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CHICAGO -- An American Medical Association (AMA) committee meeting Saturday turned acrimonious, with some progressive members criticizing a new policy vetting process they said muffles young doctors' voices and stymies advocacy on urgent issues of public health, such as the need to address global warming.

"Here we are with 3 hours together, and only five new ideas are allowed to be discussed," said Todd Sack, MD, representing the American Association of Public Health Physicians. Last June, he noted, Portland, Oregon saw 65 people die and hundreds severely injured during a heat event that he said was caused by climate change.

"Climate change is here now, not 10 years away," he continued. "We should be very disturbed and perhaps ashamed" that several resolutions that would have stepped up the AMA's national agenda on this issue were not approved for debate.

Sack's remarks were made during a 90-minute discussion on this one proposal, which was under consideration by the finance and governance reference committee at the AMA special meeting of its House of Delegates.

The new vetting process, and thus the conflict, came about because of the COVID-19 pandemic. After the AMA was compelled to replace its June and November in-person meetings with virtual Zoom sessions last year, leaders quickly realized that normal business conducted in virtual formats took much longer. Those speaking sometimes spoke for minutes not realizing they were on mute or were not promptly available when their turn was called. Technical glitches meant speakers often had to repeat themselves.

Due to these issues, a new process was put in place, in which fewer items would be considered at each virtual meeting. These items were decided by a new and anonymous 31-member resolutions committee, which scored each proposed resolution, thus narrowing down the agenda to a fraction of what would be covered in a normal session. Only those that received a threshold "priority" score made the cut.

For the current meeting, only 39 of the 166 resolutions were selected for reference committee discussion.

Resolutions dealing with Medicare coverage of dental, vision, and hearing services; pharmacy benefit manager reform; gender equity and female physician work patterns during COVID; racial and ethnic biases in scientific journals; and improving access to vaccinations all fell short, along with dozens of other timely and not-so-timely issues.

Two resolutions, entitled "Fulfilling Medicine's Social Contract with Humanity in the Face of the Climate Health Emergency" and "Fulfilling Medicine's Social Contract with Humanity in the Face of the Climate Health Crisis," one proposed by the California delegation and the other by the Resident and Fellow Section, would have propelled the AMA to be more aggressive in advocating for fossil fuel reduction, but they didn't pass muster as essential enough.

One resolution from the Texas delegation, which did make the cut to the dismay of many contingents of younger and more progressive physicians, was one that would make the resolutions committee a permanent entity. It was during this discussion that some delegates like Sack made more strident remarks.

Breyen Coffin, MD, an alternate delegate for the American College of Radiology, who said he had been a member of a prior resolutions committee, was adamantly opposed to a permanent one. "I can speak from firsthand experience that the resolutions committee is an inherently flawed and non-democratic process," he said.

"There's no opportunity for discussion in this committee," he continued. Rather, it prevents the AMA "from exploring more creative solutions to increase efficiency." Now "we have a growing backlog of good health policy from our state and specialty societies that needs to be heard ... Frankly, an AMA with a permanent resolutions committee, which continues to squash controversial regional and specialty issues, is not an AMA I believe is worth my membership."

David Rosman, MD, president of the Massachusetts Medical Society, said the resolutions committee is using an "arbitrary" cutoff of 2.72 points, where a one one-hundredth of point difference causes an item to fail. "If it was 2.71, it failed. That's not actual decision making. That's an arbitrary approach."

"Desperate times call for desperate measures, and the resolutions committee has done its job and limited the number of resolutions to be considered in a virtual format," said Pino Colone, MD, president of the Michigan State Medical Society.

"The AMA has a long history of inclusivity. And to quiet those voices would go a long way to disenfranchise members of the AMA," he added.

While most speakers vehemently opposed making the resolutions committee a permanent fixture, some were in support of the idea as another way to winnow the volume of material that comes before the AMA each year.

Greg Cooper, MD, PhD, of the Kentucky Medical Association, said the resolutions committee should stay, even when AMA holds in-person meetings again. "The volume of material that we handle at the AMA has grown and grown," he said. Delegates should realize that when they vote on policy, they're also deciding how they use available resources and political capital, "and we can't attack every issue," he noted.

"I just want to make everybody aware that, you know, we were doing our best," said Lisa Egbert, MD, vice speaker of the AMA. "We were trying our best to streamline for this meeting. And we thank you all for your input and we look forward to your continued testimony."

Ultimately, the reference committee recommended to the House of Delegates that the issue of whether to make the resolutions committee a permanent fixture be referred for more study.

On Friday evening, AMA House Speaker Bruce Scott, MD, acknowledged the contentious nature of the issue. "I understand that some of you are critical of the process," he said, adding that Egbert and he "are sorry. ... But let me assure you that our singular goal has been to ensure that the House is able to continue its important work."

He pointed out that members have encouraged delegates to participate in the online AMA forums.

"Someone suggested to me the other night that 'some delegates don't read the online forum. So that testimony shouldn't count.' Well, I would respond that some delegates don't listen to verbal testimony either. But in either case, that does not nullify the fact that testimony was allowed," he noted.

Several items did get enough points to come up for discussion, including:

• Exploration of the AMA creating a "virtual water cooler" for members who may be experiencing burnout, isolation, or anxiety to encourage "collegial communication with each other"
• A push for the AMA to step up efforts to combat the health insurance industry's unilateral reductions in reimbursements, retroactive audits without cause, manufactured claims denials, egregious payment delays, forced arbitration in which physicians are required to pay for the process, and cancellation of contracts or arbitrary termination of providers
• The AMA becoming a lead association for self-employed physicians, helping them with legal opinions and advice regarding the contracts they enter with hospitals and health systems

The finance and governance reference committee will make a recommendation on passage or rejection of these items at Monday or Tuesday's House of Delegates session.

Joyce Frieden contributed to this report.

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