Pediatrics academy celebrates diamond anniversary

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 May 2, 2005.

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It's been said that before a diamond can show its brilliance, it must be transformed by cutting and smoothing. In other words, challenges and adversity bring out the best in a good gemstone, person or even organization.

This year, as the American Academy of Pediatrics celebrates its diamond anniversary, it demonstrates the truth of this saying. Since its founding 75 years ago, AAP has overcome many challenges facing children's health and has proven itself to be a valuable player on the stage of American medicine -- and partner of the AMA.

At the time AAP was founded, in 1930, the idea that children have special developmental and health needs was a new -- and even controversial -- concept. Preventive health practices now associated with good child care, such as immunizations and well-child health exams, were just beginning to change the custom of treating children as miniature adults. The AAP had much work to do to make the specialty and its importance understood by medicine and the public.

Yet the AAP moved its agenda forward -- and changed the nation in the process. By the nature of their training and practice, pediatricians focus on the medical care of future generations of humans. Healthy children become healthy and productive adults, which enables a civilization or country to succeed. By protecting our children and their health, the AAP contributed greatly to America's success in the past 100 years -- and will do the same in the 21st century.

What few people know is that the AMA also played a role in the development of pediatrics. In 1880, the AMA became the first national medical organization to recognize pediatrics as a specialty. That year, Dr. Abraham Jacobi organized the Section on Diseases of Children within the AMA House of Delegates.

The section and the rest of the AMA did not always agree, however, and internal controversy eventually led the section to splinter away from the AMA. The two parted ways in 1922 over legislation that was, at the time, considered controversial. The previous year, Congress had introduced the Sheppard-Towner Act, which authorized the Children's Bureau to provide small grants to the states for maternal and child health programs. The AMA House of Delegates opposed the act as an attempt to socialize medicine. But the Section on Diseases of Children supported the act. The resulting controversy was covered widely by the media.

This very public disagreement between the Section on Diseases of Children and the House of Delegates had two results. First, the House of Delegates adopted policy that no AMA section could independently adopt a resolution in support of, or in opposition to, AMA policy. Second, the controversy spurred the Section on Diseases of Children to create an independent organization that would focus solely on children and their health needs: the American Academy of Pediatrics.

Both the AMA and the AAP have come a long way since the controversies of that time. Today, both groups strongly support the idea that the hallmark of a noble civilization can be found not in its treatment of the healthy but in its treatment of the medically vulnerable, including children, the elderly and the disabled.

In our country, the medically and financially vulnerable -- including our children -- have the Medicaid program as a health care safety net. It is not surprising that the AAP, which has fought for the health of all children for as long as it has existed, has also fought to protect children covered by Medicaid and to ensure that changes to the program do not affect them adversely.

The AMA shares in the AAP's concerns about protecting children -- and about Medicaid. For example, the AMA and the AAP, along with other medical professional organizations, successfully pushed for the creation of the State Children's Health Insurance Program. This program focuses on getting care to children who lack medical coverage but are not eligible for Medicaid. The program has proven to be a success in providing access to care for uninsured children outside of emergency departments.

The AMA also shares other common ground with the AAP, including the belief that physicians should receive appropriate payment from Medicaid for professional services. Other mutual -- and key -- aims include protecting the SCHIP program, maintaining the Early Periodic Screening, Diagnosis and Treatment benefit for children in Medicaid and getting more uninsured children covered. Finally, both the AAP and the AMA know that problems with Medicaid funding must be addressed, including funding issues related to the long-term care of poor, elderly patients.

While we might not agree yet on the details of how we can attain these important goals, both the AMA and the AAP believe that workable solutions can be reached only by having our AMA bring physicians together to focus on the solutions that are best for our patients. Whereas in the distant past our disagreements separated us, today our shared commitment to the health of all of America's children -- regardless of socioeconomic or insurance status -- unifies us.

Our congratulations to our pediatric colleagues on their 75th anniversary. We look forward to continuing our work together, because together, we are stronger.

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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