Following a presentation at the Minnesota District Branch and a meeting with its leadership, I attended the AMA House of Delegates meeting. I was there as an alternate delegate from California and was also invited as president of a recognized specialty society. This was the first meeting at which our Section Council on Psychiatry was expanded from two to seven delegates and seven alternate delegates. This was due to a change in the formula for specialty representation. Dr. Allan Tasman and I appointed members with significant experience in their state and county medical associations. We also considered geographical distribution, minority and child psychiatry representation, gender, and a mixture of young and more mature members.

Our delegates are Drs. Joe English, Jack McIntyre, Jay Scully, Carolyn Robinowitz, Rod Muñoz, Judy Linger, and Lynne Moritz. The alternate delegates are Drs. Jeff Akaka, Saul Levin, Ron Shellow, Patrice Harris, Paul Wick, and Ken Certa. This is a wonderful, hard-working group.

A number of exciting things happened at this meeting. Members have to run for every position on every council in addition to the leadership positions. We learned that there might be an opening on the Council on Scientific Affairs, depending upon the outcome of another election. If that occurred, we wanted Carolyn Robinowitz to run for the position. The opportunity did occur. Carolyn was one of eight candidates, six of whom were dropped in early balloting. Carolyn did not win the runoff, but she gained major visibility as a future candidate. This is the way things work at the AMA: You earn your turn and wait for the right opportunity. Delegations determine which positions will be available each year and plan for years in advance in discussions with other delegations as to when their candidate would be the accepted choice. From my perspective, far too much time is devoted to the political process.

In other actions, the AMA reaffirmed, as policy, sponsoring legislation to repeal sections of the Social Security Act of 1965, which apply discriminatory limits on Medicare payment for outpatient psychiatric services. A second action by the House of Delegates affirmed the AMA’s strong opposition to the 50 percent copayment requirements under Medicare Part B for outpatient psychiatric services, supporting a change to the 20 percent copayment amount as for all other conditions under Medicare, and also requesting a coordinated effort with consumer and patient groups to communicate this position to HCFA and the Congress. AMA’s sponsorship and assistance is vital in reversing this discriminatory policy. We are following up on these actions with an offer to help in any way we can.

We also noted that a white paper on the Decade of the Brain, which will be placed on the AMA’s Web site, did not include any of the recent exciting discoveries in our field. Due to APA staffing changes, we had not responded to a request for our input previously. Through our efforts, and for the first time in my experience, a group that had dropped the ball was given an opportunity to add the pertinent information.

Participation in organized medicine is extremely valuable to the psychiatric profession. Many legislative and legal issues are of such magnitude that we need the additional clout of our state medical organizations and of the AMA. For example, the California Medical Association recently filed a class-action lawsuit against the three largest for-profit HMOs in California. The best way to assure that our issues are addressed by medical organizations is to play an active role in them.

Some physicians in medical organizations may not fully accept psychiatrists as their equals initially. Biases toward psychiatry have existed in medical schools. Some physicians haven’t considered us to be "real" doctors. We gradually earn the respect of our medical colleagues as they see that we are interested in all medical issues and have worthwhile things to contribute. Advances in our science, demonstrating that psychiatric illnesses have biological and/or genetic roots, have helped. Invariably, when we get involved with county, state, and national medical organizations, our spouses develop friendships with other spouses and often get involved with medical alliances that play a major role in legislative advocacy. Building and reinforcing bridges between our organizations is essential.

Participation in organized medicine is an interesting, stimulating, challenging, and important activity. I am hopeful more of our members will get involved. You won’t be disappointed.