Benefits of Association

Membership

By Michelle B.Caughey, M.D.  

Michelle Caughey, M.D.

I’ve been ruminating about associations in general and medical societies in particular. Associations are simply groups of citizens who come together for a mutual interest. Trade associations primarily have the financial interests of the trade as their focus and use their advocacy role mainly to protect the incomes of their members or member companies. There is a stark lesson, I believe, in the shortsighted actions and lobbying of the American automobile industry trade associations. They oppose laws that encourage the development of hybrid and fuel-efficient vehicles. And now, for a variety of reasons, the American automobile industry is in dire straits. One of those reasons is that the industry failed to anticipate the inevitable rise in gasoline prices and the interest and willingness to pay for environmentally friendly, fuel-efficient vehicles.

There are associations whose members share a common passion. Staying with automobiles as an example, there are groups of antique-car owners, who meet and travel together on the highways. And then there are the nonprofit associations/organizations where the shared interests are more complex. People who are passionate about the environment founded the Sierra Club. But, interestingly, many citizens contribute money to the Sierra Club because they have seen the club’s actions over the years and appreciate its voice on environmental matters. Some of those citizens may not agree with all the positions taken by environmental advocacy groups, but they are willing to support an organization that can speak to these issues in political and public arenas.

State and county medical associations, such as ours, have characteristics of all these various examples. First among them is the principle that doctors hold the best interest of patients and health care in their daily work and that we together can represent the policies, laws, and economics of the perfect delivery system. Much of what the CMA has done over the years, and very effectively, is to advocate to the California Legislature that doctors can police themselves by doing substantial peer review and education. In recent years we have seen an erosion of these privileges. The Legislature continues to introduce licensing requirements for specific kinds of education such as Pain and End of Life Care. So, clearly, the public does not agree with this premise entirely.

I find it fascinating that the federal government, through the Centers for Medicare and Medicaid, is working with the CMA on the GPCI issue. CMS gave the CMA the job of proposing a model for the GPCI component of Medicare reimbursement rates. The CMA, as an organization made up of county medical associations with specialty society representation, in the end, could not come to a comfortable compromise, since it would have required a reduction in fees for some of its members. It reminds us that the largest payer recognizes organized medicine as a trustworthy advocate for physician reimbursement. As we work with Medicare on related issues, we will need to keep in mind both the short- and long-term consequences of whatever we negotiate. My point in all of this is to demonstrate the value of participating in these organizations to have a voice in medical reimbursement.

Medical associations have a role in promoting the public good, particularly public health. During our history, doctors have responded in organized ways to epidemics such as polio. (There is an interesting section on polio in the recent history of county medicine, A Century of Medicine in San Mateo County, pp.45-49.) Under a very broad agenda, we can effectively advocate to government officials and the public. For example, medical associations were among the first to take a stand against smoking. Hospitals followed by banning smoking from their buildings largely because of the voices of physicians in those hospitals. Additionally SMCMA was instrumental in bringing about legislation mandating bicycle helments for children. These are simple examples, though not straightforward at the time. They required debate and discussion within physician groups and dialogue with various interested parties.

And, of course, associations have a social element. Humans are fundamentally social creatures. We enjoy each other in limited doses, each with our own tolerance. Broadening our social framework is important to achieve the other goals of our organization. Understanding the differences in practice styles, economic incentives, and social points of view keeps the Association "tuned in" to our members.