AMA House of Delegates: Tradition of empowerment

When the American Medical Association's House of Delegates convenes in Chicago in June, it will be carrying on a tradition that dates back more than 100 years. Its structure and processes exemplify the organization's strength as a democratic institution in which grassroots participation is the cornerstone.

For the first 55 years of its life, the AMA policies were set at a "town hall" type of meeting held in conjunction with the annual scientific session. As the organization grew and issues became more complex, this became unwieldy, and in 1901 the recommendations of a Committee on Reorganization led to the formation of a House of Delegates not much different from the one that exists today.

The delegates -- this year there will be 543 -- come from every state medical society, from every qualifying national medical specialty society, from regional organizations of medical students, and from the military, the Veterans Administration and the U.S. Public Health Service. Already, we are well into the spring and early summer annual meeting season, when many state societies hold their own yearly sessions that include discussions of resolutions to be presented at the AMA Annual Meeting. Also seated in the AMA House and offering resolutions following their own sessions on the eve of the Annual Meeting are delegates from the AMA's sections: Organized Medical Staff, Young Physicians, Resident and Fellows, Medical Students, Medical Schools, and International Medical Graduates. The Minority Affairs Consortium also has a delegate.

In a typical year the delegates will be confronted with about 225 resolutions -- any delegate may introduce resolutions, as can delegations and caucuses of delegations -- as well as some 75 reports from the AMA Board of Trustees and from the Association's six major councils.

Dealing with this vast and diverse compendium of policy and professional material requires two essential ingredients: intense and thoughtful participation by the delegates, along with a smoothly functioning operating system.

That operating system works along the lines of many legislative bodies. Each item of business is referred to one of eight reference committees which hold open hearings at which any AMA member, as well as invited guests, may comment. The hearings may last anywhere from a couple of hours to all day, depending on the complexity of the issues being discussed. Each seven-member reference committee -- topics include legislation, education and ethics -- then settles in for what is often an all-night session to produce recommendations on every item of business before it. These recommendations go back to the full House of Delegates, which may accept, reject or amend them.

Throughout the course of the meeting's five days, there are caucuses. State delegations caucus; specialty society delegations caucus. There are also caucuses involving state societies from specific regions and caucuses involving groups of specialty societies. At these meetings, which occur at breakfast, at lunch, at night, or whenever there's a gap in the schedule, delegates discuss the business before them and formulate strategy, sometimes seeking allies from other organizations to support or oppose a particular issue. There also are personal appearances by the candidates for AMA elective offices: the president-elect, the speaker and vice speaker, members of the Board of Trustees, and AMA Councils.

All in all, it is quite a week's work for the men and women who donate their time twice a year to shape the policies of the AMA. To first-time observers and participants, it may seem to be an overwhelming and almost chaotic experience, but the finished product is one of which physicians can be proud. Decisions are shaped by a broad cross section of the medical community, and the delegates -- much like members of Congress -- must be responsive to the constituents they serve.

Policies developed through this democratic process provide one of the AMA's greatest strengths. The House of Delegates, representing doctors from all walks of life, provides invaluable guidance to the medical profession, patients and the entire nation.