AMA House of Delegates: A new century of challenges

The AMA and its policy-making process are needed more than ever to confront challenges of a new century.

Editorial. June 5, 2000.

This month's AMA House of Delegates 2000 Annual Meeting is the way it is because the AMA's 1900 convention was the way it was.

Like other AMA conventions before it, the 1900 meeting was somewhat of a free-for-all. Delegates arrived claiming to represent all manner of constituencies -- not only states, but counties, regional organizations, hospitals, clinics and other groups. At AMA meetings of that era, physicians from wherever the meeting was being held also showed up and wielded clout by virtue of their numbers on the convention floor. Some 2,000 physicians attended the 1900 meeting, held in early June in Atlantic City, N.J. This was at a time when AMA membership was less than 10,000.

The AMA's 1947 official history, written to celebrate the Association's centennial, described the scene at the 1900 meeting: "The convention was now so large that difficulties were developing in the House of Delegates because it could never be clear just who was a delegate and who was not. A distinctive badge was given to the delegates, and an attempt was made to seat them separately in the convention hall, but it was clear that issues of importance were sometimes being settled by the mob rather than the delegates."

In the wake of the 1900 meeting, the AMA created a three-member Committee on Reorganization, headed by J.N. McCormack, MD. The committee's response to the AMA's organization problems was to invent the modern AMA House of Delegates, with proportional representation based on state membership at its core (in 1997, proportional representation was added for medical specialty societies). The committee's report was approved in 1901 and implemented in 1902.

In the 1984 update of the Association's history, The AMA and U.S. Health Policy Since 1940, author Frank D. Campion assessed the impact of the McCormack report: "Only after a new constitution and new bylaws redefined the House of Delegates in 1901 was the AMA able to grow into a strong, effective organization."

(It was a bargain to boot, according to the 1947 history. When the McCormack panel exceeded its $400 budget by $16.89, the AMA refused to pay the overage and told the committee members to argue the matter out among themselves.)

The AMA's ensuing rise through the 20th century speaks for itself. It is the nation's best-known, most consistent and most vocal advocate for the rights (and responsibilities) of doctors and patients alike.

But the AMA's greatest efforts may well lie ahead of it. The AMA and its policy-making process are needed more than ever to confront challenges of a new century, both in the art and science of medicine, and in the health care marketplace to which they are inexorably tied.

How will medicine respond to a host of scientific and technological advances, from gene therapy to the Internet? What is the future of patient and physician decision-making? How can patients be assured they will get the care they need? How will care be financed? What is the future of patient privacy and other elements of medical ethics?

The AMA House of Delegates is recognized as the key forum where American medicine confronts and responds to these and other important issues. The AMA house may be the way it is now because of the way it was 100 years ago, but the nation's health depends in large part on how the AMA will be remembered 100 years from now.