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Developing Sound Policy

When the American Medical Association-Resident and Fellow Section (AMA-RFS) Assembly meets, its delegates accept the responsibility of making policy for AMA resident physician members. If sound policy is to be formulated, the issues will be decided on the basis of three criteria:

  • Is the proposed matter feasible? (Can it be done?)
  • Is it advisable? (Should it be done?)
  • Is it efficient? (What is the cost-benefit ratio?)

AMA-RFS policy will be sound if those questions are answered affirmatively, or if a satisfactory compromise based on the criteria is made.

Creating or changing policy generally is initiated when an inequity is perceived, a problem is recognized, or a potential problem is identified - e.g., the effects of passive smoking, uncompensated or undercompensated residencies, decrease in graduate medical education funding. Those who frame resolutions for consideration first find the underlying problem and then identify specific objectives that will resolve the issue.

While experienced delegates may find the process of evaluating issues easy, the novice may find it long and arduous. However complex, the process produces sound policy and helps those who frame resolutions produce a sound defense of their proposals.

Following are some steps to consider when evaluating proposed policies.

Look at the alternatives.
What can be done? Is more information needed that will narrow or broaden choices? Have similar policies been presented and rejected? If so, why? Choices can depend on the feasibility of execution - legalities, financing, domain.

Ask: What mechanisms are in place to help execute these polices?
Is the proposed policy internal to the AMA-RFS and/or AMA, i.e., can they "create," "withdraw," "limit," "reduce?" If it is external, can they "urge," "inform," or "support" other bodies? Who are the actors; where is the authority for the action? Can/should some other organization take on the issue? Can/should some other organization align with this issue to give added support?

Ask: What are the consequences of each of the outcomes?
What are the relevant techniques for predicting the consequences? Who will be helped - who will be hurt? What systems will be affected? Is it consistent with current policy? Costs/benefits, social costs, program costs, governmental costs - how will the policy's success be measured in solving the identified problem: lower rates of death due to lung cancer, better learning environment, more alert resident physicians doing a better job, quality students rather than wealthy students?

Consider the value of the actions.
Depending on the environment, each criterion may be easily ranked. If money is not a problem, efficiency may be ranked last; if there is little money, efficiency may be the controlling factor. If all criteria are ranked equally, or nearly so, the decision may be more difficult in valuing the outcome. The method of ranking choices is very individualized but must have some sort of logical foundation to be credible and marketable.

Making a final choice draws upon all aspects of the analysis and comes up with the preferred course of action. The most desirable is not always the best, but it may be the best for the time and environment. Goals may have to be lowered when dealing with complex issues, and the evolving resolution or proposal may be the best to "satisfice" your colleagues or constituency. "Satisfice" is a term used by Herbert Simon in his book, Models of Man, that discusses strategies of concept attainment, which are useful for dealing with complex problems. It is a combination of satisfaction and sufficiency. This acknowledges that all goals can not be maximized when they are placed within a complex or political framework.

Although testing of policies according to the criteria presented is not the definitive process, feasibility, equity and efficiency will facilitate clear, concise and sound policy development.