By: Joseph N. McCormack, P. Maxwell Foshay; George H. Simmons
Date: May 25, 1901
Source: McCormack, Joseph N., P. Maxwell Foshay, and George H. Simmons. "Preliminary Report of the Committee on Organization." Journal of the American Medical Association, May 25, 1901, 1435–1451.
About the Authors: Joseph N. McCormack (1847–1922) was born in Kentucky and graduated from the Miami University at Cincinnati with a doctorate in medicine in 1870. From 1883 to 1913, he served as secretary of Kentucky's state medical board. He chaired the committee on organization of the American Medical Association (AMA) from 1899 to 1913.
P. Maxwell Foshay held a doctorate in medicine and served as the editor of the Cleveland Journal of Medicine.
George H. Simmons (1852–1937) was born in England and attended Hahnemann Medical College, Chicago, where he received his doctorate in medicine in 1882. He then returned to Lincoln, Nebraska, to practice medicine until 1899. He was editor of the Journal of the American Medical Association from 1899 to 1924.
American physicians were very factionalized in the mid-nineteenth century. Organizing efforts had failed, and medical colleges were not overly interested in being involved in this process. Sectional issues also divided the country. Differences in training divided physicians—some had been trained by apprenticeship while others were trained in medical colleges. There were also battles between types of physicians—homeopaths and eclectics battled with traditional practitioners.
After organizing in 1848, the AMA limited its membership to traditional, white, male practitioners. Those who did not fit these classifications had to establish their own societies. Besides struggling to keep itself together, it faced a number of issues. One major problem was with medical education, as over one hundred medical colleges were in existence, most of which did not require a bachelor's degree for admission. Another problem was attracting members. Very often the only permanent members were those who came to every convention, and, as its annual convention moved around the country, this was difficult to do. Others were "invited" to be members, but often they maintained their membership for only one year. The way that the AMA allowed representation from other organizations also had significant flaws. It was also very regional, as there were more members from the northeast than from other regions. Finally, only a small percentage of physicians were members.
Something needed to be done, and, in 1901, the Special Committee on Reorganization set forth its proposal, which eventually led to the AMA reorganizing itself.
Following the AMA's reorganization, its membership increased tenfold between 1900 and 1920. This increase solved one of its main problems: that it had previously possessed a very limited membership. Now, people who wanted to join the AMA did so simply by joining their local medical society. The AMA also became a national organization, instead of just reflecting the desires of the northeastern part of the Untied States. Furthermore, it created a House of Delegates, which allowed the delegates, elected by each state, and from several other societies, to make policy. This both eliminated the shifting number of voting members at each convention and provided a stable way to make policy.
With a larger member base, the AMA became actively involved in supporting and fighting a number of issues. It backed Abraham Flexner's report on medical schools, which greatly changed medical education by eliminating a large number of the substandard medical colleges and forcing premedical students to get a bachelor's degree before entering medical school.
In the second decade of the twentieth century, the AMA undertook a strong effort against medical quackery and patent medicines, mostly by educating the public. In the 1920s, it successfully fought against federal health insurance. During the 1930s, it opposed Social Security and loudly decried any thoughts of national health insurance similar to that in most European countries.
After World War II (1939–1945), the AMA successfully opposed President Harry S. Truman's (served 1945–1953) attempts to establish a national health plan. In the 1960s, it unsuccessfully opposed President Lyndon B. Johnson's (served 1963–1969) Medicare and Medicaid programs. From the 1970s to 1990s, it opposed more attempts by the federal government to create a national health insurance program.
Throughout the last half of the twentieth century, the AMA has been relatively successful at maintaining control over the medical industry, but difficulties remain, including skyrocketing medical costs and lack of health insurance for many. How the AMA will deal with these difficulties remains to be seen.
Primary Source: "Preliminary Report of the Committee on Organization" [excerpt]
SYNOPSIS: The proposal begins with a list of twelve recommended changes for the AMA, both in terms of how members are chosen and how the ruling body shall be constituted. It then outlines the current problems with the AMA, other advantages gained by these changes, and how the annual meeting will be altered. It concludes by discussing the financial benefits to the changes, and how the reorganization solves all of the difficulties outlined.
Your Committee expected at this time to submit a Constitution and By-Laws revised in accordance with its recommendations; these are not yet complete. They will be printed in time for distribution at the St. Paul meeting. The following embody the recommendations which will be incorporated in the Constitution and By-Laws to be submitted:
- The delegate body shall hereafter be known as the "House of Delegates of the American Medical Association."
- The House of Delegates shall consist of not more than 150 members and shall be created as follows: a, one delegate for every 500 members or fraction thereof of the state and territorial societies recognized by the American Medical Association; b, one delegate from each of the Sections of the American Medical Association, to be elected as are other officers of the Section; c, one representative each from the U. S. Army, the U. S. Navy, and the U. S. Marine-Hospital Service.
- Delegates representing the state societies shall serve for two years, one-half, or as near as may be, of such delegates to be elected the first year for one year only.
- Whenever the number of delegates exceeds 150 there shall be such a reapportionment among the affiliated state societies as will bring the total membership of the House of Delegates below that number.
- The House of Delegates—as the Sections—shall hold its sessions daily, from 9 A. M. to 12 M. and from 2 P. M. to 5 P. M., or so much of such time as may be necessary, provided that it shall hold no session on the morning of the first day of the annual meeting, nor during the time of the General Sessions.
- The General Sessions of the American Medical Association shall be composed of members and delegates who may be in attendance at the annual meeting, and the time of meeting shall be 11 A. M. on the first day of the annual meeting, 7:30 P. M. on the first three days of the annual meeting, and 12 noon (or such other hour as may be agreed upon) on the last day of the meeting, which session shall be for the installation of the officers for the ensuing year and other concluding exercises.
- All the officers of the Association shall be elected by the House of Delegates, but no member of the House of Delegates shall be eligible to any office whose incumbent is elected by that body.
- No one shall be elected a member of the House of Delegates who has not been a permanent member of the American Medical Association for at least two years.
- The election shall take place on the morning of the fourth day of each annual meeting.
- No one shall be elected to any office who is not present at the annual meeting at which the election occurs.
- The officers elected shall be installed at 12 o'clock on the last day of the annual meeting.
- The membership of the Association, in addition to the delegates, shall be composed of permanent members, honorary members, and associate members…
Objections to Present Conditions
No Present Restrictions of Delegate Representation
As the right to vote in the general sessions is limited to delegates who are presumed to represent others, this right should be carefully guarded. In all great representative bodies every precaution is taken to restrict the right of voting to those who are entitled to it. But at the annual meetings of the Association this restriction has become an impossibility. Registration of all who attend as delegates is such an enormous task that its accomplishment in a satisfactory manner is out of the question if there is the slightest attempt made to scrutinize the credentials. While the right of a society to send delegates is verified, attempt to limit each society to the number to which it is entitled would be fruitless. This could be done if there were a system of reporting membership, but not otherwise. As this system exists in but few states, any attempt at scrutiny in this regard is useless.
A large majority of those who attend the annual meetings do so without any authority to represent others. Nominally, delegates are supposed to be elected; practically, certificates are granted by secretaries of societies on request of those who desire to attend the annual meeting. While this may not be true in a few instances, the exceptions are so few that the rule is as stated.
Correct Registration of Delegates Now Practically Impossible
The By-Laws of the American Medical Association call for the preparation of the list of delegates for accuracy in calling the ayes and nays. At the last meeting over 1600 delegates were registered, and to get such a number in any uniformity for roll-call would be impossible in the time, and the calling of such a long roll as the list of delegates makes would take so long that this is now out of the question. In viva voce voting in the general body it is impossible to tell who are and who are not delegates.
Difficulties Increasing Yearly
The above difficulties are becoming more noticeable each succeeding year. The number of affiliated societies is rapidly increasing, and with this also the number of delegates increases. In brief, the number of delegates has become so great that a verification of the credentials is impracticable, and the separation of the delegates from the few who have not the right to vote is so difficult that the question resolves itself into this: Shall the delegates be reduced in number so that they shall make a body that is manageable, or shall the pretense of delegates be done away with and allow all to vote who attend the meetings? The Committee believes that the latter would be preferable to the present conditions.…
Other Objects of Organization
There are other evils to be met besides those enumerated, such as that which our confrères in England are meeting under what they call the "battle of the clubs." Lodge and club practice is only just beginning to be felt here and the only way in which to meet these is by counter-organization. Most of the quackery and fraud in its protean aspects against the people and much of the evils with which the profession of this country is afflicted are the result of apathy and lack of organization. Organization will give confidence to make effort, and with this confidence apathy will vanish.
There are medicosocial questions that may be worthy of consideration in a national representative body of medical men. Among these is the advisability of creating a department of insurance for the superannuated, for the establishment of a home for those among us who, through misfortune, have become incapacitated, for mutual protection in malpractice suits, etc. Medicoethical questions are continually arising, such as that now prominently before the profession, namely, the giving of commissions. Such questions as these should be met fairly and squarely by a representative body qualified to consider them.
The American Medical Association's Annual Meeting
The annual meeting, under the proposed reorganization, will consist of General Sessions, meetings of the House of Delegates, and meetings of the various Sections. The House of Delegates will meet at the same hours as the Sections, and in effect the House of Delegates will be the legislative and business Section of the Association.…
Functions of the House of Delegates
The House of Delegates, to all intents and purposes, will be the legislative and executive body of the Association and will take the place of the delegate body as it now exists. The only change from present conditions will be that the delegate body will be reduced in number and its members elected by the state societies only. It will elect all the officers; it will have control of all the affairs of the Association; it will be the mouth-piece to give expression to the desires of the profession of the country in regard to business and legislative affairs; and it will consider other problems affecting the profession from time to time as they arise. It will be a confederation of the state societies of the country, which in turn must be a confederation of the local societies in the state. Being created by the state societies, it must be responsible to them for its actions.
In the revised Constitution, the Committee recommends that the following be incorporated:
No member of the House of Delegates shall be eligible to any office in the Association.
By adopting this proposition, it is believed that "medical politics" will be reduced to a minimum.
The Board of Trustees shall have control of the finances of the American Medical Association as at present, and be considered officers of the Association, and therefore can not be elected from among the delegates.
The object of this is that there may be thrown around all financial matters as much protection as possible. While the Board of Trustees will be created by the House of Delegates, its term of office will extend as now for three years, one-third going out each year. Two-thirds of the Board of Trustees will always be independent of the existing House of Delegates and will be in a position to act independently as a protection should that body any year recommend some extravagant expenditure. As now the Board of Trustees could expend no money unless so ordered by the House of Delegates, except in the management of The Journal.…
As will be seen, the most important result of enlarging the scope of the state society will be the increased revenue. This is an important consideration, as now the lack of money prevents the execution of important measures. Only a few now contribute to the expenses, whereas these should be divided among the many, for all are benefited.
Referring again to the four states above, we find that the annual dues of the California State Society are $5.00, and that with the present membership this brings in $1310. With the county society members added, with dues $1, this would amount to $1162, not as much as at present, of course, but how much easier these dollars would be paid, compared to the $5.00 now. Illinois claims a membership of about 800, and the annual dues are $3, making a total income of $2400. If the members of the county societies should be included, and a per capita assessment of $1 were made, there would be an income to the state society of $3800, and yet the assessment on each member would be so small that certainly no one could object to it. The annual dues of Iowa are $2, which nets that body $1468 annually, whereas a $1 assessment on the members when membership of the county societies is admitted, will bring in $2734. In Ohio the claimed membership is 940, the annual dues are $2, making the total income to the state society $1880. Admit the members of the county societies and make the assessment $1, and the state society will have an income of $3940.
It might not be amiss here to refer to another phase of this question. The annual transactions of many of the state societies record the fact that the most discouraging feature is the collection of dues. In many societies this is an annual and a very vexed question. It is not an uncommon thing for a physician to join a state society, pay his annual fee, and then through non-attendance let his dues lapse for one, two or three years. These will then amount to such a sum that it has a great tendency to keep him away from the annual meeting and from becoming an active member again. Many societies adopt resolutions every few years remitting past dues, for the purpose of getting such men to come in and renew their membership.
The transactions of many state societies show that anywhere from 25 per cent to 50 per cent of the members are in arrears. In a circular now before us is an announcement by the secretary of one society to the effect that, while the membership is given as about 725, only 420 have paid their dues and are entitled to the transactions for the year. Under the proposed method, the county societies will collect the annual dues, adding to the sum necessary for local expenses $1 for the state society, and this will be paid direct to the state by the county society, as is done by other bodies.…
The Remedy for the Above Conditions
The only remedy for these evils is a systematic, all-pervasive organization, beginning with the county society as the broad foundation, and extending through the state societies to the American Medical Association, conferring, so far as may be possible, equal privileges and blessings on the members in New York and Chicago, and on those located in the remote hamlets of Maine and California. With such organization all things reasonably desired become possible to us, and through us to the people, for whom, as regards all protective sanitary and medical legislation, our profession must think and labor. What the Committee suggests will require time, much patient effort and no little expense.…
Each state society must insist (1) that there must be a society in every county where there are ten regular physicians; (2) that physicians must belong to their own county society, (an exception should be made where one lives much nearer to the place of meeting of an adjoining county society than to his own. In such cases his own society should have the privilege of granting him the right to associate with the other); (3) that where the population is scattered and physicians few, two or more counties may unite and form a district society.
Some of the recommendations in this report are not applicable to certain thinly-settled parts of our country. For instance, Arizona has only about 125 regular physicians, with about 62 members of the state society. Idaho has probably 190 regular physicians in the Territory and only about 48 are members of the state society. Montana has probably 275 regular physicians and probably 90 are members of the state society. Nevada has probably 55 regular physicians and about 25 are members of the state society. New Mexico has probably 130 regular physicians and about 30 are members of the state society. North Dakota has probably 275 regular physicians and about 125 are members of the state societv. Utah has probably 275 regular physicians and about 84 are members of the state society. Wyoming has less than 100 regular physicians and about 33 are members of the state society. It will, of course, be impossible to organize county societies in much of this territory, but the information for a complete enrollment of the whole profession of this country can be had in this territory with very little expense on the part of the representative bodies in them. These should be asked to co-operate to make our plan complete, although they should not be asked to go into the details as suggested, neither is it possible for them to do so. There may be other states not mentioned in which the same difficulty will arise. The Committee only suggests the above where it is applicable.
In conclusion, the Committee believes that the recommendations above made are in no way Utopian or impractical, but that they are such as can be carried out in every part of our great country and that they will result in a scientific, social, and material benefit to the individual and to the profession as a whole, as well as to the well-being of the people.
American Medical Association. Caring for the Country: A History and Celebration of the First 150 years of the American Medical Association. Chicago: American Medical Association, 1997.
Burrow, James Gordon. AMA: Voice of American Medicine. Baltimore, Md.: Johns Hopkins University Press, 1963.
Campion, Frank D. The AMA and U.S. Health Policy Since 1940. Chicago: Chicago Review, 1984.
Cooper, Melvin Wayne. The Adoption of a Code of Medical Ethics by the American Medical Association. Beaumont, Tex.: Lamar University, 1999.
Johnson, James A., and Walter J. Jones. The American Medical Association and Organized Medicine: A Commentary and Annotated Bibliography. New York: Garland, 1993.
Prabhu, Maya Gopika. "Bitter Medicine: The Role of the Canadian and American Medical Associations in Obstructing National Health Insurance Legislation, 1945–1962." Master's thesis, Harvard University, 1994.
"A Guide to Resources on the History of the Food and Drug Administration." Office of the Commissioner. Available online at ; website home page: http://www.fda.gov (accessed March 14, 2003).