Then and Now
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.
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 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 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 is 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, 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 new 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. 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
“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.