For many years, all delegates to the American Medical Association (AMA) came from state medical societies. In 1972 specialty societies were given representation in the AMA House of Delegates but were limited to one delegate per society. M.T. “Pepper” Jenkins, M.D., was the first ASA delegate, and David M. Little, M.D., was the alternate delegate. Upon Dr. Little’s death, John S. Hattox, M.D., served as the alternate from 1983-89. Dr. Hattox then served as the second delegate, and I served as the alternate delegate from 1990-92. In 1993 I became the delegate and Richard R. Johnston, M.D., the alternate. In 1998 the specialty societies were given delegate positions based on the number of AMA members in that specialty society. At the moment, ASA has nine delegates and nine alternate delegates.

The current House of Delegates has 545 total delegates with the following composition:

Examples of “sections” are the Organized Medical Staff Section and Young Physician Section.

When each specialty had only one delegate, several societies elected to have their subspecialties recognized. Dr. Jenkins opposed this, and ASA made the decision to recognize ASA only. This decision was often debated, but ASA stayed the course. This decision proved to be the right one because when delegates were allocated to specialty societies based on the number of AMA members, ASA had nine delegates, making it the third largest specialty delegation, outnumbered only by the family-practice physicians and the obstetricians and gynecologists.

The role of our delegation is to bring anesthesiology issues to the attention of the AMA House of Delegates. When we first brought up the subject of non-M.D.s practicing medicine and having prescriptive authority, we were largely ignored. When family medicine, pediatricians, obstetricians, etc., encountered similar situations, however, our concerns were recognized. This resulted in a resolution being passed that stated, “Anesthesiology is the practice of medicine.” AMA quickly recognized ASA’s patient-safety initiatives. AMA then formed the National Patient Safety Foundation.

Endorsing Liability Reform
The delegation has strongly endorsed AMA’s efforts at liability reform. We listened carefully to the American Association of Neurological Surgeons’ plan to lessen the problems with false expert witness testimony, which resulted in ASA developing its own program to deal with this issue. The delegation from the American College of Surgeons, along with our delegation, had the AMA House of Delegates pass a resolution about safety in office-based surgery and anesthesiology. This effort succeeded because it was an initiative by surgeons rather than anesthesiologists. If we had spearheaded the issue, it would have appeared to be self-serving.

Most recently AMA, along with many specialty societies, including ASA, were successful in lobbying to have the Medicare Prescription Drug Bill passed. This bill included the blockage of the 4.5-percent cut in physician payments in 2004. It also includes a 1.5-percent increase in 2004 and 2005. Additional payments to physicians in rural and underserved areas also were included.

Anesthesiologists Becoming Players
The delegation has been effective in elevating the visibility of anesthesiologists in the House of Delegates. The biggest success was the campaign to assure the election of Rebecca S. Patchin, M.D., to the Board of Trustees in June 2003. C. Alvin Head, M.D., has been elected to the Council on Scientific Affairs. Several anesthesiologists have served as reference committee chairs or members. Your delegation has become a player in the House of Delegates.

Having ASA’s top officers as alternate delegates has enhanced the effectiveness of the delegation. For serious issues, it is very important to have the ASA President speak directly about our concerns. Because of Dr. Hattox’s influence, our delegation is diverse in age, race, gender and geography. During an AMA meeting, there are open meetings where anesthesiologists who are members of state delegations attend. This provides another avenue of communication that enables these anesthesiologists to discuss our concerns with their state delegations, and they can likewise convey their states’ concerns to us.

The delegation also has the responsibility of communicating the deliberations at the AMA meetings to the ASA Board of Directors and the House of Delegates. Our delegates learn about the concerns of medical students, residents, medical staffs, international medical graduates and physicians from other specialties. In some states, for example, many surgeons have elected not to carry malpractice insurance. In these same states, some hospitals have removed the requirement to carry any level of malpractice insurance coverage. In these situations, the anesthesiologist could end up being the “deep pocket” — the one with the greatest liability coverage and therefore more likely to be sued.

Mutual Benefits
It is our responsibility as well to attempt to improve the ills that exist in AMA. This is done mainly through the election process primarily for the Board of Trustees but also for various council positions. ASA Director of Governmental and Legal Affairs Michael Scott calculates that ASA would need to spend more than $500,000 per year on services currently supplied by AMA if AMA did not exist. The delegation needs to keep our issues on the list of AMA lobbying efforts.

The most vexing issue for AMA is the ever-declining memberships of active, practicing physicians. Our delegates have learned that governance is a major issue. Whereas ASA’s House of Delegates is the final decision-maker in our organization, in AMA, it is the Board of Trustees that divides authority between the president and the chair of the Board of Trustees. This division of authority only leads to a lack of clarity and direction. In ASA the House can delegate certain authority to our three officers, but the House is the final authority. Our delegation clearly sees that ASA’s governance model is superior.

In summary your delegation works to support the good and to change or improve what is wrong. Let us know your issues so that, if appropriate, we can seek AMA’s help to address your concerns. Any comments can be made either to John B. Neeld, Jr., M.D., the Section Council Chair <jneeld@northsideanesthesia.com> or to me, the Delegation Chair <jarens@mdanderson.org>.

James F. Arens, M.D., is Professor and Chair, Department of Anesthesiology, M.D. Anderson Cancer Center, Houston, Texas. He served as ASA President in 1989.