To understand the role of the American Medical Association (AMA) in leading American medicine, it is important to first understand a little about AMA. Nathan Davis, M.D., founded AMA more than 150 years ago, primarily to improve the system of medical education in this country. It has evolved over the last century into an organization that represents U.S. physicians.

AMA is composed of sections and a federation of specialty and state medical societies. Each AMA member residing in the United States is counted toward the state or geographic membership numbers, and each member has the opportunity to designate a specialty society for representation. Currently ASA has nine delegates and nine alternates to the House of Delegates. The House of Delegates meets twice a year, with the winter meeting focusing on advocacy and the June meeting focusing on policy.

At each House meeting, the number of anesthesiologists attending and meeting with your delegation is increasing. Also increasing is the number of ASA members in leadership positions within AMA. This network of ASA members has and will continue to be effective in representing your interests within organized medicine.

There are seven elected or appointed councils in AMA: Medical Education, Medical Service, Scientific Affairs, Constitution and Bylaws, Legislation, Long-Range Planning, Ethical and Judicial Affairs; and the appointed AMA Political Action Committee Board. The 21-member Board of Trustees is composed of the President, President-Elect, Immediate Past President, Speaker, Vice-Speaker, 12 regular Trustees and four slotted Trustees, a Medical Student, Resident, Young Physician and a Public Member. The Board meets at least monthly in person or by telephone to manage AMA affairs. The Board oversees the business side of AMA, a $280-million-a-year corporation, and implements the policies set by the House of Delegates. Most board members will spend more than 80 days per year representing the association, with the President spending more than 300 days on the road.

Over the last three years, incredible time and resources have been devoted by AMA to working with the Centers for Medicare & Medicaid Services (CMS) and Congress to prevent reductions in Medicare reimbursement for physicians, which are based on the flawed Medicare statutory update formula. Success was achieved because medicine spoke with one voice, joining with AMA, ASA and virtually every other physician organization. As a result of President Bush’s signing the Medicare Prescription Drug, Improvement and Modernization Act on December 8, 2003, physicians will receive an additional $75 million. Each physician, on average, will receive an additional $16,000 in income. (This number is the average among all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands. Florida represent the highest increase at $26,000 and Alaska and the Virgin Islands the lowest at $7,000.) AMA, along with ASA and other specialty societies, continues to work with CMS and Congress to achieve a permanent fix to this flawed Medicare update formula.

The number-one legislative priority of AMA remains medical liability reform for all physicians. Together we have successfully passed a Medical Injury Compensation Reform Act (MICRA)-like bill out of the House of Representatives, but this comprehensive reform remains stalled in the Senate. Senate Majority Leader Bill Frist, M.D., (R-TN) plans to continue to bring specialty-specific liability reform bills before the Senate this year that are similar to the Obstetric Medical Services Bill, which lost a vote to limit debate last February.

Much of what AMA does in leading U.S. medicine takes place behind the scenes, from meeting with the president and working with members of Congress or their staffs on legislation, to meeting with the staff of the numerous regulatory agencies on current or proposed regulations affecting physicians or their patients such as the Department of Treasury, CMS, the Food and Drug Administration, the Drug Enforcement Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, to name just a few. Protection of the public health, upholding professional standards and ethics and setting educational standards for medical schools, residencies and continuing medical education (CME) are ongoing AMA programs. AMA owns and oversees the granting of Physician’s Recognition Award credit for CME.

As the largest medical publisher in the world, AMA publishes the Journal of the American Medical Association (JAMA) and nine archive journals in more than 19 languages. Many physicians are not aware that as part of the efforts of AMA to help the physicians of Iraq, thousands of copies of JAMA and archive journals have been sent to Iraq.

One issue percolating around the country is the relationship between hospital medical staffs and hospital governing boards. Conflicts over economic credentialing, unilateral amendment of medical staff bylaws or the ability of a medical staff member to invest in competing medical entities such as ambulatory surgical centers, imaging centers or specialty hospitals continue. To date AMA or the AMA Litigation Center is providing assistance to more than 15 medical staffs from New York and Florida to Idaho and California.

It has been my privilege to serve this year as a member of the AMA Board of Trustees. Again I thank ASA for providing me the opportunity to represent you.

Rebecca J. Patchin, M.D., is an anesthesiologist specializing in pain medicine at Haider Spine Center, Riverside, California. She was elected last year to serve on the AMA Board of Trustees.