American College of Physicians: Internal Medicine — Doctors for Adults ®

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AMA tells doctors: pick a specialty society

From the July/August 1996 ACP Observer, copyright 1996 by the American College of Physicians.

In a move akin to asking doctors to choose sides, the AMA will soon ask internists who belong to the organization to select a single specialty or subspecialty society to represent them in the AMA House of Delegates.

Starting this fall, AMA members every year will receive a "specialty-representation ballot" asking them to identify one specialty society to represent them for the following year. The specialty society will earn one delegate for every 2,000 AMA members who select it as their representative. This means that College members who are also AMA members—and who also belong to the American Society of Internal Medicine or the American College of Cardiology, for instance—will have to choose among these specialty societies.

During debate last month in Chicago, ACP opposed this aspect of the proposal. "We do not like the methodology for determining physician representation," said Walter J. McDonald, FACP, ACP's Executive Vice President. "During discussions, we emphasized that the formula guarantees continued under-representation of internists and is potentially both costly and divisive." Nonetheless, Dr. McDonald said, the restructuring should help "increase the voice of ACP in the AMA and should improve dialogue between organizations—a good thing."

The new specialty societies' representation formula, approved late last month, is a central piece of an overhaul of the AMA's House of Delegates aimed at breathing new life into the federation of physicians' organizations. Only about 40% of American physicians currently belong to the AMA; officials expect that more doctors will want to join an organization they views as more representative of their practice specialty.

In addition to restructuring the House of Delegates to be more inclusive, AMA leaders hope the change will help doctors "speak with a unified voice... on critical issues relating to patient care." Another goal is to eventually reduce the dues burden on physicians by working with other medical societies to reduce duplication of services provided.

Given the compromise worked out during debate in Chicago last month, Dr. McDonald said ACP is satisfied that the federation overhaul will not hurt the College's ability to continue to act independently where it comes to advocating for internal medicine. "Over half of our members have chosen not to belong to the AMA, and we must continue to represent them," he said. "I am satisfied the organizational autonomy will not be impaired by this."

The College, however, protested the cost and increased administrative hassles of the AMA sending annuals ballots to all its members. In addition, College officials pointed out that even after the reforms take effect, internists will continue to be underrepresented in the AMA House of Delegates, compared to state medical associations. For the next three years, delegates for specialty societies will be assigned on the basis of one per 2,000 AMA members who select that specialty society on their ballot. State associations will be represented on the basis of one delegate per 1,000. In the fourth year of the reform, representation for both types of groups will be one per 1,000 members.

Although there is no way of knowing how many more delegates ACP will acquire as a result of this restructuring, College officials say they presume it will be more than the one voting delegate ACP now sends. "This does represent an opportunity for the College to more effectively influence AMA policy," Dr. McDonald said. "Time will tell if this will occur."

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