By Lynn Lucas-Fehm, MD, JD
When the AMA was formed in 1847, the founders could not have imagined how health care delivery would change in the ensuing 150 years. The goals of the 19th century medical profession were ambitious but clear – to assure that the highest standards of excellence became the foundation for the practice of medicine.
At the first meeting of the AMA, the delegates developed policies by introducing, debating, amending and ultimately passing resolutions. One example was the policy establishing the requirement for “gentlemen” entering the profession:
Resolved, that this convention earnestly recommends to the members of the medical profession throughout the United States to satisfy themselves, either by personal inquiry or written certificate of competent persons, before receiving young men into their offices as students, that they are of good moral character, and that they have acquired a good English education, a knowledge of natural philosophy, and the elementary natural sciences, including geometry and algebra, and such an acquaintance, at least, with the Latin and Greek languages as will enable them to appreciate the technical language of medicine and read and write prescriptions.
Today, resolutions affecting how we practice medicine are still introduced, debated, and voted upon in the same basic format as a century ago. Parliamentary procedure is aptly enforced by the speaker of the House of Delegates. When resolutions are passed, they are sent to the Board of Trustees for implementation while others are delegated to governmental liaisons who lobby politicians in hopes of favorable legislation.
From October 14 through 16, I attended the annual meeting of the Pennsylvania Medical Society as a delegate. Over the many years that I have attended this meeting I find myself constantly looking for the changes which have occurred in the process and content of the event. What I have discovered is that the protocol has not changed but the issues that we address have persistently expanded to include government, political, business and legal issues which have taken control of our profession.
Examples of this outside influence were quite apparent in the resolutions presented for consideration at the PAMED House of Delegates. A synopsis of the adopted resolutions taken from the PAMED website is as follows:
Energy sources, risks to public health: Supporting energy sources that decrease environmental risks to public health and studying the state’s public health infrastructure
State regulation of medical spas: Collaborating with state and national medical organizations to advocate for state regulation of medical spa facilities
Professional liability coverage for physician volunteers: Seeking legislation requiring the state to provide free professional liability coverage in return for volunteering at free non-government clinics
Medical Staff Code of Conduct: Adopting the American Medical Association’s (AMA) Model Medical Staff Code of Conduct
Observation care codes; Medicare reimbursement: Advocate for an increase in Medicare reimbursement for observation care codes
Physical fitness guidelines: Work with other organizations to develop a checklist to identify risk factors in patients starting physical fitness programs
Water fluoridation: Working in conjunction with the Pennsylvania Dental Association to urge the state to adopt federal fluoride standards and apply them through legislative or regulatory initiatives
Collective bargaining: Supporting federal legislation authorizing collective bargaining
Several issues were referred to PAMED’s Board of Trustees for further study, which included consideration of Medicare as a public option, reforms to address problems with health plan pre-authorization programs that are outsourced to benefit managers, and controlling children’s misuse of prescription drugs.
Resolutions affecting the practice of medicine have certainly evolved since 1847.
Response to these adopted policies will likely be diverse. Healthy discourse is always good. However ultimately I hope that whether physicians agree or disagree with the resolutions that were passed at this year’s Pa Med House of Delegates, at least a few will be encouraged to get involved in the process.
There is no question that we have little time to do anything except take good care of our patients while complying with the endless red tape that is necessary to run a practice. If we are lucky we find a little time to enjoy our family and friends. However, as the rules and regulations continue to increase, the need for all of us to be involved will be essential. For more information about these resolutions please go to the Pennsylvania Medical Society website at www.pamedsoc.org.
Lynn Lucas- Fehm, MD, JD, is a radiologist at Abington Memorial Hospital and the 150th President of the Philadelphia County Medical Society.