In These Changing Times, What is the Role of Local County Medical Societies?

What is the role of a local or county medical society? Across the country, many state medical societies have been experiencing membership crises, as burned-out residents and young physicians focus on their specialty societies to establish their credentials and board certifications; on a local level, many county medical societies have also been closing shop due to declining membership.

Meanwhile, many of us are alarmed by proposed state legislation to repeal state school immunizations requirements this spring. Earlier this month, the board members of the Boone County Medical Society (BCMS) had a vibrant discussion about the role that organized medicine can play on a local level.

Overall, our BCMS has educational, social, and advocacy missions. Educationally, we use some of our dues (and endowments) to fund a few medical student scholarships. Pre-pandemic, we also held a popular “financial bootcamp series” for young physicians and graduating residents, to discuss loan repayment, home-buying, contracts, taxes, and other aspects of “business-in-medicine” that many of us never learned in medical school or residency training. With the University of Missouri in our backyard, we also participate in some medical student events, including an annual roundtable with residency program directors, as well as the “MUlation” student-physician event where physicians of every specialty share perspectives with medical students considering their fields.

Socially, we host an annual gala, hold summer family fishing trips, and invite speakers to present at our quarterly membership meetings. From an advocacy standpoint, BCMS membership is a gateway to representation at the state (Missouri State Medical Association or MSMA) and national (American Medical Association) levels. We also view organized medicine as a “force-multiplier.” For example, one of our Mizzou medical students introduced a 2019 MSMA resolution on “addressing healthcare needs of children of incarcerated parents.” This year, our state legislature will address a bill to enact a Prison Nursery program in the state’s women’s prison, shown in other states to reduce recidivism and be beneficial for mother-baby bonding.

What does this mean for us locally? In 1997, Boone County ranked #15 among the top U.S. counties with the highest number of physicians per 100K population (at 657).¹ Our three major hospitals include University Hospital (including the soon-to-be moved Women’s and Children’s Hospital), the Truman VA Hospital, and Boone Hospital; all three serve a 25-county largely-rural catchment area. Over the past few decades, BCMS has been a collegial venue for local physicians to meet, socialize, and collaborate on educational activities. And then came COVID-19.

COVID-19

In March 2020, we started a weekly Zoom webinar with public health and infectious disease experts, to update our local community physicians on the state of COVID-19 in mid-Missouri. Our featured topics included: “Controversies over Wearing Masks,” “Potential Risks of Re-opening,” “A Comparison of the 1918 Flu and COVID-19 in Four Missouri Counties,” “COVID-19 in Children and Collateral impacts of the Pandemic on Pediatric Care,” “The Impact of COVID-19 on Underserved Communities,” “COVID-19 in Private Practice,” “COVID-19 among Veterans and at our VA Hospital,” and “Legislative Updates on COVID-19 in our State Capitol.”² With over 3,000 participants in our 76 webinars to date, we intend to continue these webinars as long as a need is identified. The Missouri Public Health Association recognized our efforts with their 2021 “Group Merit Award.”³

One interesting pair of speakers has been Marc Johnson, MD, (Department of Molecular Microbiology and Immunology at the University of Missouri) and Jeff Wenzel (Chief of the Bureau of Environmental Epidemiology, with Missouri Department of Health and Senior Services), who have now given us six presentations on “Wastewater Surveillance for COVID-19 and its Variants.” In May 2021, when most of the country was breathing a sigh of relief and de-masking (in accordance with CDC recommendations, for those fully vaccinated), Marc and Jeff warned us about the soon-to-be-named “Delta” variant, which had just shown up in southwest Missouri sewersheds. In December 2021 and again in January 2022, Marc and Jeff gave us further updates on how the Omicron variant has spread throughout Missouri.

Our BCMS also participated in some local advocacy. In summer of 2020 (pre-vaccine), during a local debate over whether to mandate masks county-wide, our BCMS board met to discuss the issue. While many favored a mask mandate at the time, several private practice physicians made a compelling argument, that it would hurt their business to needlessly-antagonize some of their patients with an overly-strong statement, so we issued a public statement emphasizing the science supporting masks, without making a strong statement about mandates either way. Indeed, COVID-19 has also helped us all develop a “finer appreciation of the anxiety, uncertainty, feelings of helplessness, and fears of the unknown that regularly complicate decision-making for our patients.”⁴ We could all probably stand to be a little less dogmatic, as we start appreciating and learn to communicate the nuances^4,5 and gray areas in medicine.

In my specialty of Reproductive Endocrinology and infertility, the average physician only stays in their first position for about three years, and one of the hallmarks of being a young physician is constant transition. COVID-19 has exacerbated this “churn” of physicians, as we all complete our training, establish new practices, and then confront consolidation and the many other forces (family, financial, pandemics) that cause physicians to move. Constant changes of locale also discourage physicians from involvement in their state and local societies.

In this era of contentious public discourse, where everything seems overly politicized, organized medicine is an opportunity for all of us to collaborate on shared interests and advocacy. No matter what your political beliefs, we are all interested in advocating for our patients and our profession, which is part of what makes national physician meetings so much fun. Many of us are active in our respective specialty societies, but there is also an important social, educational, and advocacy role for local collaborations in our local and state medical societies. Communicating our work and our successes is also important, and there will likely be an ever-increasing role for social media outreach to boost our membership. As health systems continue to consolidate, and as we start learning to live with COVID-19 long-term, our hope is that physicians new to Missouri will see value in joining our state and local medical societies.