Medicine's democracy in action: Coming soon at the AMA meeting

The AMA House of Delegates will convene next month for its Annual Meeting, following a tradition of grassroots policy development that has been in place for more than a century.

Posted May 22, 2006.

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Doctors are all about giving answers. What kind of medicine should I take? Was the surgery successful? Am I going to be all right? All day, they hear these questions from patients who trust in their judgment. It is only natural, then, that these same patients, and the nation overall, would expect physicians to have answers of another kind -- answers to macro-level questions about the complex and critical issues facing health care in America. After all, physicians who toil in medicine's trenches have a unique perspective on the challenges at hand.

The American Medical Association's House of Delegates is tasked with finding answers that translate these insights into action.

Soon, starting June 10 to be exact, the AMA's Annual Meeting will convene in Chicago with an expected 544 delegates in attendance. They will represent every state medical society, every qualifying national medical specialty society, the military, the Veterans' Administration and the Public Health Service, among others.

These dedicated physician volunteers will come together to do their part to shape the future of medicine. The work they will do is intense, the opinions are passionate and the debate is sometimes fierce. The results provide guidance on topics from professional standards to public health and federal legislation.

Already on the meeting's docket are about 80 reports; at press time, resolutions were still being filed. Predicting which among them will be the hottest or generate the most news coverage is always difficult. But it is the outcome that is really important, anyway. At recent meetings, resolutions have led the house to address a range of timely subjects -- everything from pandemic planning to standards for emerging pay-for-performance programs.

The system that leads to the development of such positions stems from a rich history. Early on, AMA policies were set at a town-hall-style meeting held in conjunction with the group's annual scientific session. In 1901, however, because of the AMA's continued growth, a reorganization led to the formation of a House of Delegates. Today's processes basically follow the same format.

It's an exercise in grassroots activism -- a chance for physicians from all corners of the profession and the country to hash out issues. Here is how it works.

Each resolution or report is referred to one of eight reference committees that cover broad policy areas. The next steps are open hearings held by these panels at which any AMA member or invited guest can offer comment by lining up at a microphone -- physicians at every stage of career, from every kind of practice setting, waiting patiently to make their voices heard.

At each hearing's conclusion, the reference committee members huddle in meetings, often pulling all-nighters to produce recommendations on every item. In turn, their reports are sent to the full house, which may accept, reject or amend them.

It's important to remember, too, that the delegates are accountable to their constituencies. Thus, the opinions they advocate and the policies they pursue reflect those of the organizations they represent.

All the while, caucuses meet in the background -- discussing issues of importance from their particular points of view. AMA leadership campaigning is done and the presidential inauguration is held.

From a distance the overall effect may seem chaotic. But there is order and formality to the workings of the AMA house and in the setting of AMA priorities and policies. This system is built from the local level up so that physicians from all walks of life have their say.

Bottom line: The AMA provides an important, democratic outlet for all of medicine. It brings together voices from a broad cross-section of the profession. At times there is dissonance. But ultimately, there is a clear final product -- a shared vision to help physicians help patients.

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External links

The 2006 Annual Meeting of the AMA House of Delegates (link)

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