Why AMA Membership Matters

Over the past decade, APA has assumed greater leadership in the AMA, and issues important to psychiatry have taken on more significance as described in the several reports of the recent AMA meeting in this issue of Psychiatric News. Our president, Alan Schatzberg, M.D., has requested that I use his column to provide more information about the work of the AMA and to encourage our members' participation in the House of Medicine.

The AMA's policymaking body, the House of Delegates (house), includes representatives of state medical societies and specialty and subspecialty organizations, with representation proportional to the number of AMA members. Other groups such as medical students, residents, “young physicians,” the military, medical schools, and “organized medical staff” also have a vote. While historically the AMA functioned as a confederation of state organizations, over the past decade, there has been an increasing presence and visibility of specialties in the house. Although for much of its history, the AMA required dual membership (nationally and in state societies), physicians may join the AMA without being members of their state medical societies, and vice versa. This “unbundling” of membership several decades ago turned out to be costly to both groups, with losses outstripping gains in membership.

The agenda for the AMA's twice yearly meetings comes from resolutions submitted by the member groups, as well as reports from its Board of Trustees (which has fiduciary and budgetary responsibility) and the eight elected and appointed councils. These reports and resolutions are discussed at reference committees, and recommendations are then presented to the house for further discussion and vote.

The process is stimulating and challenging. Because it is difficult to get such a large and diverse body to come to agreement, many issues are referred to the board for study or action or to a council, which then produces a report with recommendations that are again reviewed by the house. Additionally, the board is responsible not only for the budget and its execution, but also for implementation of directions and priorities—a responsibility that creates tension between the board and the house.

Psychiatry is represented through the Section Council on Psychiatry with membership from APA, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Psychiatry and the Law, including residents and early career psychiatrists. Additionally, psychiatrist members of state delegations participate in the psychiatry caucus, and section council members also attend meetings of their state delegations to address and support issues of consequence to psychiatry.

In 2000, under the leadership of APA Past President Joseph T. English, M.D., the psychiatric delegation developed a long-range plan to enhance our effectiveness. We identified potential candidates for appointment and election to councils, which provide the background for the majority of AMA policies. We worked with colleagues in state delegations and other specialty societies to prepare resolutions and then promoted their adoption. We participated in caucuses and work groups, testified to reference committees, and served on committees, bringing the voice of psychiatry to the AMA's deliberations. APA also committed significant resources—especially first-rate staff—to support this effort.

In the ensuing nine years, five psychiatrists in the section council were elected or appointed to councils; five psychiatrists from other delegations were elected or appointed to councils; and Jeremy Lazarus, M.D., an APA Assembly past speaker and delegate from Colorado, was elected AMA speaker. All in all, outstanding results of our efforts! It is not surprising that as a result, there has been a greater focus on mental health and illness in AMA advocacy efforts as well as in policies and priorities. Recent well-received reports on topics such as college student mental health, health care disparities, generic medications, depression and suicide, the use of SSRIs in children and adolescents, and discrimination in medical licensure endorse significant psychiatric issues. Additionally, by our leadership and participation, psychiatry has positively influenced other physicians' perception of our profession.

AMA support and advocacy provide value by reflecting all of medicine, not just one specialty, in important issues such as privacy and confidentiality, parity and nondiscriminatory access to care, liability reform, and Medicare improvement. The AMA-led Scope of Practice Partnership emphasizes broad patient-safety concerns in multiple specialties.

Of course nothing is perfect. The AMA has suffered membership losses while expanding the diversity of its membership. Financial concerns have led to organizational restructuring and plans to eliminate the Interim Meeting of the House of Delegates. The AMA's history as an overly conservative organization has negatively influenced recruitment of younger physicians and underrepresented minorities, even as the house has become much more diverse. The outcome of the debate on health care reform at the recent meeting (and in particular, the agreement not to vote against a public option) reflected the AMA's move in a direction more representative of 21st-century medicine.

To continue our achievements, we need APA members' active support. Please join the AMA as well as your local medical society and be an active voice in their deliberations. Your efforts to inform and partner with our medical colleagues will benefit our patients and our profession.