Osteopathic Association was subsequently renamed to broaden its appeal — another sign of a profession navigating between distinct identity and mainstream assimilation.
● Significant — identity vs. access trade-offIn 2021, and again with escalated legal action in 2025, the AOA sued the American Board of Internal Medicine (ABIM) for a policy that blocked AOBIM-certified osteopathic physicians from serving as residency program directors whose trainees could then sit for ABIM board exams. The effect was to bar well-trained DO physicians from key academic medicine roles solely because of their certification pathway — not competence. "When DOs are excluded, patients lose," said AOA President Robert Piccinini. The lawsuit represents the AOA fighting, on behalf of its members, the same kind of institutional gatekeeping that once kept DOs off hospital floors entirely — now re-emerging in graduate medical education.
● Ongoing · Active litigation 2025Membership density is one of the clearest proxies for how well an organization reflects its constituents' interests. The three tell very different stories.
Three quarters of the physicians who would have joined in 1950 no longer do. No single cause — ACA support alienated conservatives; single-payer opposition alienated progressives; specialist dominance alienated primary care. The AMA is caught trying to speak for everyone, which increasingly means speaking clearly for no one.
The AOA's membership position is complicated. Raw numbers are large and growing — over 207,000 — reflecting the DO profession's dramatic expansion (DOs now make up 25%+ of U.S. medical students). But the 2016 antitrust lawsuit — filed by the AOA's own members — revealed a deeply coercive membership model. The ACGME merger has also blurred the AOA's institutional distinctiveness, potentially reducing its perceived indispensability.
APMA's ~80% membership density has held remarkably stable — a figure virtually unheard of among major national medical associations. When the association is your profession's most visible and arguably only meaningful defender against larger institutional adversaries (the AMA, AOFAS, and state-level opposition), the cost of leaving is simply too high for most members.
Key Pattern
There is an inverse relationship between an organization's breadth of constituency and its membership loyalty. The AMA, representing the broadest possible universe of physicians, has shed 50 percentage points of membership density. The AOA, representing a single philosophically defined school of medicine, is more cohesive but was caught running a coercive membership model that its own doctors litigated. The APMA, representing the narrowest and most embattled constituency, has the highest and most stable retention — because for a podiatrist, APMA's existence is not optional background noise but an active daily necessity.
How the three organizations navigated the same century — sometimes aligned, sometimes colliding.
What the membership actually says — from surveys, court filings, public statements, and recorded debate.
"The AMA is ignoring the 56 percent of doctors who support single-payer health care. We cannot let patients fall through the cracks of a for-profit health care system when we have a solution."
"Physicians who completed their residencies in osteopathic programs were locked in to obtaining board certification through the AOA. They are forced to purchase AOA membership even though it serves no purpose with respect to their certification or their medical practice."
"The federal government recognizes podiatrists as physicians, and podiatric physicians' education and training are equivalent to the education and training of MDs and DOs."
"At least one young medical student burned their AMA membership card in protest — at the organization that some had nicknamed the 'American Murder Association.'"
"I have come to the conclusion that the things I have worked so hard for all my professional life will have a better chance of being scientifically proven, developed, and established by the unification of COA and CMA."
"Recent evidence confirms no increase in complications when podiatrists perform certain ankle procedures, directly rebutting claims that scope expansion endangers patients. Legislatures and hospitals modernize scope laws consistent with advancements in podiatrists' education and training."
"Stemming the flow of doctors from the AMA's ranks will require a more dramatic change — a complete structural overhaul. Currently the AMA is governed as an organization of organizations, yet still recruits as an independent member association, even though independent members have little say in operations."
"When DOs are excluded, patients lose. This policy removes skilled program directors from leadership, disrupts career paths and limits mentorship for young physicians. At a time when the nation faces a growing physician shortage, ABIM's actions close essential training pathways that ultimately hurt patient care."
"The editorial is riddled with misleading messages, exaggerations, and outright falsehoods. It is problematic to suggest that not only legislators but also hospital medical staff would advance scope of practice laws without sound evidence of patient safety."
Comparing all three across key dimensions of organizational success, ethical record, and member satisfaction.
| Dimension | AMA | AOA | APMA |
|---|---|---|---|
| Membership Retention | ~25% of physicians Last place | ~65%+ of DOs; large but complicated by coercive history | ~80% of podiatrists Highest density |
| Political Influence | Enormous — $18M+/yr lobbying, PAC in ~46% of Congress Clear Win | Significant and growing; effective via DO Day on Capitol Hill | Targeted and effective at state level; smaller but focused |
| Racial Equity Record | Century of documented exclusion; apology 2008 AOA/APMA Edge | No comparable documented exclusion history | No comparable documented exclusion history |
| Public Health Leadership | Delayed on tobacco, opposed Medicare, hedged on recent crises | Delayed on pharmacology for 30 years; stronger in modern era Evolving | Focused mission; strong on diabetic foot care as public health priority Focused Win |
| Identity Coherence | Serves too many conflicting constituencies Weakest | Single philosophy (osteopathic) but navigating assimilation vs. identity; California Merger was near-fatal | Singular and clear — physician parity for podiatrists Strongest |
| Legal / Ethical Record | Antitrust conviction 1938; tobacco scandal; century of racial exclusion Worst | $35M antitrust settlement paid to own members (2018); coercive membership model exposed | OIG billing scrutiny (2025); professional turf disputes — more routine Cleanest |
| Member Satisfaction | Low — long-term flight from membership suggests systemic dissatisfaction | Mixed — members literally sued the organization; but newer DOs joining rapidly | High — retention stable at ~80%; APMA seen as indispensable Highest |
| Scientific Publication | JAMA — global impact, commercially dominant Clear Win | JAOA/JOM — respected within specialty; renamed 2021 to broaden reach | JAPMA — predates the organization itself; respected within specialty |
| Institutional Durability | 178 years — survived every crisis, including its own contradictions All Durable | 128 years — survived near-extinction in California; rebounded nationally | 113 years — three name changes, two identity reinventions; still ~80% retention |
| Scope of Practice Position | Opposed DO and DPM scope expansion; historically gatekeeping | Fighting AMA (via ABIM) for DO access to academic medicine roles Active Fighter | Steadily expanded scope in 48/50 states; ankle care nearly universal Expanding |
The AMA, AOA, and APMA represent three distinct models of what a medical association can be — and three cautionary tales about what happens when institutional interests diverge from member interests.
The AMA is the cautionary tale of scale. Once representing three quarters of American physicians, it now claims barely one in four — shed over decades of political incoherence, tobacco complicity, racial exclusion, and an inability to speak clearly when it matters most. It remains enormously powerful, but its power increasingly derives from money and institutional inertia rather than genuine member mandate.
The AOA is the cautionary tale of identity anxiety. A profession that has, twice in its history, nearly dissolved itself into mainstream allopathic medicine — first in California in 1962, and more quietly in the ACGME merger of 2014–2020. Its defining tension is whether being a DO means practicing a distinct philosophy of medicine or simply being an MD who took different classes. When its own members sued it for a coercive membership model, it was a signal that institutional loyalty had become contingent rather than assumed.
The APMA is the story of what happens when an association has no luxury of ambivalence. A profession that began as a trade, fought to become a specialty, fought harder to become a medical specialty, and is still in active litigation over whether it counts as a physician specialty at all — cannot afford institutional drift. That existential pressure is what holds APMA together at 80% density when far larger organizations cannot hold half their constituencies. It is both a strength and a reflection of how much work remains.