I have a few questions for you:
- Who do you think fights for pathology when decisions are being made by about healthcare?
- When CMS or insurance companies are deciding how to slice the pie or to lower some reimbursements over others, who reminds the relevant parties that we exist, let alone how crucial we are to the system?
- Are the internal medicine doctors making sure we get recognized for our part in all of the labs they order to diagnose a patient accurately?
- Are the surgeons ensuring we get paid for them documenting the correct procedure and clinical history?
I can tell you who, the answer is simple… pathologists.
Hopefully, you are thinking about it and realizing it makes sense. But how does this happen? I’m here to help explain how the CAP and AMA can work synergistically to get your voice heard.
Pathologists’ Presence within the AMA
We all know that bills and policies are voted on. What less of us may know is that those who vote are bombarded daily from all sides about why their way is right. If voters only hear from the insurance companies or surgeons, that’s the only side they know. We need to make pathology's voice heard, and the CAP works hard to ensure this happens. What even less of us know is that the American Medical Association (AMA) has a pretty big voice in Washington, DC. For better or worse, whether you’re a member or not, whether you agree with the AMA’s decisions, they are the voice of medicine as a whole on 'The Hill'
I have been active in the AMA for 16 years, 10 of which I’ve had a House Delegate position (I’ll explain more in a moment). And I assure you if I had a dollar for every time I heard, “Why are you part of the AMA?” or “What do they do for me?” I could retire... or at least eat a nice meal. I completely understand why some people may sometimes feel frustrated with the AMA. I, too, have had these feelings. But I will never understand why a physician would not be a member of the organization speaking on behalf of All Medicine. While the CAP is the only voice specifically for pathologists in Washington DC, imagine the impact if the same discussion points are coming from several large, influential organizations.
What most people do not know is the AMA has numerous sections. The main ones are:
- Medical Student Section
- Resident and Fellow Section
- Young Physician Section
- House of Delegates
Other sections include the Minority Affairs Sections, the Women Physician Section, and the Specialty Society Section, where pathology is heavily involved and has had representation on the Governing Council for years. Also, there is a Pathology Section Council that consists of delegates and alternates from the CAP as well as several other pathology organizations: ASCP, NAME, USCAP—we meet to ensure pathology’s needs are heard in the House.
Broadening Pathology’s Influence
You may be thinking, "That’s all well and good, Nicole, but what does it all mean? What does a delegate do and why should care? Why should I give money to the AMA (namely dues) if they just supported X and I prefer Y?" Keep on reading, and I will tell you.
The AMA’s main section is the House of Delegates, consisting of about 550 delegates (number varies based on dual membership…see below) and corresponding alternates who represent all 50 states, as well as federal service organizations, national medical societies, and specialty groups. We meet twice a year for five days to read, discuss, edit, re-read, re-discuss, re-edit, and then vote on HUNDREDS of resolutions.
That's right; you read that correctly, HUNDREDS of resolutions. Vote on.
Everything the AMA says or supports has been voted on by 550 or so of your peers—physicians from all specialties and states/ regions of the US. We gather in a big room and discuss each item under strict parliamentary procedures, sometimes for a few minutes, and sometimes for hours. People get intense, people get passionate, and sometimes, after arguing a specific position all morning, it can be near infuriating when the vote doesn't go your way. But does that portion of the delegation quit? Of course not—that would be leaving medicine to the wolves (and depending on which side you’re on, the other side is always the wolf). Though it can be frustrating, it’s also riveting and genuinely uplifting when you get something passed that will help your patients!
An excellent example is the recent FDA deferral changes to blood donation – this is directly related to a resolution that was put forth by the Pathology Section Council that was voted through and then acted upon by the AMA. Boom...the federal policy changed. It took a few years; this is the government we’re talking about. Other examples include fighting against numerous CMS payment cuts, arguing against LCD used universally, and other payment-related issues. There are hundreds of other examples; I could go on and on.
Join the AMA for the CAP
Now you might still be thinking, “Why does my AMA membership matter?” The number of pathologists who get a vote, also known as the CAP’s delegate number, directly depends on how many AMA members we have! The more dual-members an organization has, the more votes they get on the floor…pure and simple. Your membership really does matter.
This concept may sound complicated, so I invite you to contact me with questions or comments and come to a meeting. It’s free, it starts on a weekend, and all are welcome. It is in Chicago every June, and it rotates around the country for November...so it should be reasonably close to most of you at some point. Come sit in on the discussion. Watch 1,000+ doctors discuss patient care and healthcare policy. It’s an amazing sight to see. And it's worth your time, worth your effort, and it’s most definitely worth your membership dues.
Nicole Riddle, MD, FCAP is a pathologist with Ruffolo, Hooper, and Associates, a medical practice consisting of board-certified pathologists based primarily at Tampa General Hospital. Previously, she was laboratory medical director and the sole staff pathologist for a cancer center in Northeast Alabama. Prior to that, she was faculty at UTHSC San Antonio, where she was actively involved in resident/fellow/medical student training. She trained at the UFCOM, Gainesville, AP/CP at Moffitt Cancer Center/USF, Tampa, and did Bone/Soft Tissue with an additional focus in GI/Liver and Derm at UPenn. She currently sits on committees and councils for the College of American Pathologists, AMA, USCAP, and DPA.