Righting the Pyramid

UNLIKE NURSES, LAWYERS, OR STEVEDORES, physicians are free to reject our medical organizations. Many do so, in the spirit of liberty and idealism passed down from an illustrious past. Yet, to fault the AMA or the CMA for being out of touch with the "real" doc, as well as the average American, is too easy, and conveniently economical.

It is easy to become cynical when we observe a smooth-talking colleague climb the medical organizational ladder like a Cardinal, leading to a sinecure in medical politics. Too easy, I think.

But the edifice of organized medicine does look at times like an inverted pyramid, apex buried in sand, with those at the point expending all their energies to keep the structure from toppling over and driving them back to clinical practice. Critics feel the structure is unstable and senseless. Though there may be merit in such observations, in the current social, economic, and political "perfect medical storm," the question becomes, "So... what now?"

First, it is an error to assume our local or state medical societies are like most others. Our state and national delegates can tick off the differences. Too many state medical societies are undemocratic, unlike CMA, and resist change. Their national posture at AMA reflects that fact.

The AMA is changing. It has relatively few members, and its income is not dependant on dues. It has considered (and, for now, rejected) morphing into an organization of organizations to represent all physicians.

In time, this could be a good thing, providing a national forum for isolated specialties that seldom share views with one another. Yet, for the average physician, none of this is of interest if organized medicine isn't relevant to medical practice. The practice of medicine has, for better or worse, become public property, an ethical, a socio-political, and an economic matter.

SSVMS is unique. We are at the center of California politics. Our medical community is a manageable microcosm of members from all segments of a diverse three-county medical community: city, rural, solo, small group, large group, administrative, public health or government, and academic.

We benefit from the experience of an effective, astute executive, and a broadly representative Board of Directors who debate issues forcefully, tolerantly, and intelligently. These assets are not trivial. I suggest that the SSVMS is a template for the kind of local medical society that can right the inverted pyramid.

Second, the base of that pyramid needs to be grounded and broadened. The most malign effect of the inverted pyramid is to marginalize the most politically qualified and talented physicians, leaving the broader legislative process in the hands of lawyers, teachers, nurses, business owners, union officials, and religious sectarians.

Physicians with the interest, drive and ability to succeed in medical politics are capable of being active in local civic organizations, running for seats on the school board, the city council, the planning commission, and being mayors, governors, or legislators. Their impact in the real world of politics would be far greater than atop a physician hierarchy confined to organized medicine.

To right the pyramid requires leadership and timing, patience and persistence. It will not be done by mercenaries or lobbyists. It will happen when physicians interact habitually and determinedly within our own communities. Only then can our state and national medical organizations become fully effective.

john@loofbourow.com