Besieged Fort

"The state of mind of most physicians today is one of profound disquiet." With these somber words, Dr. Charles A. Hoffman took office last week in San Francisco as the 127th president of the American Medical Association, long a monolithic organization with an extraordinary success record in defending the rights and privileges of physicians. Now many private practitioners see themselves threatened from all sides, and in his inaugural address Hoffman sounded like a man assuming command of a besieged fort.

"Almost daily," he said, "there are new infringements on the way we practice, intrusions by government and by other third parties. Almost daily there are attacks on our methods of practice, on our methods of payment, even on our motives and lifestyles. And always there hangs over us the looming specter of a massive government health program."

As if these assaults from without were not enough, there are also defections and dissensions within the ranks. The A.M.A. lost 11,000 active dues-paying members in 1971, leaving it with 156,199, or 62% of the 253,000 eligible doctors. An estimated 10,000 physicians, perhaps half of them A.M.A. members, have done something that used to be unthinkable: they have formed unions (though many are called guilds or associations) for collective bargaining with hospitals and other employers.

Beleaguered though it appeared, the A.M.A. was in no mood for a radical internal overhaul. Last November, then-President Wesley Hall proposed that the A.M.A. draft an entirely new constitution. Despite speculation that the issue would at least be debated last week, it was barely mentioned. Instead, the hierarchy and the house of delegates administered verbal tranquilizers to those on both sides of several questions. While there was vocal opposition, for instance, to doctors' unions, which Hoffman thought would be improper, the delegates deferred taking any formal position on them.

Steps were taken to placate the younger physicians, interns and residents, who previously had not even been eligible for membership. This year, Dr. Eugene S. Ogrod, 27, a resident at Sacramento Medical Center, took a seat in the 241-member house of delegates.

Truism. In a marked softening of previous attitudes, the convention adopted a resolution, paralleling the recommendations of the National Commission on Marihuana and Drug Abuse, urging that felony penalties for the possession of "insignificant" quantities of pot be abandoned. In professional tones, the A.M.A. urged further scientific studies of cannabis.

The A.M.A., said Hoffman, sees no place for the consumer in its councils. However, the delegates last week voted to create an 18-member committee that will supervise graduate medical education, with one seat going to the Federal Government and one to a representative of the "general public." That move had been under study for six years.

A more important issue of public participation met heavier going. The A.M.A. insists that only doctors are entitled to check on other doctors' performance, and it took a long time to accept this "peer review," even in regard to such matters as the necessity for surgery. The next stage, peer review of fees and methods of payment, was up for consideration last week. But the issue was complicated by Utah Senator Wallace Bennett's proposal in Congress that "professional standards review organizations" be established to oversee the practice of medicine. Bennett would admit laymen to membership on these P.S.R.O.s. This was clearly anathema to the delegates, and they adopted an A.M.A. council report that roundly denounced P.S.R.O.s. Other questions of peer review were referred back to the council for more study.

Despite the pressures and criticisms, the A.M.A. obviously intends to move only with extreme caution. Dr. Russell Roth, the president-elect who will take office next summer, explained: "The A.M.A. will never please all its members. It will always be too liberal for some, too conservative for others." That truism could be a perfect excuse for severely limiting change in any direction.

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