Twice a year, Strategic Radiology’s CEO Arl Van Moore, MD, FACR, packs a bag and travels to a destination somewhere in the United States to represent radiology in the House of Medicine—the American Medical Association’s House of Delegates (HOD).  He has represented radiology as a member of the American College of Radiology’s delegation since 1996.

Twenty two years later, Moore was in Hawaii in November for the winter meeting. Hot topics included securing legal protection for physicians who participate in peer review and the relevance and need for the American Board of Medical Specialties (ABMS) to play a role in the maintenance of physician certification (MOC).

“Many physicians want to get rid of MOC altogether,” Moore reports. “It is believed to be of little value, the expense in both time and money are thought by a strong contingent in the House of Delegates to be a poor use of resources, and many feel it is a process that has passed its usefulness. But those in charge are thought to be resistant to change, wanting to maintain the status quo.  A number of specialties and state medical societies are pretty upset about it.”

Growth in Representation

Since Moore began attending, the number of delegates in the HOD has grown to more than 500, with an alternate for each delegate plus attending staff, producing an average attendance of two thousand or more. When it first began, the AMA was primarily an amalgamation of state medical societies but since the late 1990s has grown to accommodate representation from more than 170 medical societies, including the national medical specialty groups, subspecialties, and other physician interest groups, such as organized medical staffs and graduates of foreign medical schools.

“Internists and family practice physician groups have enormous power because they have a large number of physicians who are active members of the AMA,” Moore notes. “They also have numerous members on state medical societies in addition to the delegates that represent the internists in the American College of Physicians and family practice physicians in the American Academy of Family Physicians.”

Moore has seen radiology’s representation increase over the years. “In addition to the ACR delegation, we have increased delegates from the RSNA and the American Roentgen Ray Society—we also are seeing many young radiologists get involved in some of their state medical societies,” Moore says. “That has been a positive development for our profession.”

Moore points to Alex Ding, MD, who started out in the  AMA as a member of the Resident and Fellow Section representing radiology and has moved through the ranks to become a delegate for the California Medical Association. He was recently elected to be a member of the Council of Scientific Affairs.  “I’ve encouraged the radiologists in the House of Delegates to look at being involved not only within radiology but in the state medical delegations as well,” Moore says. “In doing so, like the internists and family physicians, we get more radiologists on the state delegations. When we are sitting on the floor, we have a radiology voice within the state medical society delegations in addition to those sitting in the ACR and other national radiology delegations on the HOD floor.”

In addition to Moore, at least two other radiologists who are members of Strategic Radiology also were in Hawaii in November: Chris Gibbons, MD, a radiologist with member practice University Radiology, represented the New Jersey Medical Society as their president; and Ty Childs, MD, a radiologist with the Radiological Associates of North Texas, is a member of the ACR delegation, and also very active in the Texas Radiological Society and the Texas Medical Association.   

A Political Organization

Representation in a number of venues is important because, bottom line, the AMA is a political organization. State medical societies may bring an issue forward by taking a resolution to the HOD. “They may want to see motorcycle drivers wear helmets, for instance, or that rubella vaccination is widespread to protect the public,” Moore says.

A great deal of time is spent on government relations and the economics of medicine. “It’s a big pile of money that the government spends each year, and, as they say, for all of medicine it is a zero-sum game,” Moore observes. “The HOD is the only place where all physicians, all of the representatives from the House of Medicine, come to debate the issues, whether economics related, scope-of-practice related, or focused on the overall health of the general public.  Mammography and mammography screening has been an issue we have debated for decades on the HOD floor.  Our strong radiology presence has helped define this as a public health issue.”

As such, alliances form and dissolve and caucuses are developed to represent different positions on the issues.  Years ago, Moore pulled together the hospital based physicians into a working AMA caucus to collaborate on issues that are common to hospital-based physicians— radiology, anesthesiologists, emergency medicine, pathology and hospitalists. “As physicians, we can work as a coalition to support issues of concern to our constituency in the hospital-based setting,” he says.

“The internal medicine physicians have their agenda, the family physicians and the pediatricians have theirs, all of us have our own agendas,” Moore says. “For example, urologists and radiologists often disagree about which specialty should be doing radiation oncology, but then all of a sudden we have a common issue, and we work together. We resolve that issue, and then we go back to disagreeing over who should do radiation oncology.”

Moore says it is important to pick one’s battles carefully. “If you have something that is going to be a heavy lift, you have to get an early start and lay the groundwork,” he says, paraphrasing Sun Tze, “you have to win the battle before you go to war.”

Radiology’s Issues

Moore says that a perennial issue for radiology is mammography, currently around U.S. Preventive Services Task Force (USPSTF) recommendations for the frequency of breast cancer screening, the age at which to begin, and whether and when women should stop. While family practice follows USPSTF guidelines and is not interested in contrary arguments, Moore says that radiology does have allies in the House of Medicine. 

“We have a successful history advocating for women in the fight against breast cancer in the House of Delegate,” Moore says. “We need to guard against attempts to dilute the gains for women that we have fought so hard to achieve.”

Having a strong presence in the AMA House of Delegates has enabled radiology to have a voice on the national medical landscape. “Over time, we have been pretty successful in getting support for our agenda with respect to issues that are important to radiology,” he says.

Looking ahead, Moore believes active participation on the part of radiology will be even more important to both radiologists and physicians in general.

“There are greater forces out there that are trying to intermediate health care,” he notes. “Are insurance companies necessarily the physician’s friend? I’m not sure. With respect to the government, whoever has the voice and can go in and talk with those who set public policy for medicine in the country is the one who will help set standards for our profession and for the public .That is a key piece that needs to happen.”

In order for radiologists to be included in those discussions, they have to be at the table. “Having an active AMA membership is important,” Moore believes.