You Can’t Win If You Don’t Play

It may seem impossible to speak for a pediatrician, a cardiac surgeon and an anesthesiologist all in one breath, but that is precisely what the American Medical Association (AMA) strives to do. Across the broad spectrum of medicine, physicians inevitably will have different concerns. There are, however, more than a few issues that are common to all of medicine. Moreover the general public recognizes AMA as the voice of medicine. We must work to make that voice as strong and unified as possible. We may not have agreed with each individual AMA position in the past, but that should not cause us to give away our ability to influence future platforms.

AMA speaks for organized medicine in the national debate on medicine and the delivery of health care. If that voice is to be comprehensive and representative, we must be active participants in AMA as individuals and collectively as anesthesiologists.

As anesthesiologists ASA represents our interests in the AMA House of Delegates (AMA-HOD). The size of that representation, though, is directly proportional to the number of individual anesthesiologists who are AMA members. Since the institution of subspecialty delegations to AMA, ASA has been consistently well-represented. Recently our numbers have been declining and, as a result, the size of our delegation is in jeopardy. When you join AMA, or if you are already a member, it is crucial that you assign your membership to the ASA delegation. This balloting process can be done online at <https://ssl3.ama-assn.org/ssballoting/login.jsp>. Any questions about this process can be directed to <ballot@ama-assn.org>.

Participation in AMA is as important for residents as it is for attending physicians. Within AMA physicians-in-training are represented by the Resident and Fellow Section (RFS). AMA-RFS addresses the concerns specific to its members such as resident work hours and medical school debt relief through better loan-consolidation choices. Another example of AMA’s efforts on behalf of its members is the current resistance to require passage of a clinical skills examination (CSE) in order to take step 2 of the United States Medical Licensing Examination (USMLE). The CSE is currently a requirement for international medical graduates. The implication of expanding the CSE to everyone seeking USMLE licensing is that residents and perhaps even attending physicians will eventually have this as a new requirement. AMA considers the time and expense associated with this examination, offered at only a few centers nationwide, as an unfair and unnecessary burden and is actively opposing this change.
Another major topic of discussion in both AMA-RFS and the AMA-HOD is the current National Resident Matching Program (NRMP) antitrust litigation. Three individuals who participated in the NRMP contend that the matching process is a violation of antitrust laws. The main accusation is that this system restricts the free negotiation of salary and artificially keeps resident salaries low. AMA is one of several organizations that sponsors the NRMP and was originally named as a co-defendant. At the AMA Interim Meeting of the House of Delegates last December, the RFS and the Medical Student Section passed reports that opposed the legislation and attempts at making the lawsuit a class action. If this lawsuit were to succeed, it would have profound implications for every teaching hospital in the country. More information can be found at <www.savethematch.com>.

AMA is a well-established mechanism by which we physicians can shape the future of medicine. Being a member, though, is the only way you can ensure that AMA speaks for you. AMA is an effective tool — if we use it.

Resident Note:
Consistent with the historical involvement of anesthesiologists in policy and AMA, seven anesthesiology residents were present at the RFS meeting of the 2003 AMA Interim Meeting, including Jill E. Beland, M.D. (AMA Delegate), myself (Alternate Delegate) and five others representing their state societies: Jerome Adams, M.D. (Indiana), Corey E. Collins, D.O. (Massachusetts), Robert A. Goodman, M.D. (Pennsylvania), J. Kelby Hutcheson, M.D. (South Carolina) and Aneesh K. Singla, M.D. (Massachusetts). It is encouraging to see so many colleagues taking initiative and becoming leaders in the future of organized medicine.

Please send any topic ideas, sample articles or questions to the editors of “Residents’ Review” at <residents.review@ASAhq.org>.

Natalia I. Brown, M.D., is a CA-2 resident at Weill-Cornell Medical Center, New York Presbyterian Hospital, New York, New York.