By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

 “I am often reminded of the adage, ‘If you are not at the table, then you could be on the menu.’ If I am not getting out and having my voice heard by those who make decisions, I am not doing my job.”

– Pat Rusk, elementary school teacher and former president of the Utah Education Association

In an energetic meeting marked by some controversy, California physicians debated priorities for supporting health care in rural parts of California and ensuring access to safe obstetrical services at the California Medical Association (CMA) House of Delegates (HOD) meeting in Sacramento, October 26-27, 2024.

CMA membership is dominated by physicians working in urban and large suburban areas, especially those working at large medical groups such as Kaiser and Sutter. Although the two issues under discussion were especially important for rural clinicians most CMA members expressed support for their colleagues who have chosen to practice in rural settings.

For rural health, 14 recommendations were adopted by the HOD, including:

• Supporting public health-funding allocation models to ensure adequate funding for small rural counties.
• Calling on congress to increase the number of visa waiver slots available in California for physicians practicing in rural areas.
• Calling on Department of Health Care Services (DHCS) to remedy the systematic undercounting of American Indians in Medi-Cal data.

One area of controversy was a proposal to create a Section of Rural Physicians with influence at the Board of Trustees level. The executive leadership and governance committees agreed to take up this topic at a future meeting.

To kick off the OB access topic, Surgeon General (OB/GYN) Dr. Diana Ramos presented up-to-date data on serious maternal morbidity and mortality in California and unveiled her pre-conception screening program, “Strong Start & Beyond.”

For obstetrical services, 18 recommendations were adopted by the HOD, including:

• Support for funding low volume hospitals using mechanisms such as standby capacity payments.
• Alignment with increasing the support for training clinician workforce to provide obstetrical care, including perinatal case managers.

The role of family physicians (FP) that are trained to provide operative obstetrical services in rural areas generated some controversy, with urban/academic OB/GYNs expressing skepticism that FP[1]OBs can provide safe care in rural areas, while family physicians working in rural areas spoke up to defend their role in providing rural obstetrical care. This is not a settled issue; continued advocacy is needed to educate urban OB/GYNs on how OB care is provided in rural areas.

The other important action of the HOD was that in a tight, three-way race, pediatrician Dr. Rene Bravo of San Luis Obispo won the election for president-elect. He presented an excellent understanding of rural issues and primary care; representatives from district X and XI were pleased with his election.

Many physicians from Partnership’s 24 counties enthusiastically participated in the activities, including seven Partnership medical directors. County medical societies in CMA districts X and XI represent 23 of Partnership’s counties (Marin is served by district VIII). These districts were especially active in presenting amendments and debating the proposals.

The medical directors at Partnership strongly encourage all physicians in our service area to join the CMA and their local medical society to ensure representation and a voice in CMA policy decisions. Ideally, the organizations hiring these physicians would support the membership dues because physician advocacy complements other mechanisms for influencing health policy in Sacramento, such as trade organizations and specialty organizations.

In addition to being a member of your local medical society, if you have interest in influencing health policy, the first step is to attend the county medical society events and executive committee meetings, volunteering to be a delegate or alternate delegate for the HOD.

The next HOD meeting will be on October 18-19, 2025, in downtown Los Angeles. If you want to learn more about how to influence our health care delivery system and support policies that support the health care system in rural California, we encourage you to consider attending!