Advocacy, facing the past, strengthens the profession

AMA Leader Commentary. By Joseph M. Heyman, MD, Aug. 4, 2008.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from Joseph M. Heyman, MD, chair of the AMA Board of Trustees.

This was a month of high drama for the American Medical Association, its leadership, its senior management, its dedicated staff, its members and our wonderful profession -- and so many others who care for America's patients. It also was a great time for the elderly, military personnel and the disabled. We had an extraordinary success -- and we took an important step to acknowledge and learn from the AMA's past treatment of some of our colleagues.

Two incredible issues came to a head at almost exactly the same time. Newspapers, radio and television were loaded with news about the American Medical Association, featuring our AMA leadership in unprecedented quantities. President Nancy H. Nielsen, MD, PhD; President-elect J. James Rohack, MD; and Immediate Past President Ron Davis, MD; were working around the clock with media interviews and behind-the-scene phone calls with politicians, and flying from city to city.

What energized all this activity? The failure of a vote for cloture (to close debate) in the Senate to pass a bill giving a 1.1% increase in payment rates for physicians taking care of Medicare patients, and other features consistent with AMA policy -- and avoiding a 10.6% cut. Congress had six months to prevent this Medicare meltdown but had failed to take any action.

Since 2001, there has been an annual dance in Congress of last-minute inadequate fixes to prevent increasingly large cuts in Medicare payments. This dance has taken huge quantities of time, energy and money that could have been spent on health system reform and caring for patients in our entire Federation of Medicine. Once again we were faced with a last-minute need for congressional action -- except it has been only six months since the last one. Congress knows it needs to fix the flawed Medicare payment formula. Physicians and other clinicians have faced frozen incomes since 2001, while practice costs have increased with no end in sight. Congress needed some encouragement, and we were there to help.

Within moments of that vote, we sprang into action. Teams of our staff in Chicago and Washington, D.C., worked through the night and weekend to create and place television, radio and newspaper advertisements in less than 24 hours to play over the July 4 weekend. These would play in states where senators seemed to be abandoning the needs of our patients in favor of Medicare Advantage plans. The AMA Web site featured a compelling video of Dr. Nielsen explaining exactly what happened in Congress. And several other media interviews became popular YouTube hits overnight.

And it wasn't just the AMA. The entire Federation of Medicine -- specialty, state and county medical societies across the country -- came together with congressional visits, telephone calls and grassroots advocacy. By the Wednesday after the fireworks, we had a veto-proof majority in Congress, with a climactic, heroic appearance of Massachusetts Sen. Edward M. Kennedy casting a critical vote on the Senate floor. Wow! The lion had roared.

And when Congress voted to override President Bush's veto on July 15, patients and physicians scored an enormous victory.

Even during this exciting political success, another equally compelling story developed. At the end of his term, former AMA President John Nelson, MD, MPH, initiated a three-year expert study of the history of the AMA's policy on membership of African-American physicians. An independent group of writers chosen by both the AMA and the National Medical Assn. chronicled a shameful history of exclusion starting in 1847 and continuing into the 1960s. After reading early drafts of the study a few months ago, your board made the decision not only to support the research but also to reach out to the NMA and physicians across America.

So at the same time that momentous events were occurring in Congress, we made a formal organizational apology to the NMA about our historic policy of discrimination. This was followed by publication of the study results in the July 16 Journal of the American Medical Association.

An eloquent commentary by Dr. Davis, published in the same JAMA issue, explained why a formal apology was so important. I believe that this document will become part of the healing of racial inequality, not just in our profession, but also in the United States. At the same time that I am ashamed of our historic treatment of our African-American colleagues, I am grateful that the NMA graciously accepted our apology. It can't undo the past, but I believe it can help heal the wounds and brighten the future.

As I write this, we continue to work on long-term fixes for Medicare, and we anticipate the national meeting of the NMA in late July. I cannot predict exactly what will happen next, but I do know that we have plenty of which to be proud. At the peak of the drama, both stories appeared simultaneously on the front pages of national newspapers and in countless other media. Our profession is stronger for our advocacy and our willingness to confront the past. We succeeded in Congress because the Federation of Medicine worked together with our patients. We will come together as a nation because our colleagues have shown us what it means to be gracious and accepting. We are truly helping doctors help patients. Together we are stronger.

Dr. Heyman, an obstetrician-gynecologist in private practice in Amesbury, Mass., is immediate past chair of the AMA Board of Trustees. Learn more about Dr. Heyman at the AMA's bio page.

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