Volume 56, Number 1 - Winter 2010

 

By Irina deFischer, MD

Recently at a social function a colleague, Dr. X, asked me why I belonged to CMA. “I hate CMA!” he exclaimed. “It’s because of CMA that I am no longer allowed to hold two jobs! Who are they to tell me what I can or can’t do?” 

Dr. X went on to explain that CMA had recently adopted a policy requiring a physician to be on-site when nurses perform certain procedures at health facilities. Because Dr. X had a full-time practice elsewhere, he couldn’t be on-site to supervise nurses at a particular facility, so he had to give up his job as the facility’s medical director. (Some details of the preceding story have been changed.) 

As I was listening to Dr. X, I remembered the discussion that had taken place at the 2008 CMA House of Delegates. Several delegates had raised concerns about patient safety in settings where nurses and nurse practitioners were treating patients with only nominal physician supervision. One of the resolutions passed by the House called for stricter enforcement of laws regarding adequate supervision of nurses. 

Whether or not one agrees with this resolution, it is important to understand the process by which it was adopted. CMA is a professional membership organization that includes more than 30,000 California physicians. Its mission is “to promote the science and art of medicine, protection of public health, and the betterment of the medical profession.” The CMA House of Delegates, composed of more than 400 physician delegates from across the state, meets once a year to establish the policies that govern the association. 

Each year delegates introduce dozens of resolutions addressing a variety of issues, from health system reform, to science and public health, to patient safety and physician reimbursement. The resolutions are posted online prior to the annual meeting, and members are invited to submit comments. Each resolution is assigned to one of seven reference committees. Each committee is composed of six physician delegates. 

At the reference committee hearing, the authors and any interested CMA members can present testimony for or against the resolutions. Once the testimony has been heard, the committees recommend action to the House based on the evidence presented. The resolutions are then debated and voted on by all the delegates in the House–a truly democratic process. 

After a policy is adopted by the House, the CMA board of trustees and the association’s staff implement the policy. CMA’s elected leaders and legislative advocates work tirelessly to educate legislators both in Sacramento and Washington regarding the association’s positions on health care issues. CMA also works with state regulatory and licensing agencies to ensure physician input in the arenas of health policy, insurance regulation and public health. 

At the most recent House of Delegates, in October 2009, Drs. Larry Bedard, Peter Bretan, Lori Selleck, and I represented the Marin Medical Society (MMS). I also had the privilege of serving on Reference Committee B, which considered resolutions and reports dealing with health system reform. We considered 25 resolutions, on topics ranging from inclusion of preventive services and palliative care in health care reform, to medical home advocacy, to opposition to cutbacks in adult Medi-Cal benefits. (For a complete report on the actions of the 2009 House of Delegates, visit the “members only” section of www.cmanet.org.) 

The beauty of CMA is that it is an umbrella organization representing every sort of physician throughout California. There will always be differences of opinion between individuals, but we physicians share many of the same concerns, and in order to survive we must stick together. As Abraham Lincoln famously said, “A house divided against itself cannot stand.” 

The best way to influence CMA policy is to be at the table and speak up. In short, get involved! For more information on MMS activities, visit www.marinmedicalsociety.org or call 415-924-3891. You could join a committee, become a board member or CMA delegate, or even run for office!

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Dr. deFischer, a family physician and geriatrician at Kaiser Petaluma, chairs the MMS Editorial Board.