The vast majority of physicians belong to one or more of the state and medical specialty societies represented in the AMA House of Delegates, the deliberative body that develops the policies that guide the nation’s largest physician membership organization.
“That connection conveys something specific to many, particularly those in Washington, D.C.,” said AMA Executive Vice President and CEO James L. Madara, MD, during his speech at the opening session of the 2023 AMA Annual Meeting in Chicago.
“It conveys that AMA policies provide the clearest surrogate of the net of physician voice,” Dr. Madara added, noting later that the AMA is often recognized as the “unified voice of the profession.”
The AMA contains several business units that each have their own unique product focus, such as building membership, creating physician resources, conducting health and policy research, developing educational materials and activities, providing legal support and leading state and federal advocacy efforts.
The House of Delegates is a vital entity within the AMA and, as Dr. Madara noted, policy is its “product.”
The group decisions that lead to AMA policy represent what sociologists call the “wisdom of the crowd,” Dr. Madara said, adding that he recognizes that many physicians who oppose a proposed policy will remain opposed even after the majority adopts it.
This is common among physicians and part of the “duality” of their nature, which Dr. Madara said is manifested by enjoying a robust debate of issues in the creation of policy, but then also fiercely guarding and protecting their own independence and personal agency.
Typically, Dr. Madara uses his opening address to the AMA House of Delegates to highlight the organization’s progress in its advocacy and initiatives.
This time, however, Dr. Madara said his intent is to “focus on culture—particularly given our current national discourse.”
“Increasingly, our national environment tilts toward defining our individual stance by where we differ, instead of where we agree,” Dr. Madara said.
“That’s particularly true around issues involving race, gender, reproductive rights, religious beliefs—all of which can lean toward absolutist disagreements given that focus on differences rather than commonalities.
“There’re no shortage of hot-button issues taken on by this House,” Dr. Madara added. “You debate and discuss firearm violence, reproductive health, vaccine science, gender-affirming care, the consequences of structural racism and other topics.”
The results of the debates on controversial topics are policies and the creation of important programs and initiatives such as the AMA Center for Health Equity, which is now extending to the newly launched Truth, Reconciliation, Healing and Transformation Task Force, “which was requested by this House,” Dr. Madara said.
Unfortunately, however, another result of this process may be deep disagreement that can erase all other points of common ground.
To illustrate that point, Dr. Madara told of his recent efforts to persuade a long-time member to remain with the AMA.
Interested in why this physician was going to leave the AMA after being a member for four decades, Dr. Madara said he phoned the physician, who then offered to treat him to lunch.
Over lunch, they discussed what the physician enjoyed about the AMA, such as reading different viewpoints in JAMA®, the AMA’s effective advocacy on the behalf of him and his patients, and the AMA’s fight to preserve the sanctity, privacy and freedom of the patient-physician relationship.
“He appreciated all of that, but still thought he might cancel his membership,” Dr. Madara recalled.
“So, since he believed he received value from his membership, why was he still inclined to end it after 40 years?” he said. “It boiled down to this: Regardless of the various benefits and alignments, his decision hung on a strong objection to one—I repeat, one—specific policy.”
In an environment that “nudges toward conflict,” Dr. Madara suggested that “one tonic for this dilemma might be a willingness to forgo narrow definitions of personal agency, to consider our agency as a balance instead of a narrow set of non-negotiable must-haves.”
Instead of continuing to actively resist a policy they may disagree with, Dr. Madara urged delegates to give a “tipping of the cap to the overall wisdom of physicians.”
“We would do well by gently sculpting our agency to allow greater cooperation, acceding to the wisdom of the crowd when it comes to policy—doing so to make this an ever-more-powerful convening association even more impactful as we promote the art and science of medicine and the betterment of public health,” Dr. Madara said.
Read about the other highlights from the 2023 AMA Annual Meeting.