Personal Perspectives
The American Congress of Obstetricians and Gynecologists and the American Medical Association Common Ground Makes Common Sense Robert M. Wah,
MD
A
s I begin my year as President of the American Medical Association (AMA), I would like to extend my thanks and gratitude to so many of my American Congress of Obstetricians and Gynecologists (ACOG) colleagues who have supported me through the years. It is an honor and privilege to be only the third Boardcertified obstetrician–gynecologist (ob-gyn) to serve as AMA President in 168 years. Having “grown up” with both ACOG and AMA, I see many areas of synergy and reinforcement between these two important organizations. I intend to cultivate this common ground as much as possible during my year as AMA President. In these challenging times in health care, finding and leveraging the common ground we share as physicians is more important than ever. Physicians must work together to shape the unprecedented changes happening in health care lest we find ourselves buried by them. Many find change a challenge; I see change as opportunity and I always seek to maximize opportunities. The role of organized medicine is essential in helping physicians navigate the current environment. The AMA and ACOG must remain vigilant in addressing the myriad of issues that are facing physicians. By working together, we gain a stronger voice, and mutual advocacy efforts are multiplied. The AMA is the umbrella organization that represents all physicians across specialties, geographies, practice
From the American Medical Association, Chicago, Illinois. Corresponding author: Robert M. Wah, MD, 330 North Wabash Avenue, Chicago, IL 60611; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2014 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/14
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settings, and career stages. The AMA is the largest physician organization in the nation and can serve as an amplifier to the voices of ACOG members, acting as an orchestra conductor that harmonizes the voices of many different specialties and blends them into one powerful and unified chorus. Important common ground I hope our two groups can cultivate during my year as AMA President centers on the AMA’s long-range strategy to improve the future of health care by focusing on three critical areas that intersect the professional interests and needs of every physician: • Improving physician professional satisfaction and practice sustainability • Improving health outcomes for patients • Improving medical education for the next generation of physicians. One casualty of the transformative change taking place in health care today is physician professional satisfaction. Physicians feel under siege as they try to keep pace with new models of care and an increasing array of new rules and regulations. The AMA is committed to helping physicians work in satisfying and sustainable practices. To that end in 2013, the AMA partnered with the Rand Corporation to better understand the biggest drivers of physician dissatisfaction. Our work examined 30 diverse practices, covering more than 50 sites across six states. One common and unmistakable theme emerged. Physicians want desperately to be able to deliver highquality care to their patients in an environment that focuses on the patient relationship. When able to provide such care, physicians feel fulfilled. Unfortunately, today too many obstacles are interfering with that goal. Cumbersome electronic health records are not only costly and time-consuming, but also detract from
OBSTETRICS & GYNECOLOGY
face-to-face interaction with the patient. The amount of time physicians must spend on clerical work and regulatory compliance continues to grow. Productivity quotas can be excessive, and there is not enough autonomy in structuring clinical activities. The AMA is launching both short-term and longterm strategies to help physicians navigate some of the frustrations documented by this study. In the shortterm, the AMA has identified a list of a dozen or so practice flow and practice architecture issues that we can address to help physicians, regardless of practice mode or care model. The AMA is developing resources that will provide useful guidance on routine, but important, clinical issues to help facilitate medical practice. Issues such as previsit laboratory tests and planning, systematic prescription renewals, and team documentation are in development and will be available to physicians in the near future. The AMA’s longer-term work will pursue three initiatives to help physicians in their practices. These include: • Engaging electronic health record vendors and regulators to improve electronic health record usability; • Enhancing understanding of emerging payment models and their effect on the physician practice so that obstacles can be addressed early in the implementation process; and • Promoting shared management and physician engagement for both employed physicians and those affiliated with hospitals. Improving physician satisfaction is no easy feat but our ultimate goal—and one I know ACOG shares— is to not just help physicians survive in the current environment, but to give our colleagues the tools, resources, and support they need to thrive in this new landscape. Our second strategic initiative is aimed at improving health outcomes, beginning with an initial focus on Type 2 diabetes and cardiovascular disease. Together, these two disease conditions wreak havoc on our patients’ health and cost our health care system more than $500 billion a year. This work has important intersections with ACOG efforts to reduce the rate of gestational diabetes mellitus (GDM), which affects up to 18% of pregnancies (more than 276,000 pregnancies in the United States annually) and accounts for 90% of diabetes-affected pregnancies. Of patients affected by GDM, 35–60% of them will develop Type 2 diabetes in the years after their pregnancies. Both ACOG and the AMA therefore have a strong interest in decreasing the rate of Type 2 diabetes. At the AMA, we are launching an innovative partnership with the YMCA of the USA to reduce the
VOL. 124, NO. 1, JULY 2014
incidence and progression of Type 2 diabetes. Many YMCAs are at the frontlines to offer patient education and health and wellness programs that can help patients live healthier, manage a chronic disease, or both. The YMCA program is based on the Centers for Disease Control and Prevention’s National Diabetes Prevention Program. The National Diabetes Prevention Program seeks to delay or prevent the progression of prediabetes through lifestyle interventions. The National Diabetes Prevention Program is based on research funded by the National Institutes of Health showing a 58% reduction in the number of new cases of diabetes among adult participants in the Diabetes Prevention Program and a 71% reduction in new cases among those older than age 60 years who have prediabetes. The YMCA is participating in a Centers for Medicare and Medicaid Innovation award that allows people older than age 65 years to attend the Diabetes Prevention Program at no cost in some communities. The AMA has engaged physician practices to test our Diabetes Prevention Program referral models and feedback loop at clinical sites in Delaware, Florida, Indiana, and Minnesota. Once the pilot phase is complete in mid-2014, we will create more clinical–community linkages by refining our tools and expanding to more cities and physician practices. The AMA’s improving health outcomes initiative is also aimed at preventing heart disease. The AMA is collaborating with two research centers within Johns Hopkins University (the Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities) to improve hypertension control rates. Physicians and care teams in Illinois and Maryland are helping us develop and test a set of evidence-based recommendations for achieving optimal hypertension control. This work supports the widely publicized federal government’s “Million Hearts” initiative and its goal of bringing the high blood pressure of 10 million more Americans under control by 2017. The AMA will use the lessons learned from these pilot sites to identify effective strategies and clinical workflows for managing hypertension and then work to spread hypertension control improvement models to more practices and communities. A third area of AMA focus is enhancing medical education and training to better align with new realities within the current delivery system. In 2013, the AMA awarded $11 million dollars in grants to 11 U.S. medical schools to address gaps within the current medical education curriculum. This AMA
Wah
ACOG and AMA
135
initiative seeks to ensure the next generation of physicians is adequately trained in key areas and disciplines that will become important cornerstones in the future delivery system including: chronic health management, population health, team-based care, and widespread use of health information technologies. The 11 medical schools participating in the AMA grant initiative are now working to develop innovative curriculums to bridge current gaps in training. A learning consortium has been formed so these schools can facilitate adoption by sharing their curriculum ideas with each other and with other medical schools nationally. Just as the AMA played a foundational role in developing the first standards of medical education more than a century ago, we are precipitating transformational change in medical education today. Ensuring the next generation of physicians are well prepared is something ACOG has always taken seriously. The teaching and mentoring I received from ACOG as a Junior Fellow, national Chair of Junior Fellow Congress Advisory Council, and member of the ACOG Executive Board and Healthcare Commission has been instrumental in shaping my professional career. The ACOG program for medical students interested in obstetrics and gynecology careers is a model for other specialties. Today, through group membership with the AMA funded by ACOG, more than 4,000 Junior Fellows gain valuable learning opportunities and give voice to the AMA’s advocacy efforts—those that affect ob-gyns directly and others that are more global. As the AMA pursues its ambitious long-term strategy, it continues to address other wide-ranging issues important to physicians and the practice of medicine. The efforts I have outlined to improve medical education in this country, for example, must be accompanied by a commitment to adequately fund graduate medical education. Earlier this year, 5.6% of U.S. allopathic medical school seniors were not placed into first-year residency programs. This comes at a time when millions of newly insured Americans are seeking medical care services. This disconnect is real and could have dire consequences. Workforce experts predict that the United States will face a shortage of 130,000 physicians across all specialties by 2025. With a larger number of medical school graduates seeking residency slots combined with the growing national physician shortage, adequate funding for graduate medical education must be a priority for Congress and the future of medicine. The AMA’s “Save GME” campaign continues to call on Congress
136
Wah
ACOG and AMA
to preserve funding for residency training and expand the number of residency slots to produce an appropriately sized and geographically distributed physician workforce. Another important effort the AMA and ACOG must continue to work toward collaboratively is the ongoing implementation of the Affordable Care Act. The Affordable Care Act is not only expanding insurance coverage to millions more women, but coverage includes important preventive care services with no copays or deductibles. These essential services can keep women healthier, preventing acute problems from becoming more serious and more costly. In addition, the Affordable Care Act offers important insurance protections as well. It prevents insurance companies from charging women higher premiums than men—once a common practice. This new policy ensures that more women can afford coverage and get care, including treatment for genderspecific conditions. The Affordable Care Act also does away with preexisting condition denials, meaning women with a chronic disease can no longer be denied coverage. It also eliminates caps on the amount of care a person can receive annually as well as over the course of their lifetime. The Affordable Care Act also ensures that women are covered for other services that are vital to their sexual, reproductive, and overall health, including Pap tests and human papillomavirus screenings. Also covered are important services such as counseling on sexually transmitted infections, human immunodeficiency virus and contraception, screening for GDM, breastfeeding support, screening and counseling for depression, and domestic violence. These services will improve the health care quality—and health care outcomes—of millions of women across the nation. These advances were won as a result of collaboration within organized medicine and demonstrate the value of working together. While we work to translate better coverage into better care for our patients, we must also work collaboratively to improve parts of the Affordable Care Act that do not work well for physicians. The AMA, like ACOG, continues to call for the elimination of the Independent Payment Advisory Board, which grants this isolated body the ability to impose Medicare payment cuts with little accountability. The AMA is also working to address concerns over narrow networks, in which some insurers are excluding physicians from their panels with little or no explanation or justification. Medical liability is another important piece of common ground to forge. While the AMA continues
OBSTETRICS & GYNECOLOGY
to urge Congress to pass Medical Injury Compensation Reform Act-like reforms pioneered and successful in California with caps on noneconomic damages, we recognize that other incremental steps may offer the best opportunity for advancing this issue. The AMA continues to advocate for additional funding to develop promising reform alternatives, including safe harbor protections for the practice of evidence-based medicine, health courts, early offers, and administrative determination of compensation. The AMA and ACOG are also well aligned on keeping lawyers and legislators out of our examination rooms and protecting the sanctity of the doctor–patient relationship. Through the AMA State Advocacy Resource Center campaign, “Keeping politics out of the examination room: protecting the patient–physician relationship,” the AMA has worked with ACOG to combat state legislation regarding dense breast notification, ultrasound, and fetal heartbeat laws. Meanwhile, through the Scope of Practice Partnership, the AMA has joined forces with ACOG to help establish state regulations on the practice of lay midwives. These examples are just a sampling of how the AMA is working with ACOG to shape a better future for health care. The AMA is not only tackling the acute issues affecting physician practice, but we are pursuing a long-term agenda that defines and advances important issues for our medical profession and for each of us as physicians. Forging common ground makes common sense. As physicians, we know that the best patient care often comes as the result of teamwork. We all want to do our best for our patients, and sometimes doing the best means working with others—others who may have different skill sets and resources.
VOL. 124, NO. 1, JULY 2014
Teamwork is the same in organized medicine. Individual physicians and state and specialty societies can benefit from the extensive skill set and ample resources of the AMA. From working to permanently repeal the Medicare Sustainable Growth Rate to marshaling powerful forces to fight chronic disease, to helping us sustain rewarding practices, the AMA is engaged in the important issues affecting physician practices and the care of their patients. At the AMA, the ACOG delegation, headed by Dr. Carol Brown from Memorial Sloan Kettering Cancer Center in New York, is the second largest specialty delegation and larger than most state delegations. AMA membership determines the size of delegations so each ACOG member who becomes an AMA member will help increase the ACOG delegation in size and stature in the AMA House of Delegates where AMA policy is developed and voted on. These are exciting, challenging times in health care and there are a lot of forces aligned against our profession. Now more than ever, physicians need to join together. If you are an AMA member, thank you for your membership and support. If you are not a member, please consider joining your physician colleagues in these times of change, challenge, and opportunity. I look forward to working with my ACOG colleagues in the year ahead in shaping the best outcomes for physicians, patients, and medical students. By joining together and focusing on the common ground we share, I believe we can shape a better future for health care in this country. Help me be successful as AMA President and send me your comments, compliments, and criticisms to Robert. [email protected]. You can follow me on Twitter (@RobertWahMD).
Wah
ACOG and AMA
137
The American Congress of Obstetricians and Gynecologists and the American Medical Association Common Ground Makes Common Sense Robert M. Wah,
MD
A
s I begin my year as President of the American Medical Association (AMA), I would like to extend my thanks and gratitude to so many of my American Congress of Obstetricians and Gynecologists (ACOG) colleagues who have supported me through the years. It is an honor and privilege to be only the third Boardcertified obstetrician–gynecologist (ob-gyn) to serve as AMA President in 168 years. Having “grown up” with both ACOG and AMA, I see many areas of synergy and reinforcement between these two important organizations. I intend to cultivate this common ground as much as possible during my year as AMA President. In these challenging times in health care, finding and leveraging the common ground we share as physicians is more important than ever. Physicians must work together to shape the unprecedented changes happening in health care lest we find ourselves buried by them. Many find change a challenge; I see change as opportunity and I always seek to maximize opportunities. The role of organized medicine is essential in helping physicians navigate the current environment. The AMA and ACOG must remain vigilant in addressing the myriad of issues that are facing physicians. By working together, we gain a stronger voice, and mutual advocacy efforts are multiplied. The AMA is the umbrella organization that represents all physicians across specialties, geographies, practice
From the American Medical Association, Chicago, Illinois. Corresponding author: Robert M. Wah, MD, 330 North Wabash Avenue, Chicago, IL 60611; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2014 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/14
134
VOL. 124, NO. 1, JULY 2014
settings, and career stages. The AMA is the largest physician organization in the nation and can serve as an amplifier to the voices of ACOG members, acting as an orchestra conductor that harmonizes the voices of many different specialties and blends them into one powerful and unified chorus. Important common ground I hope our two groups can cultivate during my year as AMA President centers on the AMA’s long-range strategy to improve the future of health care by focusing on three critical areas that intersect the professional interests and needs of every physician: • Improving physician professional satisfaction and practice sustainability • Improving health outcomes for patients • Improving medical education for the next generation of physicians. One casualty of the transformative change taking place in health care today is physician professional satisfaction. Physicians feel under siege as they try to keep pace with new models of care and an increasing array of new rules and regulations. The AMA is committed to helping physicians work in satisfying and sustainable practices. To that end in 2013, the AMA partnered with the Rand Corporation to better understand the biggest drivers of physician dissatisfaction. Our work examined 30 diverse practices, covering more than 50 sites across six states. One common and unmistakable theme emerged. Physicians want desperately to be able to deliver highquality care to their patients in an environment that focuses on the patient relationship. When able to provide such care, physicians feel fulfilled. Unfortunately, today too many obstacles are interfering with that goal. Cumbersome electronic health records are not only costly and time-consuming, but also detract from
OBSTETRICS & GYNECOLOGY
face-to-face interaction with the patient. The amount of time physicians must spend on clerical work and regulatory compliance continues to grow. Productivity quotas can be excessive, and there is not enough autonomy in structuring clinical activities. The AMA is launching both short-term and longterm strategies to help physicians navigate some of the frustrations documented by this study. In the shortterm, the AMA has identified a list of a dozen or so practice flow and practice architecture issues that we can address to help physicians, regardless of practice mode or care model. The AMA is developing resources that will provide useful guidance on routine, but important, clinical issues to help facilitate medical practice. Issues such as previsit laboratory tests and planning, systematic prescription renewals, and team documentation are in development and will be available to physicians in the near future. The AMA’s longer-term work will pursue three initiatives to help physicians in their practices. These include: • Engaging electronic health record vendors and regulators to improve electronic health record usability; • Enhancing understanding of emerging payment models and their effect on the physician practice so that obstacles can be addressed early in the implementation process; and • Promoting shared management and physician engagement for both employed physicians and those affiliated with hospitals. Improving physician satisfaction is no easy feat but our ultimate goal—and one I know ACOG shares— is to not just help physicians survive in the current environment, but to give our colleagues the tools, resources, and support they need to thrive in this new landscape. Our second strategic initiative is aimed at improving health outcomes, beginning with an initial focus on Type 2 diabetes and cardiovascular disease. Together, these two disease conditions wreak havoc on our patients’ health and cost our health care system more than $500 billion a year. This work has important intersections with ACOG efforts to reduce the rate of gestational diabetes mellitus (GDM), which affects up to 18% of pregnancies (more than 276,000 pregnancies in the United States annually) and accounts for 90% of diabetes-affected pregnancies. Of patients affected by GDM, 35–60% of them will develop Type 2 diabetes in the years after their pregnancies. Both ACOG and the AMA therefore have a strong interest in decreasing the rate of Type 2 diabetes. At the AMA, we are launching an innovative partnership with the YMCA of the USA to reduce the
VOL. 124, NO. 1, JULY 2014
incidence and progression of Type 2 diabetes. Many YMCAs are at the frontlines to offer patient education and health and wellness programs that can help patients live healthier, manage a chronic disease, or both. The YMCA program is based on the Centers for Disease Control and Prevention’s National Diabetes Prevention Program. The National Diabetes Prevention Program seeks to delay or prevent the progression of prediabetes through lifestyle interventions. The National Diabetes Prevention Program is based on research funded by the National Institutes of Health showing a 58% reduction in the number of new cases of diabetes among adult participants in the Diabetes Prevention Program and a 71% reduction in new cases among those older than age 60 years who have prediabetes. The YMCA is participating in a Centers for Medicare and Medicaid Innovation award that allows people older than age 65 years to attend the Diabetes Prevention Program at no cost in some communities. The AMA has engaged physician practices to test our Diabetes Prevention Program referral models and feedback loop at clinical sites in Delaware, Florida, Indiana, and Minnesota. Once the pilot phase is complete in mid-2014, we will create more clinical–community linkages by refining our tools and expanding to more cities and physician practices. The AMA’s improving health outcomes initiative is also aimed at preventing heart disease. The AMA is collaborating with two research centers within Johns Hopkins University (the Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities) to improve hypertension control rates. Physicians and care teams in Illinois and Maryland are helping us develop and test a set of evidence-based recommendations for achieving optimal hypertension control. This work supports the widely publicized federal government’s “Million Hearts” initiative and its goal of bringing the high blood pressure of 10 million more Americans under control by 2017. The AMA will use the lessons learned from these pilot sites to identify effective strategies and clinical workflows for managing hypertension and then work to spread hypertension control improvement models to more practices and communities. A third area of AMA focus is enhancing medical education and training to better align with new realities within the current delivery system. In 2013, the AMA awarded $11 million dollars in grants to 11 U.S. medical schools to address gaps within the current medical education curriculum. This AMA
Wah
ACOG and AMA
135
initiative seeks to ensure the next generation of physicians is adequately trained in key areas and disciplines that will become important cornerstones in the future delivery system including: chronic health management, population health, team-based care, and widespread use of health information technologies. The 11 medical schools participating in the AMA grant initiative are now working to develop innovative curriculums to bridge current gaps in training. A learning consortium has been formed so these schools can facilitate adoption by sharing their curriculum ideas with each other and with other medical schools nationally. Just as the AMA played a foundational role in developing the first standards of medical education more than a century ago, we are precipitating transformational change in medical education today. Ensuring the next generation of physicians are well prepared is something ACOG has always taken seriously. The teaching and mentoring I received from ACOG as a Junior Fellow, national Chair of Junior Fellow Congress Advisory Council, and member of the ACOG Executive Board and Healthcare Commission has been instrumental in shaping my professional career. The ACOG program for medical students interested in obstetrics and gynecology careers is a model for other specialties. Today, through group membership with the AMA funded by ACOG, more than 4,000 Junior Fellows gain valuable learning opportunities and give voice to the AMA’s advocacy efforts—those that affect ob-gyns directly and others that are more global. As the AMA pursues its ambitious long-term strategy, it continues to address other wide-ranging issues important to physicians and the practice of medicine. The efforts I have outlined to improve medical education in this country, for example, must be accompanied by a commitment to adequately fund graduate medical education. Earlier this year, 5.6% of U.S. allopathic medical school seniors were not placed into first-year residency programs. This comes at a time when millions of newly insured Americans are seeking medical care services. This disconnect is real and could have dire consequences. Workforce experts predict that the United States will face a shortage of 130,000 physicians across all specialties by 2025. With a larger number of medical school graduates seeking residency slots combined with the growing national physician shortage, adequate funding for graduate medical education must be a priority for Congress and the future of medicine. The AMA’s “Save GME” campaign continues to call on Congress
136
Wah
ACOG and AMA
to preserve funding for residency training and expand the number of residency slots to produce an appropriately sized and geographically distributed physician workforce. Another important effort the AMA and ACOG must continue to work toward collaboratively is the ongoing implementation of the Affordable Care Act. The Affordable Care Act is not only expanding insurance coverage to millions more women, but coverage includes important preventive care services with no copays or deductibles. These essential services can keep women healthier, preventing acute problems from becoming more serious and more costly. In addition, the Affordable Care Act offers important insurance protections as well. It prevents insurance companies from charging women higher premiums than men—once a common practice. This new policy ensures that more women can afford coverage and get care, including treatment for genderspecific conditions. The Affordable Care Act also does away with preexisting condition denials, meaning women with a chronic disease can no longer be denied coverage. It also eliminates caps on the amount of care a person can receive annually as well as over the course of their lifetime. The Affordable Care Act also ensures that women are covered for other services that are vital to their sexual, reproductive, and overall health, including Pap tests and human papillomavirus screenings. Also covered are important services such as counseling on sexually transmitted infections, human immunodeficiency virus and contraception, screening for GDM, breastfeeding support, screening and counseling for depression, and domestic violence. These services will improve the health care quality—and health care outcomes—of millions of women across the nation. These advances were won as a result of collaboration within organized medicine and demonstrate the value of working together. While we work to translate better coverage into better care for our patients, we must also work collaboratively to improve parts of the Affordable Care Act that do not work well for physicians. The AMA, like ACOG, continues to call for the elimination of the Independent Payment Advisory Board, which grants this isolated body the ability to impose Medicare payment cuts with little accountability. The AMA is also working to address concerns over narrow networks, in which some insurers are excluding physicians from their panels with little or no explanation or justification. Medical liability is another important piece of common ground to forge. While the AMA continues
OBSTETRICS & GYNECOLOGY
to urge Congress to pass Medical Injury Compensation Reform Act-like reforms pioneered and successful in California with caps on noneconomic damages, we recognize that other incremental steps may offer the best opportunity for advancing this issue. The AMA continues to advocate for additional funding to develop promising reform alternatives, including safe harbor protections for the practice of evidence-based medicine, health courts, early offers, and administrative determination of compensation. The AMA and ACOG are also well aligned on keeping lawyers and legislators out of our examination rooms and protecting the sanctity of the doctor–patient relationship. Through the AMA State Advocacy Resource Center campaign, “Keeping politics out of the examination room: protecting the patient–physician relationship,” the AMA has worked with ACOG to combat state legislation regarding dense breast notification, ultrasound, and fetal heartbeat laws. Meanwhile, through the Scope of Practice Partnership, the AMA has joined forces with ACOG to help establish state regulations on the practice of lay midwives. These examples are just a sampling of how the AMA is working with ACOG to shape a better future for health care. The AMA is not only tackling the acute issues affecting physician practice, but we are pursuing a long-term agenda that defines and advances important issues for our medical profession and for each of us as physicians. Forging common ground makes common sense. As physicians, we know that the best patient care often comes as the result of teamwork. We all want to do our best for our patients, and sometimes doing the best means working with others—others who may have different skill sets and resources.
VOL. 124, NO. 1, JULY 2014
Teamwork is the same in organized medicine. Individual physicians and state and specialty societies can benefit from the extensive skill set and ample resources of the AMA. From working to permanently repeal the Medicare Sustainable Growth Rate to marshaling powerful forces to fight chronic disease, to helping us sustain rewarding practices, the AMA is engaged in the important issues affecting physician practices and the care of their patients. At the AMA, the ACOG delegation, headed by Dr. Carol Brown from Memorial Sloan Kettering Cancer Center in New York, is the second largest specialty delegation and larger than most state delegations. AMA membership determines the size of delegations so each ACOG member who becomes an AMA member will help increase the ACOG delegation in size and stature in the AMA House of Delegates where AMA policy is developed and voted on. These are exciting, challenging times in health care and there are a lot of forces aligned against our profession. Now more than ever, physicians need to join together. If you are an AMA member, thank you for your membership and support. If you are not a member, please consider joining your physician colleagues in these times of change, challenge, and opportunity. I look forward to working with my ACOG colleagues in the year ahead in shaping the best outcomes for physicians, patients, and medical students. By joining together and focusing on the common ground we share, I believe we can shape a better future for health care in this country. Help me be successful as AMA President and send me your comments, compliments, and criticisms to Robert. [email protected]. You can follow me on Twitter (@RobertWahMD).
Wah
ACOG and AMA
137
