Hands-on leadership: A new president takes the helm of the AMA

Since he was a boy, William G. Plested III, MD, has loved working with his hands.

He and his father tinkered with woodwork in the basement of their Wichita, Kan., home. One of the pine tables Dr. Plested crafted now graces his second home near Bayfield, Colo., a mountain oasis outside Durango in southwestern Colorado.

He's been known to pop the hood of his 1959 Chevy Impala convertible and fiddle with the engine. Many a time he's gutted and cooked fish caught from nearby ponds or the Los Pinos River, which flows just a few steps from the wooden deck on the back of his house.

And for more than three decades, his hands were the tools of his trade as a thoracic and cardiovascular surgeon in Southern California.

"I always worked with my hands with my dad. I knew I wanted to do something [professionally] with my hands," Dr. Plested said.

He also always knew that something involved being a doctor. "I just never considered anything else," said Dr. Plested, 70.

He plans to use a hands-on approach as president of the American Medical Association, a position he took on this month. He'll promote the AMA's Health Care Advocacy Agenda, which focuses on issues such as medical liability reform, patient safety and Medicare physician payment reform.

"In this day and age, there are so many challenges in medicine," he said.

Being active and tackling challenges such as the AMA presidency suit Dr. Plested's personality, family and friends said.

"He's never been one to sit," said Carolyn Plested, his wife of 26 years and an active leader in the AMA Alliance.

Growing up in Wichita, Dr. Plested was a backup quarterback on the high school football team and wrestled at a weight around 115 pounds, not exactly a hulking presence. He loved to fish and hunt -- two of his favorite hobbies to this day.

"I was a tiny little kid. I'm still growing. I'm growing sideways," he said with humor that sneaks up on you.

Dr. Plested received his bachelor's degree from the University of Colorado, where he spent some time on the wrestling team. He earned his medical degree from the University of Kansas Medical School, then completed his surgical internship and residency at the University of California, Los Angeles, School of Medicine.

He honed his surgical skills for three years as chief of a general surgery service at Wadsworth VA Hospital in Los Angeles.

"We started operating on coronary arteries, which we hadn't done during my residency training. We were just doing valves and congenital work. Coronary artery surgery became the main focus of heart surgery during my practice career," Dr. Plested said.

In 1971, he went into full-time private practice in Santa Monica, Calif., after an offer to set up a cardiac surgery program at Santa Monica Hospital. In 1974, he personally felt the crunch of a medical liability crisis that struck California.

"Overnight, liability insurance went up 386%. That, for me at the time, was just something I couldn't handle," he said.

Dr. Plested and some physicians in Los Angeles decided to do something about it. Joining the cause were about a dozen of their wives, who camped out in the governor's office in protest, he said. Initially, the governor ignored their pleas, but the wives wouldn't budge, and the media took notice.

"All the press in the state started sitting down and listening to their stories," said Dr. Plested, adding that the governor then told the wives he would see what he could do. "They came home and said, 'OK, you guys. Now we've opened the door and we've got the governor's attention. You do something.' "

Dr. Plested and other doctors formed their own medical association, United Physicians of California, and started working for change. Dr. Plested spoke at hospitals. The association grew to 3,000 members.

The group joined forces with the California Medical Assn., and together their efforts led to the 1975 passage of the Medical Injury Compensation Reform Act, which includes a $250,000 cap on noneconomic damages in medical liability cases. Ever since, MICRA has been viewed as the gold standard of liability reform legislation and is credited for helping keep insurance rates affordable for California physicians, even as doctors in other parts of the nation saw their premiums soar in the early 2000s.

Dr. Plested went on to serve as president of the Los Angeles County Medical Assn. and the California Medical Assn. He has been an AMA member since 1972 and was elected to the AMA Board of Trustees in 1998. He was board chair for 2003-04. He is a clinical professor of thoracic surgery at UCLA's medical school.

Undertaking today's challenges

Dr. Plested's experiences prepared him for the liability crisis and other issues facing medicine today. He said more needs to be done to keep insurance rates from climbing out of physicians' reach.

"Caps will stabilize premiums until you fix the problem. The problem is the tort system," he said.

"The way I see it is that you've got a patient in the emergency room bleeding to death. The first thing you do is stop the hemorrhaging. The cap will stop the hemorrhaging, then we go ahead and cure the patient."

The AMA's 2006 advocacy agenda calls for continuing leadership of an aggressive, multiyear campaign to reduce medical liability premiums. The agenda also calls for pushing Congress for national MICRA-like reforms.

"The answer is to change the tort liability system," Dr. Plested said. "[Medical liability cases] should not be a part of the tort liability system. We need a different method of adjudicating these types of things."

Dr. Plested will address other major issues, as well. For example, the advocacy agenda also says the AMA will "battle to replace the flawed Medicare physician payment formula." Dr. Plested said physicians need to stand up and say "enough" to reimbursement cuts or their practices will be in jeopardy of collapsing.

"What the doctors are saying is, 'I can't survive with this type of reimbursement,' and what we see across the country is that doctors are not taking new Medicare patients."

Friends and colleagues expect Dr. Plested to charge head-on into these and other issues as AMA president.

"Bill Plested will be a legendary AMA president," said Donald J. Palmisano, MD, a New Orleans surgeon and a past AMA president. "Bill has the exterior of a warrior, but a soul of compassion. The physicians of America want someone who is going to go out there and fight for patients and physicians."

Dr. Plested has integrity, a strong work ethic and is a dependable leader, Dr. Palmisano said.

"I've always admired his integrity and his courage in advocating on behalf of patients and physicians," said Dr. Palmisano, who has known Dr. Plested since the mid-1980s. "Bill is not a wishy-washy kind of person. He is a decisive person. He has the courage to make a decision and live with the consequences of that decision."

J. Edward Hill, MD, the AMA's immediate past president, agrees that Dr. Plested will be good for physicians and patients alike.

"He is a no-nonsense person. He doesn't tolerate meaningless rhetoric very well," Dr. Hill said. "We've had a lot of presidents with genuine integrity, but none equal to the absolute integrity of Dr. Plested. You can absolutely hang your hat on what he says. How many people can you say that about?"

Through the years, Dr. Plested has been a dedicated father and physician, his children said.

"Growing up, when he was doing surgery, a phone call in the middle of the night was a routine thing. He'd say something to me and my sister when he was walking out the door," said son Scott Plested, 24, who recently graduated from Colorado State University. "He's a very good role model."

Daughter Andrea Plested, 24, a nursing student in North Carolina, said if something broke around the house, her father was the one to fix it. When he traveled, he would call home and ask the family what was the final question on "Jeopardy," a TV show they loved to watch.

"Every family gathering, there's Trivial Pursuit," she said with a laugh.

Dr. Plested doesn't perform surgery anymore but expects to keep a busy schedule as AMA president. When he's not traveling, he hopes to spend time at his homes in Brentwood, Calif., and in Colorado. At his Colorado home, you may find him cutting the grass while wearing jeans and a flannel shirt and riding on the mower or sporting a cowboy hat and boots as he and his wife tend to their horses, Bharidan and Candy, in a nearby field. Inside the home, heads of elk, deer and antelope are mounted on the walls.

Nature is always close. "At night, you can see a million stars," he said of the unobstructed view of the Colorado sky.

Surgery is what Dr. Plested misses most about not practicing medicine. A small wooden horse that a cardiac patient made and inscribed with "To Bill, thanks for saving my life" is on a shelf in his Colorado house, a reminder of his bond with patients.

"My escape was being in that operating room doing an operation. That was what kept me going."

Now, his hands stay busy working for the nation's doctors and patients.