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AMA proposes 'one voice' for medicine

From the December 1995 ACP Observer, copyright © 1995 by the American College of Physicians.

By Deborah Gesensway

WASHINGTON, D.C.--Arguing that the House of Medicine needs to regain its ability to "speak with one voice," AMA officials have proposed restructuring the doctors' association in ways that could dramatically change its relationship to the medical specialty societies, including ACP.

The recommendations range from expanding the AMA's House of Delegates and Board of Trustees to "be more reflective of the diversity of medical practice today and in the future" to--in some proposals--convincing the specialty societies to defer to the AMA on public policy issues. At its interim meeting earlier this month, the AMA House of Delegates voted in favor of "restructuring"its federation and directed an ad hoc team to work out the details by the house's June 1996 meeting."

I think most internists will agree that it would be nice if we could speak with one voice, but most internists would also say that single voice has to be consonant with what internists feel," said Walter J. McDonald, FACP, the College Executive Vice President. "The College has a very strong set of principles and goals that we will not give up."

A key aspect of the proposal is how to get specialty societies and other medical associations, such as those representing women, minorities, international medical graduates and employed physicians, to encourage their members to join the AMA. Currently, only about 40% of American physicians belong to the AMA. About 29,000 ACP members--accounting for about half of ACP members eligible for membership in both organizations--belong to the AMA. While the AMA has been losing membership steadily, the College's membership has remained generally stable at about 85,000, with slight increases posted each year.

The fact that a majority of delegates voted in favor of the restructuring plan showed "there was a buy-in to the vision that we have to change the way these organizations interact to try to get to one voice on key issues, and to try to give greater value for their [dues] dollar," said AMA President Lonnie R. Bristow, MACP.

The "Report of the Study of the Federation" is the result of a two-year, $2 million project of a 200-member consortium that was asked to figure out how to restructure organized medicine into a true federation of the many county and state medical societies, national specialty societies and other physician groups--in sum, how to put the "organized" back into "organized medicine." ACP has had one vote in the consortium.

The group's report was given to the House of Delegates this month, and votes were taken on many of its recommendations. Proponents of restructuring say the AMA may be on its way to extinction if it does not reform its current governance structure to become more representative of practicing physicians. For example, while ACP has one vote, the Texas Medical Association has 21.

Although many items were sent back for further work, the delegates did vote in favor of increasing the number of delegates each specialty society can send to the House of Delegates following a formula yet to be worked out. They referred for further study the thorny question of what the specialty societies might have to give up--e.g., defer to the AMA and stop speaking independently on issues--as a quid pro quo for increased representation at the AMA.

One reorganization proposal being debated would change representation in the House of Delegates this way: state delegations would make up 55-60% of the voting seats (down from 77%), national specialty societies would account for 35-40% (up from 19% today) and other physicians (organized to represent ethnic groups or types of practice) would fill another 5% of the seats. The specialty societies would be allotted their seats based on the number of members shared jointly with the AMA.

If a formula like this one were passed, ACP could see its representation at the House of Delegates expand significantly, to about 14 seats.

Winning more seats in the House would mean ACP could end up with a greater voice in determining who is elected to the AMA's Board of Trustees, arguably the most powerful physician leaders in the nation. As part of its actions on the Study of the Federation, the AMA delegates in December voted to set up a special committee to study how the Board of Trustees is constituted and how its members are elected.

More detailed proposals on how to achieve the vision for a restructured AMA will be available for the specialty societies and state medical associations to discuss this spring. ACP's Governors and Regents plan to debate the proposals at their meetings in February and April.

"We're prepared to look at more proportional representation as a very positive step," Dr. McDonald said. "But at what cost? I think we have to wait and see what are the details of the plan, in terms of both the cost in dollars and the preservation of our autonomy."

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