n his 2001 Emery A. Rovenstine Memorial Lecture, now retired ASA Executive Director Glenn W. Johnson attributed ASA’s remarkably low staff-to-membership ratio to the tradition of volunteer service to the specialty that has been such a strength of ASA’s culture.

No group better illustrates that tradition of volunteer service than our delegation to the American Medical Association (AMA) who are listed in the accompanying table. The nine delegates and nine alternates comprise the third largest specialty delegation in the AMA’s 543-member House of Delegates (after the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists) and are exceeded in size by only eight state medical society delegations.

The delegation represents ASA during nine days of actual meetings (five at the “annual” AMA meeting in June, four at the “interim” meeting in November), preceded by conference calls to review reports and resolutions assigned to the eight reference committees. The handbook for each meeting generally measures some three to five inches in thickness; in a typical year, the delegation will review some 225 resolutions and 75 reports from the AMA Board of Trustees and from the Association’s six major councils.

In order to participate in the debates at reference committees and the House of Delegates, the delegation holds several caucuses — most of which are open to the 46 anesthesiologists who are AMA delegates from their state medical association — to discuss the business of the meeting and formulate strategy. The delegation also welcomes personal appearances by candidates for AMA elective offices. In addition your delegation members attend other caucuses such as those of states or regions of the country as well as caucuses of several specialties with similar interests.

We have been successful in obtaining favorable House of Delegates actions on items of particular interest to anesthesiologists, including AMA support for the continued availability of traditional intravenous catheters, new AMA policy to require mandatory notice of production termination or interruption for drug products, AMA support for the standardization of the appearance, concentration and packaging of common classes of pharmaceuticals, AMA opposition to the Joint Commission on Accreditation of Healthcare Organizations acting as a standard-setting organization, and AMA agreement to coordinate activities between states, specialties and AMA itself concerning the growing efforts of nonphysician groups to expand their scope of practice.

Your delegation is rightfully proud of our accomplishments in the scope-of-practice arena. It was not long ago that scope issues were considered “our” problem. By persistent efforts over a number of years, we have educated other specialties, state medical associations and AMA itself about the clinical impact and patient safety risks that are inherent in the efforts of many nonphysician practitioner groups to expand their scope of practice. These efforts have culminated this year in the establishment of the “Scope Partnership,” a partnership of AMA, ASA and other specialty societies and state medical associations to coordinate nationwide activities on this issue.

Some may ask why ASA expends such an effort to have a strong and effective AMA delegation. The answer is simple: To the average citizen, reporter, regulator, or state or federal elected representative, AMA is viewed as the authoritative representative of the nation’s physicians. At the national level, medical liability reform and reform of the Medicare reimbursement formula will be dependent on AMA’s efforts, working in concert with specialty society representatives such as ASA’s Ronald Szabat, J.D., LL.M., Director of Governmental Affairs and General Counsel.

AMA’s influence is also compelling at the state level, where some medical liability reforms have been achieved and where scope issues are decided. State medical societies are strongly influenced by AMA policies, and these societies in turn are the chief advocates for the physicians of their state. In fact, in some 16 states, the anesthesiology societies have no lobbyists and are represented solely by the state medical association; in another five states, anesthesiology societies contract with the state medical associations’ lobbyists for services.

Given these facts, it is wise for ASA to emphasize the actions of its AMA delegation and to support that delegation by urging ASA members also to be members of AMA, which will allow us to at least maintain, if not increase, the size and influence of our AMA delegation.

Please express your appreciation to your representatives to AMA for the sacrifice of time and income they make to serve ASA.

John B. Neeld, Jr., M.D., is Chair of Anesthesiology, Northside Hospital, Atlanta, Georgia. He is on the Board of Directors of the Wood Library-Museum and the American Medical Association Political Action Committee. He was ASA President in 1999.