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Published on Monday, April 14, 2014

Inclusive policy making

By Cindy Firkins Smith, M.D. and Dave Thorson, M.D.

For the past few years health care in Minnesota and across the country has experienced dramatic change. This has not only impacted our patients; it has affected every physician and every practice (IT, reimbursement, employment, quality, generational changes and more).

As the environment of medicine has changed, so too has the MMA, especially when it comes to how we create policy. We are morphing into a nimble, inclusive policy making body.

This evolution has come through a lot of hard work. We are striving to address new issues, communicate more effectively, and continually demonstrate value for all physicians. Over the past three years we have undertaken the challenges of changing the fundamental governance of the association. We have worked to become more agile and engaging, to focus on the most important issues to the largest number of physicians, and to expand our influence in the many issues of public policy affecting our patients, practices and personal lives.

One of the most debated changes has been the transition from the MMA House of Delegates (HOD) to a more agile and responsive approach to policy making. This change was the subject of many internal committee and task force conversations, and extensively discussed last September at the HOD. At that time, the HOD recommended suspending its activities for three years in order to try a new approach to policy making – the use of policy forums, broader member input and a new policy council.

We are now just six months into the new process. In fact, the policy council will meet for the first time in April. But, given recent events, we can see that we are well on our way.

An unprecedented response
Legislation on legalizing medical marijuana gained tremendous momentum early in the legislative session. (The MMA last discussed this issue many years ago and had a policy of neutrality on the topic.) In early March, we hosted a policy forum bringing together physicians (members and non-members) from around the state to learn about the topic, discuss pros and cons, and share recommendations. A few days later, we surveyed MMA members – nearly 900 respondents provided additional input and direction. We’ve rarely had this kind of input on policy in the association’s 161-year history. Information from the policy forum and survey was discussed by the MMA Public Health Committee (in the future this is the kind of topic that could be reviewed by a fully formed policy council) and helped guide the formation of a recommendation to the Board of Trustees. The board subsequently discussed and approved a policy. While individuals may or may not agree with the policy decision, we are confident that all will agree that the MMA created a rich and inclusive decision-making process on behalf of Minnesota physicians. 

The old way of setting policy – via the HOD – wouldn’t have worked as well for this issue because the timing was wrong, the range of voices wasn’t as deep or broad, and there would not have been enough time for in-depth education and discussion.

We won’t always have issues that are prominently featured in the daily newspaper or that generate as much passion with our members as medical marijuana, but here’s hoping we are on the right track with our new inclusive policy making strategy!

Tell us what you think.

Smith is the MMA’s current president. Thorson is chair of the MMA Board of Trustees.

Comments (9)Number of views (149)

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9 comments on article "Inclusive policy making "

Patricia D'Aquil

4/15/2014 5:45 PM

Obviously, there was a response that indicated MMA members were most anxious to have their opinions heard. Reflecting their consensus in your policy making will convey a sense that their opinions mattered and encourage their continued involvement in the organization at a time when changes in the practice of medicine seem to occur at mach speed


Greg Plotnikoff

4/15/2014 6:06 PM

Your point is very well taken re: timing and MMA capacity for responsiveness. 900 responses is absolutely worth celebrating. In my humble opinion, most physicians are bored with public health promotion issues like smoking, seat belts or obesity. No clear added value for a physician to add his or her voice to these worn out topics. However, on the medicinal marijuana issue, the MMA has done a superb job of convening, facilitating and responding with a new, uniquely well-informed professional voice in a very timely manner. Double-bonus for the timing of Minnesota Medicine's issue. Great job!


jeff taber, md

4/15/2014 6:26 PM

Marijuana policy at this time: Very reasonable approach.

Whatever we do, our input on this matter should be no less scientific, evidence-based, and ethically guided than any other promoted medication use / treatment protocol.

Political correctness should have nothing to do with our medical professional opinion / advice.


Richard Morris, M.D.

4/15/2014 8:17 PM

It has been said many times that the policy forums and the HOD are two separate entities that could have co-existed, each with its own strengths and uses. The fact remains that the HOD was the way the rank-and-file docs could hold leadership accountable to the members, through annual resolutions and debate, and that accountability is gone, at least for three years. The input on the marijuana issue was great, but it did not require dissolution of the HOD to accomplish that.


Terese Shearer

4/16/2014 9:06 AM

How about asking members whether they think we need a law regarding conscience protection? Previous laws were decimated by Obamacare. Personally, I don't want to be required to do abortions or prescribe the morning after pill, let alone assist with suicide or all the other myriad tasks that medical doctors may be asked to perform, when we have pledged to "do no harm".


Dick Geier

4/16/2014 9:45 AM

Good policy! New drugs or delivery systems should be tested scientifically and proved to be safe and effective before being allowed to be marketed. E-cigarettes and tanning beds are examples where this was not done and then we have to address something that already has a foothold.


Brendon Cullinan

4/16/2014 9:46 AM

The MMA is on the right track, and the response to the recent legislative proposals is heartening. The public does value the contributions of physicians to this debate. In this case there was no economic self-interest in our advocating a position on medical marijuana; but too often the MMAs policy statements reflect that bias. When we rail against pharmacists giving vaccines and nurse practitioners prescribing medications I fear we lose credibility in the eyes of the public. Will this new way of developing and representing the physician perspective on public policy affect that aspect of the MMA's voice?


Robert Doan

4/16/2014 11:00 AM

The policy on marijuana is an excellent job of combining 900 (!) opinions into a well-reasoned scientific and legal policy for something that might help but has not really been studied. I always thought the HOD was a superb example of real democracy in action, and I hope it does not go away permanently. However, this most recent result on medical marijuana is a quicker and very acceptable substitute for handling one issue and should be used in other situations. Perhaps the proposed reclassification of hydrocodone combinations needs this kind of input. AMDA just put out a survey about that topic.


Jeffrey D. Nelson

4/17/2014 2:50 PM

The formal MMA position based on the input of membership was a thoughtful process. I appreciate this mechanism for effective input and efficient use of our time. The ongoing challenge for our society is to give alternatives when they are safe and likely to be effective, but to avoid the pitfall of a policy that increases risk to our patients, is not verified with scientific research, and only enables someone to make more money.

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