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To understand what AMSA is today, you must understand our past as well as the past of other health activist organizations. As medicine has responded to the influences of society, so has AMSA. The practice of medicine was changed forever with the release of the Flexner report in 1915. This widely publicized report, supported by the Carnegie Foundation, claimed that quackery was rampant in a profession totally lacking educational standards. The outcry following this very controversial report resulted in the closing of more than half the medical schools in the United States, and one by one, the state legislatures adopted minimum standards for licensure. Medical education was formalized, standardized and moved exclusively into the university environment. Traditional medical institutions were again shaken in the mid-1930s as interns began an effort to improve their working conditions. At that time, internships were two years long, paid no salaries, prohibited marriage and required residence in the hospital. The Interns Council of America was formed, and the group won the first successful collective bargaining agreement, calling for $12 a month wages for interns. To expand their influence, the Interns Council of America formed a coalition with a medical student group, the Association of Medical Students, to create AIMS-the Association of Interns and Medical Students. Over the next 15 years, AIMS was in the forefront of the movement for change in the working conditions of interns. They advocated national health insurance and racial equality in medical education during the Great Depression, long before the advent of Medicaid or even private health insurance. Largely because it was identified with the organized labor movement, which was gaining strength in America, AIMS came under attack. Its endorsement of what were being considered radical causes in the days of McCarthyism led to its being labeled a "subversive" organization, and though the young organization fought hard to defend itself, all efforts were futile. Seventeen years after founding, AIMS was disbanded. The Student American Medical Association (SAMA) was founded in 1950 by medical students to counter AIMS, an activist medical student group. Like AIMS, it was vocal in its support of national health insurance and other progressive public health issues. Although established as an independent organization, SAMA's positions on most medical, social and political issues mirrored those of the American Medical Association (AMA). Joseph Garland, then editor of the New England Journal of Medicine, noted that the goal of the new organization was "to indoctrinate students early in the internal and external relations of their profession and to interest them in the organizational means through which these relations are intended to achieve uniformity." During the next two decades, SAMA grew to include chapters at almost all of the nation's medical schools. The organization's publication, the Journal of the Student American Medical Association was renamed The New Physician in 1957 to reflect the addition of intern and resident affiliate members. Other highlights during this period include the introduction of life, disability and health insurance plans, the establishment of the SAMA Foundation to provide low-interest educational loans, the launching of several art and scientific competitions and the founding of a women's auxiliary for wives of SAMA members. The late 1960s saw dramatic changes in the organization's objectives and philosophy. At the 1967 annual convention, the Stanford University chapter presented a formal proposal to withdraw from SAMA. Other chapters voiced the same sense of frustration with the organization's direction. For the first time, vigorous debate in SAMA's House of Delegates produced resolutions concerning health care for the poor and medically underserved. Soon after the convention, the first community health committee was created, and SAMA successfully proposed the first project to involve medical students, to be funded by the AMA. That same year, SAMA leaders surveyed the organization's members for support for a more activist SAMA. The following year brought even greater change to the rejuvenated SAMA. The resolutions passed at the 1968 convention set up mechanisms to expand the number of training programs for medical students and evaluate internships. The organization also began to take a stand on more socio-medical issues such as organ transplants and drug prices. In a speech to the AMA House of Delegates, SAMA's president announced that from that point forward, SAMA would chart its own course as an organization both philosophically and financially independent from the AMA. From 1968 on, SAMA increasingly provided medical students with opportunities to gain primary care experiences. Beginning with the 1969 Appalachian Student Health Project, the organization has placed students in community clinics, migrant health centers, Native American communities, rural and other medically underserved areas to expose them to career opportunities in community health. Another major area of interest for SAMA was medical education reform. In 1968, the SAMA Joint Commission on Medical Education, made up of students and medical educators, proposed numerous reforms and model curricula to make medical education more responsive to community needs. A short time later, SAMA co-sponsored the first national student conference on medical education. Since then, the organization has remained committed to the reform of medical education. In 1969, two medical students spearheaded a national letter-writing campaign in support of health professional student loans. SAMA also helped introduce the original Family Practice Act of 1970 and testified in support of legislation establishing and later expanding the National Health Service Corps (NHSC). By the 1975 annual convention, SAMA's place as the nation's leading medical student organization was certain. For this reason, and to make clear that SAMA was not associated with the AMA, the organization changed its name to the American Medical Student Association (AMSA). Throughout the years, AMSA has been critically involved in the health policy field. To become even more active in health policy and to be closer to sources of funding for community health programs, AMSA relocated in 1978 from Illinois to the Washington, D.C. area. Soon afterward, its leaders wrote and successfully supported passage of a bill that extended the tax-exempt status of NHSC and military scholarships. Since moving to the Washington area, the organization has continued its efforts to increase its impact on medical education. In 1977, both the AMSA Foundation and Association were reorganized under the leadership of executive director Paul R. Wright. That same year, the office of president became a full-time position, served by a medical student or recent grad, allowing each elected president to serve a one-year term in the national office. In a move to strengthen AMSA's role as a player in the health policy arena, the organization appointed its first full-time legislative affairs director (LAD) in 1985, a medical student who represents the interests of medical students on Capitol Hill and alerts association members to important health policy issues. AMSA has also bolstered the personal benefits it provides its members. The AMSA HEAL Deal, introduced by the AMSA Foundation in 1986, was the first discounted Health Education Assistance Loan (HEAL) program available to medical students on a national basis. AMSA currently offers a competitive, full-service loan and loan consolidation service. In 2004, AMSA announced its in-school consolidation program that allowed students to lock in interest rates at their lowest rates in 38 years by consolidating their loans while in school. If just 38% of eligible students participate, this program would save AMSA members over $100 million in interest payments. Many other benefit programs have expanded over the years as well, including book discounts, medical equipment sales, personal digital assistants and student health insurance. The AMSA Foundation has, throughout AMSA's history, provided medical students with opportunities to gain primary care experience in medically underserved areas. Since 1985, the NHSC Health Promotion/Disease Prevention Project has placed more than 2,700 medical and other health professional students in community-based systems of care to complete prevention-related service projects and to become exposed to community-oriented primary care in underserved areas. Currently, at least 20 percent of the students placed annually are preparing for careers as dentists, nurse practitioners, certified nurse midwives and physician assistants. A longitudinal evaluation and tracking system has been in place since 1988 to monitor the continued education and career choice of project participants. AMSA has long been committed to training primary care physicians. AMSA's Generalist Physicians In Training (GPIT) began in 1992 and focused on developing a community-responsive physician work force and increasing the number of medical school graduates entering primary care fields. At its peak, GPIT had more than 9,000 students participating in the program. AMSA has also piloted a Primary Care Apprenticeship to offer college and premedical students community health experiences. Currently, AMSA is a sponsor for National Primary Care Week-in 2004, we had over 269 student leaders participate in over 160 schools nationwide. Numerous programs through the AMSA Foundation address primary care leadership, including the Primary Care Leadership Training program that brings 40 students every year to focus on leadership primary care fields. By tradition, AMSA has had strong international health interests and ties. In the 1970s, AMSA led study tours to Cuba and China. In 1986, with the help of the Pew Memorial Trust and the "We are the World" Save Africa Rock Group effort, AMSA developed the first international consortium of medical schools for exchanging and training physicians in Nigeria, Ghana, Colombia and Mexico. AMSA's International Health Studies Center continues to expand and enhance students' experiences abroad, and we have sponsored foreign language and training programs in many countries. AMSA has made tremendous strides in becoming the leading voice of health professionals in calling for medical education reform. Following on our "Handbook for Change" in the 1970s, AMSA has pioneered numerous innovative programs. The AMSA Foundation currently has a five-year grant funded by the NIH to develop, promote and disseminate Complementary and Alternative Medicine education curricula and programs at medical institutions. The innovative Washington Health Policy Fellowship Program, initiated in 1989, and the State Health Policy Fellowship Program, launched in 1993, continues AMSA's commitment to provide medical students with unique health policy learning opportunities. Numerous institutes exist on the national and regional levels to further teach students about global health, community & public health and to develop students into physician-leaders. Some other major contributions in the late 90s and 2000s: in 1995, with the help of Public Citizen, AMSA convinced the National Resident Matching Program (NRMP) to change the Match algorithm in favor of students. In addition, AMSA succeeded in calling for full contract disclosure from residency programs before signing students on to the Match, and in calling for additional student representation on the NRMP Board of Directors. In 2002, 2003 and 2005, AMSA was instrumental in introducing federal legislation to limit resident work hours to improve work conditions and reduce medical errors. As a result of AMSA's work, the Accreditation Council for Graduate Medical Education changed their accreditation requirements to include tougher standards on resident work hours. In 2002, AMSA launched its now brand-named PharmFree initiative to encourage students to use unbiased sources of information on pharmaceuticals and to think critically about the drug industry's marketing practices to physicians. This initiative, and the Counterdetailing Campaign in 2005, have since been quoted by multiple lay and medical news sources, and have encouraged thousands of students to use integrity and professionalism throughout their education and careers. AMSA's legislative efforts have thrived. On the Hill, AMSA always been the voice that has stood up for patients. AMSA was instrumental in the support for the establishment of the National Health Service Corps, and fought for legislation on access to healthcare on the statewide and federal levels. It subsequently introduced legislation on resident-physician work hours that led to the 80-hour guidelines. In 2006, AMSA introduced to Congress the concept of the United States Public Health Medical College. This legislation, and another bill that AMSA also wrote to restrict pharmaceutical representatives access to resident physicians, will be introduced in the 109th Congress. AMSA continues to lobby on hundreds of pieces of legislation affecting medical education and healthcare, and members have the opportunity to develop further lobbying and leadership skills through the Paul Ambrose Political Leadership Institutes (named after past LAD Dr. Paul Ambrose who passed away tragically on September 11th, 2001). While we have taken the lead on our external priorities, we also have been proactive about establishing our internal infrastructure. The organization kicked off a three-year building fund program in 1990 to facilitate the purchase of a permanent home for AMSA's headquarters. In 1993, the building at 1890 Preston White Drive in Reston, Virginia, was purchased. The following year, an opportunity became available to purchase a building in an association park in Reston that would considerably reduce AMSA's operating expenses. This building, located at 1902 Association Drive, was purchased, securing a permanent home for AMSA and ensuring that the needs of the future generations of physicians -in-training would be met. Another major expansion occurred in 2005: a rural retreat center was established in Washington, VA, about an hour and a half from the national office. This retreat center, called the Paul R. Wright Retreat Center after AMSA's long-standing Executive Director, will be the home of AMSA's many leadership institutes and retreats. A further building expansion on AMSA's property in Reston is planned for the future. In terms of our internal structural: in 1997, some major changes were made to the existing student groups within AMSA. In an effort to unify and coordinate AMSA's activist efforts, four Standing Committees were formed to consolidate the 28 Task Forces that were in existence. These Standing Committees-Medical Education, Health Policy, Community and Public Health and Advocacy were intended to represent the various ways in which change can come about within the American Medical establishment. Standing Committees were intended to represent-long standing interests of the Association, or pillars on which AMSA's activity would be based. Along with Standing Committees, the third full-time student staff position was created. This position, Director of Student Programming, was designed to serve as a resource at the national office for all members of AMSA. As the role of the Standing Committees and of activism within AMSA evolved, other changes were inevitable. Two new Committees were added-Global Health and Humanistic Medicine. As the Standing Committees became more issue- and activism-focused, it was felt that the term Action Committees would be more appropriate and this was formally changed in 2001. AMSA now has six Action Committees: Advocacy, Community & Public Health, Global Health, Health Policy, Humanistic Medicine and Medical Education. Numerous interest groups (as of 2005, we have 13) also exist to provide a home for students who may have additional specialty or other specific interests that are not addressed by an Action Committee. Also, at the turn of the millennium, through consecutive strategic planning sessions, AMSA identified three priority areas for advocacy: Universal Health Care, Diversity in Medicine and Medical Student and Resident Well-Being. In this spirit, AMSA began the hard fight to reform resident physician working conditions and created a new student/physician staff position entirely dedicated to developing a long-term strategy for the universal health care initiative called the Jack Rutledge Fellow, in honor of an inspiring past AMSA leader, Dr. Jack Rutledge. The Strategic Priorities were evaluated in 2001 and 2003, and reaffirmed in 2005, and currently our four areas of focus are: Fighting for Universal Healthcare, Eliminating Health Disparities, Advocating for Diversity in Medicine and Transforming the Culture of Medical Education. May, 2006 is a time of transition for AMSA. AMSA's long-standing Executive Director, Paul Wright, is retiring after having served AMSA for 38 years. John Cudahy is replacing Paul as AMSA's next ED/CEO. AMSA will always be grateful to Paul, who assumes the title of Executive Director Emeritus, and will always remain in the hearts and minds of generations of physicians as a mentor, leader, socially-responsible change agent, and the person who truly made AMSA who we are today. As always, AMSA members continue to search for new and innovative ways to improve health care, health-care delivery and medical education. © copyright 2006 Benedictine University : All Rights Reserved |
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