AMA an important corner of the triangle

A message to all physicians from the chair of the AMA Board of Trustees, J. James Rohack, MD.

By J. James Rohack, MDis senior staff cardiologist at the Scott & White Clinic in Temple, Texas. He was AMA president during 2009-10 and served as chair of the AMA Board of Trustees during 2004-05. Posted Sept. 6, 2004.

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Looking at the American Medical Association's tag line, "Physicians dedicated to the health of America," you might wonder how that can be accomplished.

One answer might be found in examining what it means to be a physician in the first place.

Since its creation in 1847, the AMA has recognized the importance of the government in the ability of the medical profession to function. That recognition was and is paramount.

Since medical care is provided mainly at a local site in a state, the state government -- through the creation of medical practice acts -- has control of who can call themselves a physician and what constitutes the practice of medicine within the borders of that state.

Hence, the state medical board's primary purpose is to protect the public through proper licensing and regulation.

In the past, some referred to the medical profession as a guild. The hallmark of a guild is power and control over the association of workers, the workplace, the market and the relation to the state.

A guild would define who could be trained, and control how many to train through its own self-organization and self-government.

But, when physicians came together to create state medical societies and the AMA, they gave up some of that power to the state to allow the creation of medical practice acts to protect the public from those who would call themselves physicians without proper education or training.

This separation created two corners of a triangle -- the profession of medicine and the legal, regulatory and enforcement functions of government.

In addition to a profession and a government, the third corner of the triangle belongs to the marketplace -- finance and market capitalism -- those who control money.

With each playing its appropriate role, the economy influences and shapes the profession and the government; government influences and shapes both the marketplace and the profession, and the profession acts to influence and confront the power of both government and the economy.

Three institutional roles; three players in a continuing process:

  • The medical profession.
  • The political and regulatory system.
  • Marketplace economics.

Our AMA supports the state medical boards to protect the public by removing unlicensed doctors from the workplace.

A strength of the profession lies in the basic cooperation that many county medical societies and state medical associations provide state medical boards. Encouraging the sharing of information between state medical boards has been long-standing AMA policy.

It protects the public. And it further demonstrates how we in the AMA, we in the medical profession, help influence and shape government actions and attitudes.

Another example of the tricornered principle is the AMA's help in providing members with needed information regarding proper coding and reimbursement processes.

In the interface between the profession and the marketplace, the profession has motives different from those of a corporation fixated on the bottom line and justifying multimillion-dollar compensation packages for the favored few at the top of the corporate pyramid.

We in the AMA, we in the medical profession, help influence and shape market capitalism in the process.

And, there is a final example of interaction among the three corners of the triangle: Recent joint efforts of the AMA and our state medical associations in seeking medical liability reform through state constitutional amendment.

In these cases, the capitalist corner includes those who profit from jackpot justice who strenuously oppose the profession and enlightened governmental leaders trying to change the system.

The success of Proposition 12 in my home state, Texas, last year demonstrates in an encouraging way how a state medical association and its allies can invoke change.

Our AMA continues the fight at the federal level. We recognize the current challenge in the Senate to get meaningful reform. At this writing, meaningful reform is in a log jam.

However, the battleground has shifted to the state level. The AMA is helping colleagues in Florida and Wyoming in the next skirmishes this fall.

But in the future, as in the past, our profession will be constantly pulled and tugged by the other two corners of the triangle.

Regardless of their motives, the effect of their overwhelming us would be erosion of our professional autonomy and our ability to define ourselves as physicians.

Having a strong medical association that speaks for all physicians -- regardless of geographic and specialty interests -- is our best chance for preservation and enhancement of the medical profession.

I am convinced the American Medical Association is that association.

Its strength is in its membership.

It produces the kinds of results that serve us all well -- but most of all serve the patients of America.

I urge you to continue your commitment to the profession as a member of the AMA.

Together, we can encourage our nonmember colleagues to become one with us, one in common effort, strengthening the professional corner of the triangle I described.

Together, we can shape the future of our profession, influence the marketplace and the halls of government, and provide for the public well-being.

Together, we can insure that checks and balances among the three corners of the triangle I've described work to the benefit of every citizen of this great land.

J. James Rohack, MD is senior staff cardiologist at the Scott & White Clinic in Temple, Texas. He was AMA president during 2009-10 and served as chair of the AMA Board of Trustees during 2004-05.

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