For the first time in at least two decades, the American Medical Association is considering changing its policy on physician supply, amending its longtime stance that there are too many doctors in America.
The issue is one of about 100 reports and resolutions that will be considered when the Chicago-based AMA's House of Delegates gathers in Honolulu this week for its annual midyear meeting. The 545-member policymaking body will cover everything from bankruptcy reform and physician supply to public breast-feeding and tire safety during the four-day meeting.
Along with the tropical weather, the delegates are certain to celebrate one of the organization's biggest legislative victories in recent years-the new $400 billion Medicare reform bill that erases a scheduled 4.5% reduction in physician payments next year, replacing it with a 1.5% increase each of the next two years.
AMA President Donald Palmisano, a surgeon, hailed the legislation as a "historic victory for Medicare patients and their physicians" that enhances senior citizens' access to care at a time when many doctors were considering opting out of the federally funded program.
This year's gathering probably will be a bit more subdued than last year's interim meeting, when the delegates and alternates-more than 1,000 of them-staged a raucous protest in the ballroom of the Hilton Riverside New Orleans, waving placards and chanting in unison for Congress to provide additional Medicare funding for physicians.
Next up, Palmisano said in an interview en route to the meeting, is persuading Congress to enact a cap on noneconomic damages in medical malpractice cases. Liability reform ranks as the AMA's top priority, even higher than Medicare payments, and is likely to attract considerable attention from delegates at the interim meeting. The AMA is expected to spend a considerable portion of its estimated $15 million lobbying budget on the fight for liability reform.
"Liability reform is a big challenge," Palm-isano said. "We're going to win this battle. The only question is whether it's going to be in the long term or the short term."
Meanwhile, the workforce issue has become more important than ever to the AMA. After years of maintaining that the country had more than enough doctors, the AMA, whose membership now stands at about 260,000, may amend that policy. A board report suggests that the AMA "should abandon its policy that an oversupply exists or is immediately expected."
"However," the report adds, "declaring that there is a shortage, overall or in some specialties, may be premature without the detailed, specialty specific studies being contemplated" by several groups, including the Council on Graduate Medical Education. The board recommends that the AMA work with state and specialty societies to develop a "national consensus" on workforce policy.
Focusing almost entirely on advocacy issues at the interim meeting, delegates are expected to vote on a plan to propose amendments to pending federal bankruptcy legislation that would provide additional protection for personal assets when doctors face huge settlements in malpractice lawsuits. A report on the topic calls for the AMA to push for amendments that would protect homes and retirement savings that aren't already shielded by federal or state laws from seizure by creditors.
The report from the AMA's board of trustees acknowledges, however, that any additional protections also would apply to individuals who owe money to physicians. "This could make it more difficult for physicians to collect money that is owed to them," the report notes. What's more, further protections for physicians' assets might blunt the AMA's argument that doctors need federal legislation to limit damages in lawsuits.
"It will be important to carefully coordinate such (bankruptcy reform) efforts so as not to undercut the AMA's primary legislative priority: achieving medical liability reform," the board report said.
The AMA delegates also are expected to discuss membership initiatives-the organization has lost about 33,200 members over the last four years-and to consider a proposal to move all or part of the organization's staff to Washington as a way to beef up advocacy efforts in the nation's capital. That proposal has been dismissed as too costly in past years. About 100 individuals-or almost 9% of the AMA's total workforce-are based at a Washington office a few blocks north of the White House.
"There have been resolutions in the past about moving the AMA to Washington because so much of what we do is in the political sphere," said Joseph Annis, an AMA delegate from Austin, Texas, who is attending the meeting in Hawaii. "But the bottom line is that a lot of what we do is scientific, and there are a lot of medical groups in Chicago. I think we need to keep our priorities straight. And it's very expensive real estate (in Washington)."
Palmisano said the organization is constantly looking at ways to make itself more effective and efficient. "I don't have a crystal ball," he said. "I don't know that (a move) will happen. The AMA will look periodically at this issue."
The AMA also must sift through a diverse list of resolutions, some more momentous than others. In addition to attending a forum on national public health readiness and an address by Carolyn Clancy, director of the Agency for Healthcare Research and Quality, delegates will vote on whether the AMA should "develop guidance on what constitutes a safe tire ... including but not limited to tread depth, side wall size, width of tread, stiffness of material, heat resistance, traction, vehicle load, proper inflation, average duration by mileage of safe use and diligent monitoring of same."
The U.S. Section of the International College of Surgeons, which drafted that proposal, also has called on fellow delegates to approve a resolution calling on the AMA to oppose policies that discourage mothers from nursing infants in public places.