A Glance Into the AMA - RFS

A Report From the 2007 AMA Annual Meeting

The Resident and Fellow Section (RFS) of the American Medical Association (AMA) is the governing body that represents current residents, in all specialties, to the AMA House of Delegates. The AMA is aggressively involved in advocacy efforts related to the most vital issues in medicine today. As our nation's largest physician group, the AMA has tremendous influence on legislation that affect patients and physicians alike. The AMA holds two meetings every year. The interim meeting is in the fall at various locations (It was held in Las Vegas last year and this November it's in Honolulu!) and the annual meeting is in June in Chicago, home of the AMA headquarters.

The RFS meets at both the interim and annual meetings just prior to the opening of business for the AMA House of Delegates. AMA-RFS policy on issues in medicine and public health is decided through a democratic policy-making process. A resolutions is brought forth by individuals or groups (e.g. local and state medical societies) and is heard before a reference committee that listen to individual testimony, in support of, or against, the proposed resolution. After all testimony is finished the reference committee goes into deliberation to amend and revise each individual resolution. When finished, the resolutions are reintroduced to the RFS section body for further tweaking and voting (i.e. adopt, not adopt, refer file, etc.). Every year, several resolutions may immediately be forwarded to the AMA House of Delegates for review, while other resolutions are held over till future meetings to allow time for reports and other data collection to be completed.

Many resolutions that have been submitted by past and current residents have served to create and/or change current AMA policy on numerous issues. For example, the top priority on the AMA's agenda this fall will be to launch a multimillion dollar program called, "Voice for the Uninsured." The program will promote expanding coverage for the uninsured and increase access to care. The legislation that eventually led to this massive campaign was brought to the AMA House of Delegates by the RFS . Pretty amazing if you ask me!

At this year’s annual meeting, the AMA-RFS was extremely busy. We held elections for executive positions on the governing council; attended state and regional council meetings; and listened to educational sessions about the AMA's initiative to transform medical education, preparing residents to practice, and current problems regarding the growing number of uninsured patients. On a more leisurely note, there was plenty of time to schmooze and socialize with other attendees at the RFS Welcome Reception and other section social events. The meeting is always well catered and the conference/meeting rooms are state-of-the-art. Also, those that want to take time for sightseeing and enjoying the nightlife have ample opportunity to do so.

The highlight of the meeting though, is usually the reference committee hearings. This year we had 14 new resolutions and six reports from previous meetings to discuss during our business sessions. I was fortunate to be able to serve on the RFS reference committee this year, although I lost a lot of sleep in the process. After we finished hearing all the testimony, the reference committee exited the meeting to go into deliberations. We began rummaging through all the testimony at Noon Friday afternoon and didn’t finish debating until nearly 3 am Saturday morning. After it was over, I can honestly say that I'm so glad I'm not a lawyer spending long hours meticulously scrutinizing over syntax, content, and grammar. However, in the end, I considered myself very fortunate to have been involved in the process.

At the conclusion of our business meeting, the following three resolutions were recommended for adoption by the RFS:

Resolution 4: Amending Child Restraint Laws - Asks that the AMA support federal legislation that increases law enforcement standards for child safety seat use in the US and update child car seat violations from a secondary to primary law.

Resolution 10:  Improving Transfer of Care Communication to Decrease Medical Errors - Asks that the AMA-RFS investigate models of effective, efficient transfer of care communication, taking into consideration the use of electronic medical records.

Resolution 12:  Securing Medicare GME Funding for Research and Outside Rotations During Residency - Asks that the AMA continue to encourage research and extramural educational opportunities, and work to change current regulations and funding guidelines that may limit research and extramural educational opportunities during residency. Also, this resolution asks the AMA to study current funding mechanisms and potential limitations to funding for residents who engage in research or pursue outside rotations. Testimony noted that programs do not get GME funding when residents do research or outside rotations and this may create a disincentive for residency programs to encourage research or other educational opportunities outside the home institution.

The following eight resolutions were recommended for adoption as amended or substituted:

Resolution 1:  Physician Scientist Benefit Equity - Asks the AMA to support the concept that all residents (in clinical residencies or fellowships as well as resident physician scientists) receive equal benefits packages.

Resolution 3:  Pediatric Suspected Trauma - Asks the AMA to support comprehensive reporting and investigation of all cases of reasonably suspected child abuse and neglect and also support the creation of a national standardized pediatric intentional trauma curriculum for medical students and residents.

Resolution 4:  Quantifying the Costs of Defensive Medicine in the United States - Asks the AMA to survey physicians regarding the practice of defensive medicine and report back at the 2008 meeting. Also asks the AMA to work with other interested parties to asses the true annual cost of defensive medicine to the national health care system.

Resolution 6:  Criminalization of Providing Healthcare to Undocumented Residents - Asks AMA to reaffirm existing policy that opposes any legislation that would criminalize the provision of health care to undocumented residents of the U.S. or require providers to obtain documentation of citizenship or immigration status before providing treatment.

Resolution 7:  Protecting Graduate Medical Education: Revisiting the All Payer System - CMS covers nearly 75% of GME costs. This funding is often threatened by spending cuts in Washington. This resolution asks the AMA to work with other stakeholders to actively lobby congress for an “all-payer” model, and simultaneously advocate for protecting Medicare and Medicaid GME payments.

Resolution 9:  Evaluation of Increasing Resident Review Committee (RRC) Requirements - Documentation requirements for program accreditation and resident competency are building up. Essentially, do the 6 new core competency requirements really help make us better doctors?

Resolution 13:  AMA Policy on Physician Provider Information - Asks the AMA establish policy that protects providers from internet sites that provide erroneous information.

Resolution 14:  Assessing the Health Care Proposals of the U.S. Presidential Candidates - Asks the AMA to request and widely disseminate details on the health care proposals of all U.S. presidential candidates now and in the future.

The section decided not to adopt three resolutions. Only resolution 7 was immediately forwarded to the AMA-House of Delegates (HOD) at this year’s meeting. It was introduced to the Reference Committee on Medical Education and it was widely supported by all testimony. The AMA has adopted the resolution as a substitute resolution that includes language that supports active AMA involvement in exploring additional sources of GME funding and how this funding will impact the quality of resident training and patient care. Seven resolutions, previously adopted by the RFS at the fall 2006 interim meeting were forwarded to the AMA-HOD this year. A full report of the actions taken by the AMA HOD can be reviewed at the link below.

Resolutions submitted by the RFS at AMA Annual Meeting 07 (PDF Download)

Michael Cicchetti, MD
PGY2 – University of Virginia
AMA-RFS liaison

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