TMA House of Delegates
A representative democracy

Did you ever wonder how the Texas Medical Association comes to take a position on issues? Who decides TMA policy? Directly or indirectly, you do!

The TMA is a true representative democracy. Here’s how it works. DCMS sends 45 delegates to the TMA House of Delegates. Every year you receive a ballot to vote on TMA delegates (in addition to DCMS officers). Just like our state representatives in Austin and our congressmen in Washington, these delegates represent you and vote on your behalf on all the issues (resolutions) that come before the House of Delegates. The resolutions that are to be voted on must be submitted in advance. Resolutions can be submitted by a TMA Council, a TMA Committee, a delegation of the TMA (such as DCMS), or individual delegates. They are printed in a delegates handbook and are mailed to each delegate before the meeting. The DCMS delegation meets a few weeks before the House of Delegates meeting to discuss the resolutions. If a delegate finds, in this discussion, that he needs more information on the issues involved in a resolution, he still has time to do “homework.”

When the House of Delegates convenes, each resolution is assigned to one of four reference committees, which hears comments for and against each resolution. Every TMA member (that would be you) is welcome to attend reference committee meetings. After hearing all the input, reference committee members meet in closed session to make a recommendation on every resolution assigned to it. These recommendations are then printed overnight. Before the House of Delegates reconvenes the next day, the DCMS delegation meets at breakfast to review all the recommendations from the reference committees. The delegates may agree with many of the recommendations, but the entire delegation may disagree with the reference committee recommendation on certain resolutions. Other resolutions will generate heated debate within our own delegation. Unlike Congress, there is not a “party whip” who is trying to get all the delegates to agree to “party line.” Every delegate can vote his own conscience without coercion.

When the House of Delegates reconvenes, each resolution will be presented individually. The reference committee will be in the front of the room, and will give its recommendation and the reasons for it. Physicians will offer comments and debate from the floor. If the entire DCMS delegation is in agreement on an issue, a cochair of the delegation, Dr Roland Black or Dr Jerry Sudderth, may rise to speak on behalf of the delegation. If the delegation is divided, then any member may speak on his own behalf. After all viewpoints have been expressed, the House of Delegates votes on the resolution and any amendments made to it in the debate.

If the resolution was for the TMA to adopt a new policy, then passage of the resolution by the House of Delegates makes that the official TMA policy. If the resolution was asking for a study to be made of ways to deal with a specific problem, then passage of the resolution results in referral of that issue to the appropriate council or committee for study, asking it to take specific recommendations for further action to the House of Delegates.

Does all this sound dry and boring to you? Twenty years ago, I would have thought so. Growing up, I never aspired to be a politician. I never could get charged up over political debates my fellow students had in college. When I became a practicing physician, I found a virtual unanimity of political opinion around the tables in the doctors’ dining room. Opinions about what policies the TMA or AMA should or shouldn’t adopt were nearly as unanimous. I naturally expected there would be similar unanimity of opinion at the TMA House of Delegates. When I went to my first House of Delegates meeting many years ago, I was dumbfounded by the diverse opinions. At my first meeting, resolutions had been introduced asking for the TMA to adopt sweeping positions on gun control and abortion on the same morning! More importantly, I came to realize that sitting in the doctors’ dining room in a big city left me out of touch with the needs and concerns of physicians in rural areas. I found that some resolutions received a different final vote than they would have received at my lunch table in Dallas!

So, do you like TMA policies? Do you think they should be changed? Either way, get involved! Come to TEXMED at the Adam’s Mark Hotel in Dallas on April 18, and sit in on the reference committee meetings from 9:30 am to 1:30 pm and see how the process works. Let us know if you would like to serve as a TMA delegate. (New delegates begin as alternate delegates, sitting in and voting when a full quota of regular delegates is not present.) If you’re not involved and you don’t like the way things are going in organized medicine, then you have only yourself to blame!

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