History
Take a brief journey through the 177-year history of the Tennessee Medical Association.
By Brenda Williams
On May 3, 1830, 47 physicians gathered in Nashville to organize the Medical Society of Tennessee. The state legislature had passed a law that January making way for its creation – the product of intense lobbying by well-educated physicians hoping to improve the practice of medicine in their state. Surgery was crude, anesthetics was in its infancy, and they were concerned about rampant quackery and the lack of training and education among those who would hang a shingle.
Tennessee was no longer a frontier state but some of its early settlers still lived. One of the charter members of the Society, Dr. Felix Robertson, was the son of General James Robertson and the first white male child born in Nashville. He later served as mayor of Nashville and was president of the Medical Society of Tennessee in 1834-1840 and again in 1853-1855.
Still the Same
There are two well-documented, thorough compilations of TMA history, Philip Hamer’s The Centennial History of the Tennessee State Medical Association and History of the Tennessee Medical Association, 1930-1980, written by Dr. Rudolph Kampmeier. What is striking is that, as one reads through these volumes, there is a similarity of spirit and struggle that still exists today.
The TMA had and still has its membership challenges. In 1839, Dr. A.H. Buchanan lamented the “lack of unity” and low attendance at meetings; one 1849 meeting saw just nine attendees, and Society activities stopped altogether during vithe Cil War. In the 1940s, there were complaints about the “Old Boyism” within the House of Delegates and a movement by younger physicians to change what they saw as an ineffective, boring and cliquish leadership structure. Sound familiar?
There were also many years of frustration in efforts to influence the state legislature – for instance, it took the Society more than 30 years to win passage of a law creating the State Board of Medical Examiners. Some of TMA’s current-day legislative battles are decades old, while others appear to be headed for similar status.
Yet the organization’s years are also full of golden moments – crowning achievements that have bettered the practice of medicine in Tennessee.
Averting a Crisis
Without a doubt, TMA’s shining accomplishment in recent history is considered to be the creation of State Volunteer Mutual Insurance Company in 1976, now one of the nation’s largest and most successful physician liability insurers. At the time, Tennessee was experiencing another medical liability insurance crisis. Escalating lawsuit claims and judgements caused most insurers to cease writing such policies, and TMA led the charge to form a physician-owned mutual company that not only provides coverage but educates physicians about how to lessen the risk of medical malpractice lawsuits.
Then-TMA President J. Kelley Avery, MD, played an instrumental role in the SVMIC solution. “It was a time when TMA stood up and acted as the pivot around which physicians rallied, and produced an organization that has endured,” he recalled. “It should never be forgotten that the TMA, our organization of physicians, was where it all began.”
Advent of Managed Care / TennCare
To Chief Executive Officer Don Alexander, who joined the Association as a field representative in 1973, the advent of managed care in the 1980s marked a radical change in the practice of medicine. That, along with the 1994 launch of TennCare by executive order from then-Governor Ned McWherter, are two huge milestones.
“With the advent of managed care and TennCare, doctors became just basically overwhelmed, weary; they were forced to become less focused on patients and patient care, and more focused on the bottom line and paperwork,” he stated, adding that both issues are a major drain on TMA resources in terms of time and money spent to monitor, mitigate, negotiate and advocate on behalf of physicians and their patients.
In a moment of candor, Alexander explained the TMA is still working to recover from the negative impact of TennCare. “(Members) didn’t blame us, they supported us; we raised $1 million in a capital campaign to delay its implementation but when it didn’t happen, they took a defeatist attitude and even though they didn’t blame us for not being able to stop it, they somehow blamed us for not fixing it.” He said the TMA will never stop working for the good of doctors and their patients in these areas.
Advocacy Initiatives
For former TMA and AMA President Tom Nesbitt, MD, the milestones achieved during his tenure included legislative and public advocacy efforts initiated while he served as Legislative Committee chair in the late 1960s and as president in 1970. Home district meetings with state lawmakers, annual trips to Washington, DC, to meet with members of Congress, editorial board and news media meetings are still being used by TMA today.
Dr. Nesbitt said a personal highlight was his 1971 debate with U.S. Senator Ted Kennedy over national health insurance, when the Senator brought a nationwide tour on his HR-1 bill to Nashville. “I was briefed by the AMA people and TMA people on how to handle myself in front of Ted Kennedy; I sort of ignored their instructions and did it my own way, and it worked,” Dr. Nesbitt recalled, adding the issue was still being pursued by Sen. Kennedy more than three decades later.
Helping Impaired Physicians
TMA doctors had made efforts to assist their impaired colleagues starting in the late 1970s, but that movement strengthened in 1982 when it was formalized as the Impaired Physician Peer Review Committee. In 1992, the program was renamed the Physicians Health Program and placed under the auspices of the Tennessee Medical Foundation. “To me, that was a major milestone,” Alexander said. The PHP is now a model for similar programs across the nation and even worldwide, assisting doctors with recovery and advocacy in cases of addiction and/or mental or emotional illness.
New TMA Headquarters
Believe it or not, a new building has made all the difference for the TMA. That from several veterans who say the 1991 move from cramped, outdated quarters into a three-story headquarters facility was a positive change both organizationally and financially.
“We had to sell people on it,” recalled John B. Thomison, MD, editor emeritus of the TMA Journal and a member of the building committee. “We had to get out of the building we were in because it was in disrepair and we had no room to grow,” he said. The new offices were paid off within five years; they’ve allowed for staff expansion with potential for more growth as needed. In the meantime, the extra space is being leased for additional income.
Leadership Changes
In 1999, faced with declining membership and changing demographics, the TMA began examining its aging, antiquated leadership structure with an eye toward change. A Futures Task Force recommended updating and wider representation to inject new life into the organization. “We needed to make radical changes in order to be the vital organization we need to be in the future in terms of membership and political and marketplace influence,” stated
Tennessee Medicine Editor David G. Gerkin, MD, who served as FTF chairman.
The Board of Trustees also switched gears in 2003 and began mapping out annual strategic plans to keep the Association focused on top priorities. “The HOD is the membership giving us direction, but somebody’s got to step up and say ‘Here are the top 10’ and stick to it; otherwise, there’s a real tendency to waste resources,” Alexander said, adding TMA leaders knew they could not go down the road of “being all things to all people.”
The latest leadership milestone is the launch of TMA’s Physician Leadership College (PLC) to identify and train the next generation of physician leaders. “I think this will pay great dividends for the future of TMA to get physicians excited about organized medicine and what they can do to help their patients and colleagues,” said former TMA President John J. Ingram, III, MD, who was instrumental in implementing the PLC.
Insurance Lawsuits
Another standout moment was in 2002, when the Association signed on to a national class-action lawsuit against major insurance companies. The TMA and 19 other state medical associations have since won settlements with Aetna, CIGNA, Health Net Inc., Prudential Insurance Company of America, Anthem Inc. / WellPoint, and Humana, Inc.; the settlements of over a half-billion dollars include industry-leading improvements to physician-related business practices, as well as $384 million so far in cash recovery for physicians.
MLR Battles
In the category of important, ongoing milestones, our TMA veterans list the current battle to win medical liability reform in Tennessee. That battle continues, even after significant reforms were won in 2009 and 2010.
“We are in a crisis mode, we are a crisis state; it is a critical issue for us,” emphasized Alexander, who said the ups and downs on Capitol Hill are to be expected and doctors should not be swayed from their commitment to this issue.
“Doctors are trained to identify the problem, come up with a plan to correct it, fix it, and go on. We’ve identified the problem and the solution, but fixing it is not quite what docs are used to. You can’t cut it out or throw drugs at it, you can’t do treatment on it. You have to fix it in the political arena and there’s where the frustration and impatience sets in,” he said, adding the fight may take years but staying the course is no less than TMA’s pioneers would do.
TimelineJanuary 9, 1830
Tennessee Legislature passes “An Act to incorporate a medical society in the State of Tennessee.”
May 3, 1830
Medical Society of Tennessee organized; Dr. James Roane of Nashville elected first president. May 5-7, 1846
President Dr. A.H. Buchanan helps establish American Medical Association; he is elected AMA vice president.
1850
Society begins sending delegates to AMA annual meetings.
1857
Dr. Paul Fitzsimmons Eve elected first AMA president from Tennessee. April 20, 1866
Interrupted by the Civil War, the Medical Society of Tennessee holds its first meeting in five years to reorganize.
May 1867
Name changed to Tennessee Medical Society; the delegate system is established; first attempts to create county medical societies begin.
April 1876
Name changed to The Medical Society of the State of Tennessee.
April 1889
First female physician, Dr. Mary T. Davis of Knoxville, joins Society. 1889
Society wins state law requiring medical licenses and creating State Board of Medical Examiners.
1902
Reorganized as the Tennessee State Medical Association; county medical societies begin receiving charters; new constitution and bylaws label the House of Delegates as the business and legislative body.
June 1908
First issue of the Journal of the Tennessee State Medical Association published.
1909
First Board of Trustees elected.
1913
Committee on Medical Defense created to address liability issues.
1927
TSMA Women’s Auxiliary established; Mrs. W. D. Haggard of Nashville elected first president.
1930
TSMA celebrates 100th anniversary.
1937
TMA Board begins devising the Tennessee Plan, prepaid health insurance, at one point covering over 1 million Tennesseans and operating successfully until dissolved in 1966.
1943
Annual meeting of TMA canceled due to World War II.
1947
TMA Committee on Cancer helps establish the Tennessee chapter of the American Cancer Society.
1951
TMA establishes first annual award, “Outstanding General Practitioner of the Year.”
1955
Tennessee Medical Foundation established to assist with community healthcare, physician recruitment and support, largely in rural areas.
1963
TMA Student Education Fund established and funded for medical student loans.
July 30, 1965 Despite opposition and support of alternative plan by AMA and TMA, Medicare is signed into law.
1968
Medicaid (Title XIX) implemented in Tennessee with input from TMA Committee on Governmental Medical Services.
1972
TMA Committee on Emergency and Disaster Medical Care helps establish statewide EMS program.
1974
Health Maintenance Organization Act signed into law.
October 12, 1975
House of Delegates approves BOT recommendation to avert a malpractice insurance crisis by forming a physician-owned mutual insurance company.
April 2, 1976
State Volunteer Mutual Insurance Company (SVMIC) officially licensed.
1978
Impaired Physician Committee established.
1980
TMA sesquicentennial observed.
1982
Physicians Health Program created to treat and advocate for impaired doctors.
1991
TMA moves into new headquarters on 21st Avenue in Nashville.
January 1, 1994
TennCare launched by executive order from Governor Ned McWherter.
1997
TMA makes first big information technology investments, including Medwire.org and e-mail.
2002
TMA joins national class-action lawsuit against major insurance companies.
2003
Board of Trustees adopts Strategic Plan to set and analyze annual priorities.
January 21, 2005
TMA holds Town Hall Meeting to gauge support for medical liability reform; special HOD session leads to funding of MLR Campaign.
April 2005
Dr. Phyllis Miller of Hixson becomes TMA’s first female president.
February 14, 2006
AMA declares Tennessee a medical liability reform “Crisis State.”
February 2007
TMA Physicians Leadership College launched.
October 2009
First major medical liability reform law takes effect in Tennessee, requiring certification and notification for medical liability lawsuits, to help weed out cases that are deemed without merit.
August 2011
Gov. Haslam signs new into law a bill that sets the state's first caps on the amount of non-economic ("pain and suffering") damages that can be awarded in tort cases, including medical liability lawsuits.