CMA House of Delegates Report

By Sean Deane, MD

After several years of primarily virtual sessions necessitated by COVID and other challenges, the 153rd session of the California Medical Association House of Delegates met in person again at last for 2024. Sacramento hosted the House from October 25 to October 27 to bring new leadership into the fold and address two of the fundamental major topics facing medicine in our state: the growing twin crises of rural health and maternal health care deserts.

The House of Delegates, as the member representative body of the California Medical Association, is comprised of almost 500 physician leaders chosen from among constituencies of their medical societies and modes of practice. It meets annually to debate and improve policy on the serious issues affecting medicine today, with virtual sessions throughout the year in which proposed policy making resolutions are processed.

The first day of the three-day House of Delegates agenda is devoted to smaller constituent meetings, then the remaining two days are mostly spent in plenary sessions. Accordingly, the Friday pre-session on October 25 was devoted to meetings of several of the individual practice forums (The Young Physician Section, Solo/Small Group Practice Forum, Ethnic Medical Organization Section), administrative meetings such as the Board of Trustees meeting, and a discussion panel on the rising role of artificial intelligence in medicine.

The October 26 proceedings started with our District XI delegation meeting to review the day’s policy making plans, after which the plenary session began with the National Anthem followed by an Indigenous invocation from Miwok Elder Dr. Mary Tarango. Following basic business proceedings to establish procedural roles and approve medical society mergers, David Ford, CMA’s vice president of health information technology, presented information on initiatives undertaken by CMA to provide services to solo providers and other independent practices through its subsidiary, the Physician Services Organization. The Physician Services Organization provides an invaluable one-stop solution to managing the business side of an independent physician practice, removing critical barriers to the establishment of new medical practices that can address California's unmet needs.

There was an interesting presentation from Dr. Holly Yang of CMA’s Governance Technical Advisory Committee. She first reviewed the current structure of the House of Delegates, which took form after a major change in 2014. She then discussed opportunities for further evolution to hone and optimize the policy making structure of CMA and maximize our ability to protect the health and wellbeing of our patients and our profession into the future.

Choosing the leadership for the upcoming year is a primary task of the House of Delegates. There were three outstanding contenders for the office of president-elect, who will serve as president following next year’s HOD meeting: Dr. C. Freeman, Dr. Rene Bravo, and Dr. Ramin Manshadi. Each gave a presentation on Saturday morning, followed by a panel debate that was both informative for the electorate and collegial in its conduct.

In the end, after a well-run and mutually respectful campaign among colleagues, Dr. Bravo, a San Luis Obispo pediatrician, received the most votes. The electorate and other candidates all welcomed him as CMA’s new president-elect; it is perhaps the case that certain public officials and candidates would benefit from attending a CMA House of Delegates session to learn by example of what a productive election debate should look like.

The policy discussion began in earnest on the afternoon of October 26, addressing "maternity care deserts," the first of the two related major topics selected for policymaking for this year's House of Delegates. The facts are stark: it was noted that in a span of just 10 years, at least 35 hospitals in California had made the decision to stop providing obstetric services, with closures accelerating between 2019 and 2022. The House developed comprehensive policy to address reimbursement models, workforce shortfalls (including language regarding the critical importance of appropriate training and dangers of inappropriate use of nonphysician practitioners), and crafted innovative proposals to eliminate administrative barriers to use existing facilities (such as Department of Defense facilities). The policy document developed by the delegates will serve as a springboard to address this rapidly expanding series of holes in the fabric of

California's health care system.

After a long day of business, the October 26 deliberations of the House wrapped up with long-deferred in-person networking opportunities. We welcomed the installation of San Francisco pediatrician Dr. Shannon Udovic-Constant as CMA’s new president at the Presidential Gala, and delegates also had a chance to meet our newest up-and-coming colleagues at the Future of Medicine event.

Following another bright and early delegation caucus, the October 27 plenary session of the HOD reconvened with officer elections and award presentations, then dove right into the second major issue chosen for policy making at this year's House of Delegates: the critical hurdles facing rural health care delivery in California. Dr. Raul Ayala of Adventist Health, a major provider of California rural health care, presented on the current situation from the viewpoint of that major health care system. Meanwhile, Supervisor Rhonda Duggan of the Mono County Board of Supervisors provided perspective on the challenges county governments and the populations they serve face in ensuring the availability of adequate oral health services.

During the presentations, an eye-opening visual was presented as a reminder that although legislative activity often reflects the needs and opinions of just a few geographically circumscribed population centers, the vast majority of the land area of our state is rural. Following a lively policy debate, the House perfected and adopted an omnibus guide to help our legislators address existing and expanding shortfalls in care delivery to the frequently neglected populations that occupy that enormous land mass of our state. The adopted policy included important discussions with respect to ensuring the inclusion of medical technology and business skills in physician training to maximize opportunities for success in the establishment of small practices, provisions for financial assistance to small practices, and addressed public health allocation and regulatory models that are applicable to the real-world conditions that exist outside highly concentrated urban centers.

The 153rd CMA House of Delegates was, as always, an exhilarating and profound experience for the delegates honored by the privilege of representing their peers. It was an opportunity to hear and be heard, to learn and to educate. Importantly, it was a chance to shape policy that will be part of shaping California law as we work to protect our patients and our profession from the many enemies at the gate clamoring to divert our state’s resources to serve projects of profit instead of people. Service as a delegate is, critically, a way to get involved and make a difference. All CMA members are encouraged to learn more about how they can shape policy by becoming a delegate; to find out how you can get involved, visit cmadocs.org.