AMA’s democracy in action at this defining moment in the history of medicine

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

Delegates Vote to Continue AMA’s Commitment to Reform, Medicare Vote Pending in U.S. House of Representatives

AMA’s democracy in action at this defining moment in the history of medicineTwice a year, physicians come together for an exhibit of democracy at its best through the AMA House of Delegates meeting. Since 1901, physicians and medical student from every state and every qualifying medical specialty debate and vote on behalf of their peers during discussions that shape the AMA’s health care agenda. The work they do is intense, the opinions and debate are passionate. This representational-style system makes the AMA, without question, the umbrella organization of American medicine.

This week, the AMA House of Delegates met in Houston and again demonstrated its unique ability to bring together voices from across the profession to create a national consensus of physicians and medical students on health reform. I was honored to be a part of the civil debate on health reform at the nation’s broadest, most inclusive assembly of physicians and medical students.

Physicians at the meeting passionately defended their positions and then voted on a course forward for the AMA. At times there was fierce debate, but ultimately there was a clear final product – a shared vision on how to help physicians help patients.

The physician prescription for reform that emerged from this meeting reaffirmed the AMA’s commitment to health system reform. As the country’s foremost organization of physicians – for physicians – the AMA must continue in its role at the center of the health reform process.

President Theodore Roosevelt, in a famous speech said:

“It is not the critic who counts, not the man who points out how the strong man stumbled, or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena; whose face is marred by the dust and sweat and blood; who strives valiantly.”

Roosevelt stressed the need to participate. In following this admonition, the AMA will continue to be guided by bedrock principles: Freedom of choice for patients, freedom of practice for physicians, access to care for all and a system based on pluralism – neither all public nor all private.

We want to build on what works and fix what doesn’t to make a better health care system for our patients and our profession.

American doctors are among the best educated and trained and most innovative in the world. At our fingertips are advanced technologies, the latest treatments, and the most effective procedures. But all this is meaningless for those who cannot afford medical treatment because they do not have health insurance. Our nation took an important step toward expanded coverage for Americans and improvements in the health system with passage of the House health reform bill. AMA recognizes that the bill is not perfect, and we’re staying engaged to improve the final bill.

This week, our attention turns to passage of H.R. 3961, which repeals the broken Medicare physician payment formula and provides payments to better reflect the cost of providing medical care. The time for band-aid fixes to a long-term problem is over. Congress created the “sustainable growth rate” (SGR) formula that sets Medicare payment rates, and it’s up to them to do-away with the formula that projects a 21 percent payment cut next year and more in years to come. At stake is physicians’ ability to continue to provide high-quality care to seniors, the disabled, military families and the baby boomers who reach age 65 in two years.

These cuts are across the board to all physicians caring for Medicare and TRICARE patients. Active engagement is crucial at this time, and physicians need to call their members of Congress and let them know that Medicare’s physician foundation must be secure and stable for comprehensive health reform to succeed.

The AMA’s unique position at the center of American medicine has produced policies that are integral to a health system overhaul and trusted by patients. Polls show that Americans place their trust in physician groups like the AMA to do the right thing for health reform. We’re working hard to honor that trust, and the policies voted on by AMA delegates assure that we’ll continue to be actively engaged in the health reform process.

J. James Rohack is President of the American Medical Association.

Comments are moderated before they are published. Please read the comment policy.

  • ninguem

    How does one actually become a AMA delegate, does anyone know? Just wondering.

  • Hans Arora

    As a medical student and AMA member I have to say that there has never been a more exciting and progressive time to be in medicine!

    The day after I returned from the AMA meeting in Houston, strikers from a nearby hotel entered our lab office to ask for support for their cause: over the course of six years, a strike has been ongoing that has left them without insurance, unable to receive care from a physician for themselves or their children. The look of helplessness on one elderly woman’s face was even more impacting than the story she told. It only strengthened my resolve and made me even prouder to be part of an organization that’s striving for change.

    I watched a historic vote in AMA history that went back on 60 years of tradition and proves the AMA is headed towards positive change. Its a debate in which every medical student and physician needs to be involved, and I could not imagine a better way to learn about the issues than having attended meetings of the AMA and my state and county medical societies. There are a lot of naysayers out there, arguing that no reform is necessary, or that the reform efforts aren’t enough and that nothing is better than something, but tell that to the millions of Americas who stand to be insured (who were previously uninsured) as a result of us passing SOMETHING. It bothers me when some of my classmates say, “Well the AMA did this X number of years ago.” Well, 1) that was before most medical students were born and 2) what are you doing about it? Having watched the 500+ member AMA House of Delegates, I can honestly say that the AMA agenda is 100% decided upon by the majority of its members–no on else. Growing up in a progressive area of the country, we were taught that if you do not vote for your Congressperson, you effectively give up your right to complain–likewise, if you quit the AMA you have not tried hard enough. If you dislike something our government does (e.g. go to war), you don’t leave the country and start a new one or lobby the UN, but instead you try to change it from the inside. Its beyond me that medicine, unlike every other profession, is so unwilling to band together under one banner, even if they disagree with some things. If ever there was a catalyst for physicians to start working together to emulate the team-based care we so often tote in medical school, let this be it!

  • Carlo A. Dall’Olmo, MD

    Kudos to all the delegates in the AMA HOD for the lenghty and spirited debate on the issues physicians feel are important in true health care reform. Each and every delegate had the opportunity to discuss each and every issue and given the length of debate, it seemed as if almost all took the opportunity to comment. In the end, the resolution on health care reform that as approved by the HOD reflects the spirit of the debate and delineates the AMA principles that it and all physicians need to advocate if there is to be true health care reform.

  • Steve Parker, M.D.

    For an alternate view of health insurance reform that emphasizes freedom over hamfisted government intervention, visit the Association of American Physicians and Surgeons website.


  • Neil Brooks, MD

    AMA delegates are elected by the constituent medical societies. These are for the most part geographically (states) or specialty based. There are also delegates from special groups such as students and residents.

    Dr. Rohack, the AMA Board and the House of Delegates have made a brave and consientous decision which puts the welfare of our patients first. The tenor of the debate at the House of Delegates meeting displayed principled positions by both sides and the ultimate decision was forward looking.

    Non members need to join the AMA and help us all develop a health care system of which we can be proud.

  • Steven Wynn

    Where did all of these AMA members come from? According to the normal comments on the posts, I didn’t think AMA members existed!

    The ideal of reducing the amount of uninsured in America is a noble idea and something worth fighting for, but is the current path of health care reform the best way? Well, I can’t really say yes or no, but is it in the best interests of physicians? To that question, I say no.

    Where is the malpractice reform? What about the solution to the sustainable growth rate provision? If you cut millions of dollars from Medicare, what’s going to happen to physician payments?

    These are some very important issues for physicians that are not addressed by the current health care reform movement. Not only that, with more government intrusion into health care there is bound to be more red tape in medicine as the government becomes more highly invested in health care. I don’t know about everybody else, but I don’t like the idea that my livelihood is going to be dependent on the political whims of politicians.

    I don’t think it’s in the best interests for physicians for the AMA to be endorsing such a bill that will 1) not address key issues affecting physicians and 2) introduce more government intervention into medicine. The AMA is supposed to be a physician advocacy group, and it’s not doing its job. This is why many AMA members (and former members) feel disenfranchised from the organization. The AMA does not represent physicians!

  • Primary Care Internist

    I echo the sentiments of Dr. Wynn.

    Being an advocate for uninsured patients, or homeless people, or those who don’t have food or other vital services is certainly noble. But can someone tell me which organization PRIMARILY LOOKS OUT FOR THE INTERESTS OF PHYSICIANS? It apparently is not the AMA.

    Only a small minority of physicians are represented.

    For medical student issues, there is AMSA. I didn’t really know anything about the actual practice of medicine as a med student – forming opinions about health policy took the process of starting my own practice after residency. Only then does one really learn what issues face primary care doctors trying to treat patients.

    Hans, I did in fact try to be involved before rejecting the AMA – I joined committees of my own state medical society, and attended a couple of their meetings. This is what happens: a group of 10-15 “doctors” sit around a big oak table, rehash the issues from the last meeting where nothing changed, call the “table” most issues until the next meeting 3 months from now. I don’t think any of these docs were actually seeing patients, as I was the youngest in the room by 30+ years.

  • ChristopherMD

    Each and every one of those who voted for the Pelosi mess have voted to end their careers in Congress.

  • Happy Hospitalist

    I know so many people who have exited the AMA as a direct result of their reform positions. I wish them luck as they try to maintain relevancy for future generations of doctors.

  • throckmorton

    The AMA likes to say that it is at the center of American Medicine, but at last count it had as its membership less than 15% of US physicians and that number has dropped even more in the last year. At present the AMA represents a group of physicians who may or may not represent the views of physicians in general. Many of us, myself included feel the AMA has essentially sold out for political interests rather than those of physicians and patients. As a result, we have voted by not joining or resigning our membership in the AMA.

  • Doc99

    So, Dr. Rohack, I now see that is petitioning the AMA to leave the US Chamber of Commerce because the AMA “endorses” HR 3962 while the Chamber does not. This would be a good time for the BOT to show America the difference between support and endorsement. What say you?

  • G.V.Morin. MD

    Has everyone read and understood the multiple pages of the bill?
    Support for tort reform, quality care for our patients, and fair access for all patients with affordable care with no punitive actions should be a no compromise stance for the AMA.
    Aren’t these worth fighting for? Now is the time, not after the fact when politicians haveade the choices for us

  • Keili Meyer

    As a medical student and AMA member who was also in attendance at the recent AMA HOD meeting, I will second the sentiments of Mr. Arora and say that I am proud to be part of a dynamic organization that is striving to do what is best for America’s patients and America’s physicians. To those who doubt the will of the AMA, I must ask if you have ever attended an AMA meeting? Have you ever seen the HOD in action and watched (or even better yet, PARTICIPATED in) the process that allows all voices to be heard? Standing on the sidelines as ONE voice who complains will accomplish nothing. Become a member, come to a meeting and then take your stand at the microphone and attempt to change what you think is wrong with health system reform efforts or any other issue facing American medicine today. If you disagree with the path the AMA is taking, speak up from within the organization. Several years ago, the medical student section did just this and bought forth the Cover the Uninsured campaign of the AMA. In response to our voices, the AMA responded and the organization is better because of it. As states the motto of the AMA, Together we are Stronger, and it is only as a united front that our voices will be heard.

  • Phil

    As a resident, I have only one question. Will this help me pay my loans?

  • Paul MD

    I attend my state’s medical society executive committee meetings as the representative from my specialty society. There is a definite air of liberalism and kumbya at the “great oval table” that I am not in agreement with. Last week, our AMA delegate and alternate described the difference between the AMA’s current position on the Pelosi bill (approval) vs the more heavily weighted position that can be ascribed (endorsement). We are told to wait patiently as the “approval” gets the AMA a seat at the table in further bill modifications that the AMA would have been shut out of had a vote of “not approval” been the result. Sure.

    Long story short, my state medical society has done some positive things for physicians in my state and for my specialty society as well. I do not, however, feel that on a national level that they nor our AMA delegates are serving the interests of a large portion of the folks that are paying to be members of our state medical society and the AMA. Where is the advocacy for MY concerns and the concerns of other dues paying members of my specialty society?

    The defeatist language that precedes all of the bobbleheads at the “great oval table” explanations always starts with….”its going to happen anyway….this ensures us a seat at the table”. It is this weakness and consistent namby pamby approach to the best interests of ITS MEMBERS that has resulted in this weak defensive position, hoping for scraps like SGR and Tort reform to fall from the political table.

    I am only one man, but I am not alone in my less than stellar approval rating of my AMA.

    I am not going to renew my membership in the AMA after some 17 years as a member and will instead take the sizable amounts and donate them to my current PAC funds of my specialty society in order to best serve MY interests. In so doing, I hope to benefit, patients will benefit and hopefully government and insurance interests may be further marginalized. This will not be done out of anger or rash decision making. It is merely strategy because money and power are the best weapons against the political agendas of those with whom I and many others disagree.

    To the rest of you, you should be careful what it is that you are wishing for as it seems you (and I) just may get it.

    And Phil, sorry pal. You and I and anyone with half a brain know that your debt is for you to enjoy. So eat up. Remember that the next time a demanding surly cross armed patient eyeballs you and angrily tells you about “their right” to your services.
    I can guarantee you that the thoughts of “Kumbya” will not remotely enter your mind.

  • Lori Heim, M.D.

    Leadership of the American Academy of Family Physicians attended the AMA House of Delegates meeting and offered a resolution commending the AMA for its strong advocacy of health system reform. Others in the HOD had a different perspective and challenged AMA leaders on their decision to support HR 3962 and send a letter to Congress saying so. Following passionate debate, the House of Delegates soundly DEFEATED two important motions — one to oppose the public option and one to oppose the House bill. What this represented was an understanding by the HOD that if the AMA didn’t continue in the discussion the physician voice would be lost and they would give up their political capital. The AMA leadership has shown political understanding of the cost if we silence our voice and how best to use that voice. So the AMA emerged from the meeting with a reaffirmaation of support for health system reform and can continue to engage with Congress in a constructive advocacy role on behalf of patients and physicians. The AAFP commends the AMA for continuing to advocate for health system reform legislation before the Congress on behalf of patients and physicians.
    Lori Heim, M.D.
    American Academy of Family Physicians

  • ninguem

    Neil Brooks, MD “…..AMA delegates are elected by the constituent medical societies…….”

    Who does the electing there Neil? Having belonged to State medical associations, I have not once been asked to vote for an AMA delegate.

  • R Watkins

    The AMA, with its specialist dominated RUV committee, has been one of the major causes of the death of primary care in this country. It is very discouraging to see Dr. Heim jump to the defense of an organization that is so hostile to the doctors that she represents.

  • ninguem

    Steven Wynn “……Where did all of these AMA members come from?…..”

    Medical students. Fewer and fewer real-live practicing physicians every year.

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