Residents Exert Substantial Impact on AMA Policymaking

This past June, we attended the AMA House of Delegates meeting in Chicago as delegates to its Resident Fellows Section (RFS). While there has been a trend over the past decade of physicians becoming less involved in the AMA, the work that was accomplished at this meeting underscored the importance of why our involvement with the “House of Medicine” is so crucial.

Several key issues that were on the house's agenda have a direct impact on physicians in training. First, the RFS reviewed the Institute of Medicine's recommendations on residents' work hours and sleep schedules and ultimately decided that it is not possible to develop one general standard governing these issues that applies to all specialties. Since the RFS has a representative on the Accreditation Council for Graduate Medical Education, input from the RFS will be integrated into the new work-hour regulations.

Second, the federal ban on same-sex marriage and resulting problems with access to medical coverage for same-sex couples was discussed, and the RFS debated whether we as a body should take a position on this issue. This made for a lively debate that ended in a consensus to support equal access to medical coverage and medical decision making for all couples regardless of sexual orientation.

Third, the pending Supreme Court case of Mayo v. U.S. was brought up. This case is likely to decide whether medical residents are students or employees. The Court's ruling will be important because if they are “students,” residents will be exempt from Social Security taxes. In contrast, if residents are designated as students, we may be exempt from some taxation but will no longer be considered employees, which could mean a loss of significant employment legal rights and protections. The importance of this issue and the unknown consequences of the Court's ruling prompted the RFS to ask the AMA to examine the case in detail. Once the AMA examines this issue for the RFS, we will be able to debate the costs and benefits from a number of viewpoints, ultimately helping the RFS craft a policy that benefits all residents and ensures that residents' best interests are served.

Obviously, the RFS's scope of debate is very broad and encompasses many issues that span the profession of medicine, and the debates within this House of Medicine are crucial in determining how our profession is depicted in the media, represented to other professionals, viewed by governmental agencies, and most importantly, understood by our patients.

While those issues have considerable impact on how we will practice medicine throughout our careers, the involvement of psychiatrists in the AMA is crucial for several important reasons as well.

First, as the new health care reform law is implemented, the unique needs of the mentally ill must be highlighted and addressed, and the availability of psychiatric care, which is a problem in so many areas of this country, must continue to be in focus. In addition, by giving voice to our profession at meetings of the RFS, we can continue the process of carving in or reintegrating mental health within the larger field of medicine.

And just as is the case for APA leadership, the AMA House of Delegates will eventually be made up of physicians who are currently residents and fellows.

Thus, our involvement must happen now, so we are prepared to assume leadership roles in the future.

Second, since we psychiatrists are viewed as experts in managing multidisciplinary teams and providing liaison services to our medical colleagues, we can serve as unique participants in the group process at the AMA's RFS. The perspectives that we bring to this organization are highly valued, and our presence will foster closer relationships among all specialties.

We are fortunate to be involved with both APA and the AMA. It affords us the chance to interact with diverse groups of physicians in and out of our specialty. In the end, we consider it our duty and privilege to think of ourselves as physicians first. As such, we have come to understand that medicine is not practiced in isolation but within a complex landscape of legal, legislative, economic, public-policy, and special-interest issues.

By being involved and actively participating in the house of medicine, we have benefitted much and become better advocates for our patients and our profession. We strongly encourage all of you to become more involved with the medical organizations working on behalf of you and your patients. Your input will be welcomed both locally and nationally.

Please contact us at [email protected], so we can share information about specific opportunities available to you at the local, regional, and even national levels.