AMA's first female president:
'What's best for patients?'
Nancy Dickey, M.D., center, chats with residents Garth Morgan, M.D., left, and Anna Lichorad, M.D., right, and observer Zenia Nicolwala, M.D., at the Brazos Valley Family Practice Residency. COLLEGE STATION, Texas -- More than 300 people at a recent fund-raising luncheon for a low-income clinic here were captivated by keynote speaker Nancy Dickey, M.D.
What the crowd didn't know was that the soon-to-be AMA president had just breezed into town to find that the speech she'd written on her computer while flying from Chicago wouldn't print. A back-up plan to read the speech from the laptop screen fizzled; the battery ran down. So the family physician extemporaneously addressed issues of medical ethics and professionalism.
"Even as we struggle with the new technology, even as we struggle with delivery systems, we are committed to doing what's right for our patients," she said.
The luncheon was just one activity in a nonstop day that would jangle the nerves of most people. But Dickey was unflappable.
Following Dickey's talk, she and her administrative assistant touched base regarding the goings-on at the Brazos Valley Family Practice Residency Program, where Dickey is director. Then Dickey headed to the county courthouse, where she successfully defended her $50,000 funding request for the residency. From there, she popped into the residency to read messages, meet briefly with residents, review her schedule and collect a fresh pile of work. And she was off. Destination -- an Oklahoma Medical Society meeting in Oklahoma City.
Dickey said her high energy level and supportive family and staff enable her to maintain such a hectic lifestyle. Her husband, Frank, and children -- Danielle, 21; Wilson, 19; and Elizabeth, 16 -- have tagged along to AMA meetings all over the world.
The second of seven children, Dickey said her life has always been packed with activity. "I could write the book on the 'type A' personality," she said with a laugh.
She has continued to see patients, deliver babies and take call during the time she's served on the AMA Board of Trustees, although she'll cut back in the coming year. "I do think leaders need to continue to see patients. Otherwise we're talking about something that you do and I don't," she said. "Frankly, for all I enjoy the policy and the administration and the challenges of problem solving, my heart is still in patient care."
The Academy nominated Dickey for a seat on the AMA board and supported her candidacy for board chair and ultimately president. Recognizing that she "has two parents" -- the AAFP and the AMA -- has kept her sensitive to issues of representation in the house of medicine. "The AMA must recognize that the federation of medicine is more than just geographic units," she said. "More and more we have to look at how physicians define themselves."
What's the significance of being the AMA's first female president? "Clearly, it's an indication that medicine is changing," Dickey said. "We have watched over the years as states, counties and specialty societies celebrated their first women trustees or their first women presidents, so to finally breach one of the last bastions is simply a confirmation that there is substantial change happening."
However, she quickly pointed out that being the first isn't nearly as significant as being the fourth or 10th female president. "If one woman gets elected against all odds, then it's not change; it's a fluke," she said. "I hope it's a sign that there will be some increasing diversity -- gender diversity, ethnic diversity, branch-of-medicine diversity -- among the people bringing their talents, commitments and voices to organized medicine."
As AMA president, Dickey has a lot to do in one short year. "The kinds of things I'm interested in are clearly indicative of the personality that made me a family physician," she said. "There's no one issue that has consumed my interest or energy, but rather a whole series of issues. It's never boring." Some of those issues are:
Medical ethics. Dickey said she "grew up" on the AMA's Council on Ethical and Judicial Affairs. "I was only two years out of residency when I was elected to that council, and biomedical ethics exploded on the scene. So I have a deep, abiding interest and affection for issues such as what it means to be a physician, end-of-life care, and the conflicts between continuing technology and cost constraints."
Health system reform. In her early years on the AMA board, Dickey addressed the Clinton administration's proposed national health plan. She spent her mid-years on the board dealing with managed care issues.
"Now for my presidential year, I hope it's time for the AMA to get to a relatively simple answer, easily understood, that has the goal of putting the doctor and the patient back into the decision-making process," she said. "I hope we'll address universal coverage and a way to pay for it. In a country that is spending hundreds of millions of dollars each weekend on new movies and heaven only knows how many millions of dollars on pet food and Nike tennis shoes, I find it hard to believe that we can't afford some defined level of health care for every American."
Women's health. "It's part of my agenda because I am a woman and because I have taken care of scores of women and because, while we have begun to address women's health issues, we still haven't eliminated the disparities both in access to care and in perceptions of care," Dickey said. "Any woman who has an opportunity to be a spokesperson has to look at those issues."
Nonphysician practitioners. Dickey said groups representing physicians and nonphysician practitioners are missing opportunities to cooperate and work together efficiently as they butt heads over who is qualified to do what.
"On the other hand," Dickey said, "it's terribly important for patients to be given appropriate information about different players in the health care arena. A nurse practitioner is not the same as a physician. Five hundred hours of clinical training is not the same as four years in medical school and three years in postgraduate training. We have to resolve the issue based on what's best for the patients."
By Sharon Dickinson Dent,
Associate Editor
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.
