Question: What is power of the AMA presidency? Is it mostly a figurehead position these days?
Answer: I think the power of the AMA president is in the title. I've got a bully pulpit, so it comes down to my ability to present our agenda. If I show up tomorrow in Tulsa, call up the leading newspaper and say I'd be willing to drop by and meet with the editorial board, I'll get a hearing. Not because they know who I am, but because of my title and the experience behind it.
Q: At what point did you know you wanted to become a doctor? And why surgery instead of family practice?
A: There was never any question in my life, as far back as I can remember, that I was going to be a surgeon. That's all I ever wanted to be. I love to work with my hands. I also learned carpentry from my father, who had a shop in our basement. And I restore old cars.
Q: You grew up in Kansas and went to medical school there. How did you end up in Southern California?
A: The opportunity came with a chance to study at UCLA, where I did my internship and residency from 1962 to 1968. After that I was hired at the Veterans Administration hospital here. After three years was invited to help start the heart program down at Santa Monica Hospital (now Santa Monica UCLA Medical Center).
Q: What led you to heart surgery as a specialty?
A: I originally wanted to be a plastic surgeon. They had a tremendous plastic program at the University of Kansas, but I come out here and it's all cosmetic surgery. They weren't doing the really exciting reconstructive procedures I got to see back in Kansas all these grotesque farm injuries where they'd be putting people back together. But there was a lot happening in UCLA's heart program, which was in its infancy. In my first year as an intern, I scrubbed in on the first artificial aortic valve that was put in at UCLA. That just blew me away.
Q: You were still establishing your practice when you got involved in organized medicine. How did that happen?
A: Not long after we started our private practice in 1974 malpractice insurance went up 386 percent almost overnight. That was just out of the question. I couldn't afford it. So we just stopped doing regular surgeries for a while. We'd handle the emergency room calls and didn't charge people. We didn't have insurance and you couldn't be sued if you did it as a Good Samaritan. Eventually, a bunch of us from around the state got together and decided we weren't going to take it.
Q: And that's how United Physicians of California was born?
A: Eventually. We at first went to the medical association, but they kind of blew us off you young kids don't know what you're doing; we'll take care of it. So we said, to hell with you. About a dozen or so of us started going around the state holding meetings in hospitals, rabble rousing with the doctors there and decided to form our own organization. We eventually had more than 3,000 members, but starting out we were just a bunch of young guys in our 30s who didn't know anything about how to do this.
Q: Eventually you won the support of the local and state medical associations, right?
A: We got the attention of some of the people in leadership positions, particularly at the CMA, who became a little more friendly to what we were doing. The MICRA legislation wasn't something that we did on our own. The legislation was a CMA product, but we were the ones who had gotten the attention of the legislators and governor.
Q: But then you and your United Physicians colleagues joined the establishment?
A: Dr. Joseph Boyle, who had been president of LACMA and later became president of the CMA and the AMA, encouraged us to run for office. He pointed out that while we had done good work, there really didn't need to be two physician groups in the state, so why not get involved with the association? So we decided to take over LACMA. All of us who ran won because we had such name recognition, and I became treasurer. Dr. Richard Corlin, another West L.A. doctor from the United Physician days, was AMA president around five years ago.
Q: What is your platform as AMA president?
A: Historically when a new president came in, he'd bring his agenda and that's what the association would focus on. That never made sense to me because you're always jumping around every year among issues. Over the past several years the association has evolved this exhaustive agenda-setting process that's evolved with grassroots input. The president should go with those priorities.
Q: And what are those priorities now?
A: Among the top issues are medical liability, Medicare payment, and health system reform. Medical liability outside California has been tough; we can't even get a hearing on it in the U.S. Senate. We've been spending more time on the Medicare payment issue during my term because we had some fires to put out, blocking some decisions that would have slashed reimbursements and probably would have led to more doctors dropping out of the system.
Q: What about health system reform?
A: I personally consider system reform to be our biggest issue, because it encompasses all the others medical liability, Medicare, care for the uninsured.
Q: What do you consider the main problem with our system in the United States?
A: I spent a lot of time on this issue, traveled to other countries and seen what they do. The main problem with our health care is an ironic one: it's a crisis of success. We have so much to offer now, people are living so much longer, and they're gobbling all of this care we have to offer. It's these two tsunamis: technology and demography. Everybody's had their cataracts fixed, their hips replaced and two stents put in their arteries.
Q: What's the solution then?
A: I see a combination of government and private systems. It's becoming pretty clear that nobody can afford to give everybody every service they want for free. The first basic rule is that there's got to be a limit. Perhaps what we do is guarantee a certain basic level of care; then the individual has to pay for everything beyond that. We tried doing that with managed care, but it hasn't been enough. I'm a dyed-in-the-wool capitalist. I believe that if you make your money you have the right to chose to spend it on anything you want, and if that's medical care, so be it. But if you're going to ask other people to pay for your medical care, there has to be limits.
Q: Have you been able to maintain your surgical practice during your term?
A: Not really. Being AMA president is a three-year commitment first you're president-elect, then president, where I'm at now, and then past president. But I really had begun cutting back earlier when I became chairman-elect of the board two years before. I couldn't schedule surgeries because I wouldn't know this week what I would be doing next week. A commitment would come up and I would have to do it.
Q: Will you resume your career as a surgeon after your term is over?
A: I'm afraid that's about over. I don't think I'll go back. I'll be 72 years old and five years away from it by the time I finish my obligations. I could handle the surgery better than anything else, but there are a lot headaches involved in having a medical practice these days. I'm not sure I'd like going back to that.
Q: Any regrets about devoting so much of your career to association work?
A: Not at all. I tell doctors that in order for the profession to survive, you need to put some time into improving the profession as a whole.
Q: Any worries about staying busy once your term with the AMA is finished?
A: Not at all. We have a ranch in Colorado that we'll spend more time at. I haven't done any carpentry in a while, and I have all these old cars out back one is a '57 T-Bird that I've been tinkering on for years. I'll find something to keep my hands busy.
Dr. William Plested
Organization: American Medical Association
Born: 1936, Witchita, Kan.
Education: Bachelor's degree from University
of Colorado, doctorate from University of Kansas Medical School; surgical internship and residency at UCLA School of Medicine
Career Turning Point: Helping to form United Physicians of California in the 1970s to fight skyrocketing malpractice insurance rates
Most Influential People: His parents; a junior high school math teacher, Mr. Stuart, who made learning fun; and Dr. Mahlon Delp, a medical school professor who was the epitome of a doctor who would do anything for his patients
Personal: Wife Carolyn, a retired surgical nurse; five children (three from a previous marriage) and two grandchildren
Hobbies: Carpentry, restoring vintage cars,
hunting and fishing at his ranch in Colorado
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