AMA delegates balk at major changes

Changes in how the House of Delegates conducts its business, recommended by a special committee, will be studied further by the Association's Board of Trustees.

By Bonnie Booth, amednews staff. Jan. 3/10, 2000.

San Diego --Those attending meetings of the AMA House of Delegates often grumble about the size of the handbook and the time it takes to get through the policy-making business that comes before the house.

But it doesn't appear they're ready to make big moves -- at least not yet.

The Special Advisory Committee to the Speaker of the House of Delegates -- established to look at ways to streamline house business -- put forth 16 recommendations at last month's Interim Meeting. Delegates accepted several of them, but the reforms that would have really shook things up were referred to the AMA Board of Trustees for study.

"Governance is the most difficult issue," said Gary Krieger, MD, a California pediatrician who was chair of the special committee. "One-on-one we agree change is needed. But as a collective body, you get people with one issue that is very important to them.''

Delegates worried the democratic process was being threatened by the changes, despite reassurances from Dr. Krieger that the committee was trying to maintain the house's democratic tradition even as it jumps from 500 to 788 members in June.

At issue for many were recommendations that debate in the house be limited to two minutes and that the speaker "strongly encourage" that all resolutions come from a delegation rather than individuals.

"This really concerns me," said K. Barton Farris, MD, a delegate from Louisiana. "'Strongly encourage' could get to the point where you are limiting an individual's right to introduce a resolution."

Jack F. Menendez, MD, a Georgia general surgeon, agreed. "We should be hearing from every individual who has an idea," he said. "There were five resolutions introduced by individuals this time out of more than 180."

Some delegates agreed with the committee's recommendation, saying that a resolution should be endorsed by a state or specialty society before being debated by the AMA house.

"If an individual cannot carry the message to the state or specialty, it speaks to the lack of support for the subject of the resolution," said D. Clifford Burross, MD, a family physician from Texas.

Combined meeting idea on hold

Opposition to limiting debates was also fierce.

"I want to have people walk away feeling like they have been heard," said Richard F. Corlin, MD, speaker of the house. "I am really opposed to the two-minute debate rule."

Another recommendation from the committee that drew much debate was its recommendation that the Interim Meeting and the National Leadership Development conference be combined into one meeting. Young physicians supported the change.

"We have a hard enough time stepping out [of our practices] for any length of time," said John Armstrong, MD, immediate past chair of the AMA's Young Physicians Section. "We support the combination."

However, there was also strong opposition to the idea.

Former AMA President Daniel H. Johnson Jr., MD, said combining the two would dilute the Interim Meeting and begin a decline in the amount of democracy at AMA meetings.

After referring the proposals to combine meetings, limit debate and restrict resolutions introduced by individuals to the board for further study, delegates agreed to make several other changes, including:

Presenting all awards at the opening session of the Interim Meeting and encouraging the recipients to keep their remarks to two minutes.
Limiting speeches during the opening session to the AMA president and executive vice president.
Giving the president of the AMA Alliance opportunity to speak at both the interim and annual meetings, but reducing the AMA Foundation presentation to once annually.
Requiring a majority vote of the house to extract an information report, with the exception of reports and opinions from the Council on Ethical and Judicial Affairs.

Dr. Krieger said he believes the house will undergo some changes.

"I think the house has to see how things work when it gets bigger," he said. "Then I think they will make the appropriate modifications."