Every physician can look around and see a policy change or improvement that could make life better for their patients and colleagues. The Texas Medical Association’s House of Delegates, the organization’s policymaking body, is often the best place to set reform in motion.
Via open, democratic, physician-driven input, the house serves as a forum for proposals that trigger change at the local, state, and federal levels.
“We have a practice-friendly environment here in Texas. That’s due to many of the policies developed in the House of Delegates,” said TMA President-Elect Bradford Holland, MD, an otolaryngologist in Waco.
The process starts with a resolution proposal by member physicians, who cast the net wide by discussing the topic with members of their local county medical society, specialty societies, TMA councils, committees, and sections, as well as relevant TMA staff, says Little Elm internist John G. Flores, MD, speaker of the house.
Any member can write a resolution and testify on its behalf, and then voting members of the House of Delegates, county medical societies, and TMA sections can decide to approve it or not.
“Our policy is made through the parliamentary process, led by evidence-based and peer-reviewed medicine,” Dr. Holland said. “We typically have many physicians with great expertise and diverse backgrounds eager to weigh in on what is being proposed.”
Once the research is done, the first audience for a resolution proposal will be one of four reference committees made up of physicians chosen for their expertise in science and public health, socioeconomics, financial and organizational affairs, or medical education and health care quality.
The reference committees typically do much of the vetting of resolutions – hearing testimony, asking hard questions, and probing for unintended consequences of a proposal.
The reference committee is where “most people have their eyes opened to the full implications and long-term benefits or consequences of the proposed policy,” Dr. Holland said.
The reference committee can recommend to the house that the resolution be adopted, adopted with amendments, not adopted, referred for further study, or referred for a decision by the TMA Board of Trustees or Board of Councilors. Resolutions may get a vote based on those recommendations or sent for further debate on the house floor, and they can face amendments in both the reference committee and the house.
Old-fashioned debate
In considering a resolution, a reference committee first hears open, online testimony from the author, who also submits written material supporting the resolution. During the COVID-19 pandemic, TMA found that taking the initial testimony online was an effective way to iron out problems early and made that part of the process permanent.
“We’re ending up with a better quality of resolution by the time it hits the house floor, and that’s made the house more efficient,” Dr. Holland said.
After the online testimony, the reference committee writes an interim report on what it thinks should happen with the resolution and then holds a live hearing to address the report.
“This is old-fashioned debate,” Dr. Holland said. “You need to be ready to put your points forward and be ready to refute those that are against you.”
The reference committee wraps up its business by sending a final report on the resolution to the house, including a recommended action. What happens in the live reference committee is frequently a preview of what happens on the house floor, where between 300 and 400 delegates – fellow physicians – representing their county will vote on the resolution during TexMed, TMA’s annual policymaking conference.
“As with anything, you never know. The will of the house could be different from the will of the reference committee,” Dr. Holland said.
Both the reference committees and the house follow the American Institute of Parliamentarians Standard Code of Parliamentary Procedure, he adds. It also helps to study the TMA Handbook for Delegates and TMA’s policy compendium.
And just because a resolution isn’t adopted by the house – or isn’t adopted right away – doesn’t mean it fails to have an impact. Since the house meets annually, any physician can study the issue further, find new ways to approach it, and try again.