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A challenge to the House of Delegates

Saturday, Nov. 8, 2008

2008 AMA Interim Meeting
Marriott Orlando World Center
Orlando, Florida

Michael D. Maves, MD, MBA
Chief Executive Officer
American Medical Association

Mr. Chair, Madame President, thank you for the opportunity to speak before this House of Delegates. My address this afternoon is going to be a little different from those in the past because the times we're facing are much different. There are 46 million uninsured Americans who continue to bear the brunt of our nation's neglect. Your practices continue to face challenges that you have never faced before. But, since we last met, the country has slid into a financial crisis of mammoth proportions.

Without question, we are meeting at a critical time in the history of both our nation and our profession. I don't have to recite for you all the challenges we face. And, I don't have to tell you that this nation , and our profession , has always stood up to those challenges.

Five months ago, I stood before you and spoke about the need to think outside the box to solve our problems; to be aggressive in reaching out to your colleagues about the work of the AMA; and to do what is necessary to advance medicine by improving the quality of life for physicians and patients.

Five months later, if you look at the forces shaping our future, can you say we are doing the right things to be a shaping force?

Five months later, if you look at the issues under consideration during this meeting, can you say that these are the most important issues facing physicians?

Today, and over the next few days, are you confident that the work you do demonstrates the value of the AMA to the daily lives of physicians?

I recognize that even bringing up these questions, some might think I am treading in dangerous waters. This discussion is done out of love for our association and respect for our profession, not out of spite.We need to unflinchingly realize that times have changed, but we have not changed with them.

My intent today is to challenge our approach, to emphasize our opportunities, and to begin a changing thought process that brings sharper focus to the work of the AMA and in so doing, clarifies our role in the personal and professional lives of those we serve.

I am willing to bet that Rolling Stone magazine is not found in too many of your offices. It's a magazine I use to try and stay in touch with my teenage son. A recent cover that harkens back to the year 1973. It is a tie-in to a network television program: "Life on Mars" where the central character finds himself transported from the present to 1973. When I saw it, I recalled that 1973 was when I was a newly minted medical school graduate , filled with hope, optimism and yes, even a little fear.

The inside covers point out some of the signs of the times then, such as the debut of the video game Pong, the popularity of eight-track tapes and the exorbitant average cost of a new home, $35,000.

Looking back, we are often struck by the naïveté, simplicity and sometimes the ignorance that colored our lives. In 1973, more than 50 percent of physicians in the U.S. were members of the AMA. As good as that sounds now, even that was down from our peak. In 1960, 75 percent of the physicians in the U.S. were AMA members.

Health care reform was one of the dominant issues in the nation , Medicare was on the horizon. Life expectancy was less than 70, and doctors could still be seen endorsing cigarettes on advertisements.

That was clearly a different time. Today, about 20 percent of physicians in the U.S. are members of the AMA, and the trend line continues to go south. The other 80 percent either do not understand what we do, or they do not value what we do.

We are constantly in the market, speaking with physicians, asking questions so we can adapt our strategy to better meet their needs.

Often, the answers to those questions aren't pretty but they are real, and they bring into sharp focus the need for us change.

Here's some of what we have learned in some recent focus groups.

Hard truth number one: The constant stream of obstacles (declining reimbursement, medical bureaucracy, barriers to quality care and a decline in professionalism) hinder physicians' power to care for patients the way they know is best , leaving them feeling dissatisfied and drained.

As I mentioned in June, many physicians feel they have lost control of both their professional and personal lives.

Hard truth number two: Physicians feel they lack allies in their quest to overcome these obstacles and express a desire for a physician-focused resource working for them.

Hard truth number three, perhaps the most difficult of all: Physicians don't think that the AMA gets "it" and gets "them" and can act as an agent of positive change.

Later on we showed them a few posters that reflected those questions but detailed how the AMA would answer them.

"Can doctors prescribe the best treatment if insurance companies hold the prescription pad?" The AMA says doctors , not administrators , are best qualified to decide the course of patient care.

"How can physicians operate with both hands tied behind their back?" The AMA believes it's time to put the power of medicine back into the hands of physicians.

"How can we realize our full potential to heal, if restrictions and regulations render us powerless?" The AMA is working to remove barriers that stand in the way of physicians' effectiveness.

"How can we move medicine forward when fear of litigation paralyzes us?" The AMA is working to protect physicians from over-litigation and clear the way for real advancement in treatment and quality for all.

The commentary from physicians about these posters is even more telling:

"If the AMA can empower physicians, patients will be a lot happier."

"The idea of taking back power from insurance companies made me feel like the AMA gets it'"

"I liked this because its about physician empowerment.

It goes well with a national organization because giving power back to physicians is a global issue to be addressed as a whole."

Now, it's nice to get a positive response in a controlled environment, but in order for us attract and retain members all across the spectrum of medicine, we need to demonstrate real and lasting change.

We need to move from being seen as institutional to becoming truly personal in the lives of physicians.

We need to move from being cast as the "Fat Cats in Washington" to the nimble ally by physicians' side.

We need to transform the perception of being "political" to purposeful.

When we can do this , when your colleagues back home can see this , you will know that we are on the right track.

When your colleagues back home no longer think of the AMA as "stuck in the past" and see us as future-focused, you will know we are on the right track.

When your colleagues back home see us as "in tune" rather than "out of touch," you will know we are on the right track.

It is going to require a candid assessment of our governance and physician representation.

It is going to require that we ask the right questions , questions that we must have the courage to answer truthfully no matter how it may affect us within this room.

How much of our work focuses on fleeting issues?

How much of it will address the needs of the 80 percent of physicians we need for our future?

Because I think we all know the hard truth that too much of our work does not reach the concerns of the rank and file doc.

We are not relevant.

As the leaders of organized medicine, are we willing to put aside the issues that do not impact the overwhelming majority of physicians?

As the leaders of organized medicine, are we willing to accept that the way we have done our business in the past has put us in our current 80-20 predicament?

These are not easy questions to ask, and I don't presume to tell you how to answer them.

I'm not even sure I have the right questions.

This is the hard truth we at the AMA are constantly confronting.

To be an agent of change, we must show we are changing.

The research and the results have given us a clear picture of what doctors want.

It is up to all of us to deliver.

Now, this does not mean we should ignore our accomplishments.

This past year, we managed to break through the political noise and make sure that Congress did not leave us out to dry on Medicare.

But we have a lot more work to do, particularly in the next 14 months before I'll stand before you and say that the Medicare crisis is over.

This past year, we beat back numerous scope of practice challenges by working with you. Now, the challenge for us is to think about how we can work with our colleagues in allied medical professions to truly work as a team.

This past year, we cheered the reauthorization of the Higher Education Act.

It was a good win, but we must continue to help medical students and residents from their crushing debt load. Only then will we respond to their needs.

To help the 80 percent of our colleagues in the trenches, we developed the AMA "Heal the Claims Process" campaign.

It's a tool that physicians can use to reduce the substantial administrative burden of ensuring accurate insurance payments for physician services.

To develop and test physician performance measures that can help physicians demonstrate the quality of care they provide, the Physician Consortium for Performance Improvement has completed 261 individual measures covering 42 topics.

The Institute of Medicine reported this year that elderly patient office visits will increase from 200 million in 2000 to 312 million by 2020.

Through the Aging Initiative at the AMA, we are working with many groups, including several national medical specialty societies to establish residency geriatric competencies for tomorrow's physicians and develop the tools for today's physicians to meet this challenge head-on.

It is a testament to all of your hard work that we achieved so much when the stakes were so high.

I am confident that in 2009, the AMA and the House of Medicine will join together and achieve much in the halls of Congress, in state legislatures, and in the lives of practicing physicians across the United States.

Why? Because that is what we are supposed to do.

And that is what we will continue to do.

But, in 2009, you're going to see some changes.

We're going to prioritize a little differently.

We'll be putting more resources where they will be most helpful.

In 2009, you will see the AMA reach out to all practicing physicians with very practical, tangible products and services.

We are dedicated to fundamentally changing how we relate to all the 800,000 practicing physicians in the United States.

We will not shrink from the challenge of reaching the 80 percent of physicians who have dismissed us in the past.

I am holding my staff to strict guidelines.

I am demanding tangible results.

I urge you to continue to challenge me.

And while you do, I would like to offer a simple challenge in return.

In the hours and days ahead, resist the temptation to focus only on doing things right.

Challenge yourselves and your colleagues to ask: "Are we doing the right things?"

If we acknowledge the hard truths, we will be able to stand proudly with each other and new colleagues within the House of Medicine.

We will turn the corner for the profession, and for the House of Medicine.

And most importantly, we will become an association not just ready for the future, but an association of the future.

Thank you.