When doctors are organized, they have the power to change the course of medicine. They can take on big corporations that exploit the health care system and rip off patients. They can fight for better research funding and more effective drugs, devices and treatments for their patients. They can help sway public opinion and influence politicians. And they can reclaim their role as a trusted voice of science and reason in society.

But today, the American Medical Association (AMA) is more like a trade guild than an organization devoted to patient welfare. It keeps its members informed about major legislation that affects the practice of medicine and educates them through lectures and other mass media. It also sets standards for medical schools and internship programs and warns the public about quack medical remedies and charlatans.

The AMA’s main publication is the Journal of the American Medical Association, which was established in 1847 and remains one of the world’s most respected medical journals.

But as the AMA has evolved, it’s also become an organization that promotes the financial interests of its members. Its dues pay for lobbyists who work to protect physicians’ rights in state and federal legislatures, and it contributes millions of dollars to political campaigns. Its leaders often are elected to powerful positions in state and federal government, including the presidency of the United States.

Doctors aren’t the only professionals who have lost control of their careers to managers and bureaucrats who know little about what it takes to listen attentively, perform a thorough physical examination, or engender trust in a patient. In a study that followed the careers of physician-graduates in the early to mid-19th century, researchers found that the most successful physicians cultivated deep relationships with their patients and practiced good communication skills. They also exhibited strong clinical judgment and ethical values.

In recent years, some doctors have been organizing to regain their professional autonomy and reclaim their role as advocates for the health of their patients. They are joining groups that organize advocacy activities in their communities, fighting for affordable health insurance and healthcare, promoting environmental sustainability, and advocating for gun safety laws, e-cigarettes, and addiction treatment.

Other physicians are finding that they can get more out of organized medicine if they actively participate in it, rather than passively let the AMA and other organizations represent them. When they experience a crisis, such as dealing with an unfair or unpopular policy or being forced to retire, they discover the value of joining and supporting their fellow physicians in their efforts to make things better. Hopefully, these isolated efforts will eventually build into a movement that makes doctors more visible and influential in their own communities. This may be the best way to restore a true sense of meaning and purpose to modern medical practice. – Todd Unger, M.D., is a professor of otolaryngology and the director of the ENT Institute at Wake Forest University in Winston-Salem, NC.