HE VIEW FROM THE HOUSE ON MEEKER HILL ROAD STARTLES YOU at first. It's not what you expected from so comfortable a place.

The verdant hills through which Interstate 81 threads south of Syracuse, New York, roll up against each other with easy familiarity. None are high or craggy: all bear the impress of the dairy farms and orchards that have been the backbone of this region for more than 200 years. It is a landscape of solidity and strength, not surprises.

But when Duane Cady looks east or west, and especially north, he can see what few of his neighbors ever see--miles and miles of green hills and mowed fields stretching toward the broad basin in which three quarters of a million people live and work. Beyond, as far as the east is from the west, the waters of Lake Ontario draw a thin gray pencil line on the horizon.

That breadth of view, a taste for far horizons, somehow matches the man who sits quietly beside the piano in his living room, dissecting the challenges and crises of health care in the United States in 2005 and beyond. Duane Cady--husband, father of five, grandfather of 10, longtime member of his local Adventist church board, surgeon--is also the highest-ranking physician in the country.1 On July 1 he becomes the chair of the Board of Trustees of the American Medical Association, holding the top elected position in the influential 250,000-member professional organization that helps to shape health-care services for 300 million Americans.

There is no apparent nervousness about the man, a winsome quality in a general surgeon for whom steadiness of hand and heart is an indispensable personal and professional quality. The eyes are calm, the voice is even: an easy laughter rolls through the stories, policy discussions, and political anecdotes that fill the hour we spend in front of his great vista.

On a coming Tuesday he will be in Senate Majority Leader Bill Frist's office, comparing health-care policy notes with a fellow surgeon. An invitation to the presidential inauguration last January gave him an opportunity to network with key Representatives and Senators about legislative priorities for health care in the 109th Congress, including New York Congressman James Walsh and U.S. Senators Charles Schumer (New York), Charles Grassley (Iowa), Russ Feingold (Wisconsin), and Hillary Clinton (New York). His weeks are filled with trips to AMA headquarters in Chicago, or to Philadelphia, New York City, Washington, D.C.: councils, commissions, policy development sessions and board meetings proliferate.

A Shared Agenda
"We make no apologies for the fact that the AMA is a membership organization dedicated to improving the professional lives of thousands of physicians and their patients across the country," says Cady. "But there's more to what we're trying to accomplish than usually gets reported in the media. Sometimes the AMA is pictured in a defensive posture, only watching out for the financial well-being of physicians.

"But what's good for physicians should ultimately be good for patients as well," he adds. "This organization's creed since its founding has focused on the art and science of medicine and the betterment of public health. For decades now, we've been addressing major public health issues that affect the health and welfare of millions of Americans."

Cady points to recent AMA initiatives that directly address important health and lifestyle issues Adventists care about, including obesity, tobacco industry regulation, alcohol use and abuse, protecting patient safety, and smoking cessation. In late April the AMA publicly urged the National Collegiate Athletic Organization (NCAA), the nation's leading regulatory body for collegiate athletics, to eliminate alcohol advertising associated with NCAA events, including the NCAA Basketball Tournament, watched by tens of millions of Americans every March. In so doing, the AMA was supported by a sizable majority of viewers: an AMA poll found that 62 percent of American adults believe that the NCAA should not permit advertising by beer companies during collegiate athletic events. Almost all Adventists would heartily agree.

Cady's colleague and current AMA president John C. Nelson has courageously addressed what he calls "an ongoing epidemic of alcohol abuse in this country," noting that 100,000 people in the U.S. die each year because of untreated alcohol problems. According to Nelson, the economic impact of alcohol is equally staggering: $185 billion per year is "wasted" in criminal justice costs, property damage, and lost worker productivity.

The AMA has also lobbied legislators at both the state and federal level to make certain that antismoking initiatives at the state and county level actually receive some of the billions of dollars agreed upon in the settlements of major class-action lawsuits against the tobacco corporations. Cady is particularly concerned that state governments strapped for new sources of income are using the antismoking settlement money for unfunded Medicaid mandates, and thus effectively deflecting the sums from their intended use. That frustrates him as a surgeon, a taxpayer, and a church member.

"I've had many opportunities to talk privately with colleagues about my Adventist faith and lifestyle," says Cady. "Sometimes I get asked directly what my faith brings to a particular policy discussion. More often, the informal or social time that AMA trustees and officers spend with each other helps us understand each other better.

"I've also discovered that there is a lot of respect among my colleagues for Adventist medical education, particularly at Loma Linda University," Cady continues, smiling because he has managed to work the name of the medical school from which he graduated into a response. "I'm actually one of two Adventist physicians on the AMA Board of Trustees who graduated from Loma Linda. (Rebecca Patchin, an anesthesiologist from Riverside, California, holds another of the 19 elected positions on the governing body of the organization).

"People certainly know who we are and what Adventist beliefs are," he says with conviction. "I'm pleased that we're known as serious, credible people in the medical profession. In my opinion, that brings honor to both the Lord and His people."

The Adventist Church's Health Ministries Department agrees. "The church is blessed by the outreach of physicians like Dr. Cady and Dr. Patchin," notes Dr. Peter Landless, associate director. "They are representative of so many dedicated physicians who influence the practice of medicine and touch the lives of countless patients. The effort of professionals like these continues the Christian imperative of teaching and healing in the blended ministry."

Inside the AMA
The organization that Duane Cady heads is the oldest and most influential professional medical organization in the United States. Founded in 1847, the American Medical Association first sought to standardize medical education in the young nation, which, as Cady notes, was then a "disaster." Persons with as little as six months' clinical training could be licensed as medical doctors, and standards of care differed dramatically between wealthy urban centers and rural farm communities.

As professional standards for family practice, surgery, and a wide variety of professional specialties became established through the decades, the organization turned increasingly to address public health concerns. Drawn from an active federation of county, state, and national medical societies in which member physicians are involved, delegates craft policies and medical standards in a 535-member AMA House of Delegates designed to mirror the combined Senate and House representation of the U.S. Congress. A president is elected to a three-year term--one each as president-elect, president, and past-president. The Speaker of the AMA House of Delegates is elected to a four-year term. They work in tandem with the 21-member Board of Trustees that Cady will chair as of July 1, 2005.

Other important structures within the AMA include five House of Delegates councils that advise the organization about ethical and judicial affairs, long-range planning and development, medical education, medical service, and scientific affairs. Participation or leadership in one of the councils is frequently a precursor to larger duties with the national organization: Cady himself served on the Council on Medical Service, and in that role helped to develop AMA positions on Medicare and Medicaid programs, health insurance coverage, physician reimbursement, and managed care. He is also a past president of the AMA Foundation, the major fund-raising arm of the organization.

Cady joined the local medical society in the Syracuse, New York, region shortly after he began his surgery practice in 1966, and worked on a variety of regional and state projects, including emergency preparedness, for which he received specialized training from the U.S. military. After nearly 30 years of involvement with organized medicine, he was elected president of the New York State society, and later became a delegate to the AMA House of Delegates. Following a short tenure in the deliberative group, he stood for election as a trustee in 1999, and joined the AMA Board that year.

Reelected in 2003 to a second four-year term in July 2004, Cady was voted chair-elect of the Board, and designated to assume the one-year chairmanship this summer. When his term on the Board of Trustees expires in 2007, the doctor says that he will retire from organized medicine after a career spanning more than 40 years.

All in the Professional Family
Some of those who may be quietly looking forward to Duane Cady's slower pace of life in retirement include the members of his own family, most of whom understand the pressures of organized medicine because of their chosen professions.

Joyce (Clarke) Cady, Duane's wife of more than 40 years, trained and worked as an elementary school teacher for more than 15 years, completing her career as principal of Parkview Junior Academy in Syracuse. The eldest of their five children, Jann, earned R.N. and M.B.A. degrees, and is vice president for nursing at Hinsdale Hospital just west of Chicago. Mark, M.D., is an anesthesiologist who practices in Syracuse and serves as a teacher in the adult Sabbath school of the Westvale Adventist Church.

Another daughter, Beth, also an M.D., is an otolaryngologist (ear-nose-throat specialist) in Syracuse. Active in area musical groups, she serves as a member of the Executive Committee of the New York Conference. David, the only one of their sons to not live in the central New York region, holds an M.B.A. and is sales manager at a commercial printing firm in Clinton, Massachusetts, where he and his wife are much involved in community and church musical events. The Cadys' youngest son, Jeff, earned a bachelor of science and is an underwriter for the Medical Liability Insurance Company, a Syracuse-based company that insures nearly 40,000 physicians and 370 hospitals in New York, Ohio, and New Jersey.

Ten grandchildren (six girls, four boys) also look forward to the day when Grandpa's life slows down at least a bit. By their reckoning, that should include ample time for guided horseback rides around the pasture, walks in the nearby summer woods, and lots of laughter.

Home Advantage
Not many professionals who rise to Duane Cady's level of skill and office are fortunate enough to live near the hills of home. The new chair of the AMA Board of Trustees, however, lives only slightly more than an hour from his birthplace in Endicott, New York, a town of 13,000 just west of Binghamton in upstate New York's "Southern Tier" mountain chain. Educated in a local public elementary school, Cady attended nearby Union-Endicott High School through his junior year, but then transferred to South Lancaster Academy, then an Adventist boarding school in central Massachusetts.2

After graduation from SLA, Cady went on to attend Atlantic Union College in the same town, graduating in 1955 with a major in chemistry. His senior yearbook reveals a lifelong ability for bringing order and discipline to sometimes unwieldy organizations: he served as sergeant at arms of his junior and senior classes, and of the college's Student Association. (See the graphic on page 10). A four-year member of the college band, he also sold advertising for the Lancastrian, the college newspaper, and headed up the Foreign Missions Band during his last year.

Married shortly after his college graduation, Duane enrolled in the College of Medical Evangelists (now Loma Linda University) in 1955. He graduated from CME/LLU in 1959, and returned to central New York to complete his residency at the Upstate Medical Center in Syracuse.

In 1964 Duane began a two-year tour of duty in the U.S. Army, spending one year in Vietnam as an army surgeon and captain of the U.S. Army Medical Corps. Stationed at U.S. bases in Bien Hoa and Saigon, his work included triage, general and vascular surgery on the wounded, emergency medicine--and just about anything else that needed doing. He also worked with his Loma Linda classmate, Dr. Doug Thoreson, medical missionary at Saigon Adventist Hospital.

When he came home in 1966, Duane joined the surgical faculty at SUNY, Upstate Medical University, where he worked as a clinical associate professor of surgery. Two years later he joined the department of surgery at St. Joseph's Hospital in downtown Syracuse, and went on to serve as chair of the department, president of the hospital's medical staff, and even a member of the hospital's Board of Trustees. Along the way, he joined relevant professional and licensing organizations, including the American College of Surgeons, the American Society of General Surgeons, and the Alpha Omega Alpha Honor Medical Society. He was subsequently appointed by New York state governor George Pataki as chair of the New York State Medicaid Manage Care Advisory Council, and also served on the governor's Task Force on Hospital Reimbursement Reform.

Cady's local congregation, the Syracuse (now Westvale) Adventist Church, also benefited from his medical and business skills. He teamed with several pastors in presenting smoking-cessation programs in the community, served on the church board and finance committee, and as chairman of the Parkview Junior Academy Board for 10 years. As his children grew up through Adventist elementary schools, academies, and colleges, Duane helped to shape the quality of education they received by serving on the New York Conference K-12 Education Committee.

In April of this year Cady joined members of his 50-year class at his alma mater, Atlantic Union College, where he serves on the school's Board of Trustees. Cady's skill as a leader and businessman has been tapped yet again, as he has agreed to head the college's $25-million capital campaign, which will be launched this autumn.

The Big Picture
As the shadows stretch up Meeker Hill and the sun disappears in the direction of Buffalo, Dr. Cady returns again to the vista he spends most of his waking hours thinking about.

"Many Americans are beginning to discover that they have a very real stake in things the AMA cares very much about," Cady notes. "Physicians and politicians have a lot to say about medical liability reform these days because it's becoming a crucial issue of patient access to health care. Most Americans discover the issue only when they can't get the medical or health services they need.

"When the obstetricians leave an area because they can no longer afford $175,000 in liability insurance premiums, or neurosurgeons leave because they're continually being sued for astronomical sums, medical care in that region or state suffers. Just to illustrate: by the latest count, a third of the counties in New York State--21 out of 62--don't have obstetricians residing in them anymore."

Cady also points out that access to health care is restricted when Medicare reimbursement to physicians from the government continues to drop--and it's projected to go down 33 percent in the next five years. "Fewer and fewer doctors can afford to treat those who most have a rightful claim on tax-funded health care," he notes.

"One of the AMA's biggest initiatives at the moment is to try to devise a plan to help the uninsured in America," Cady adds. "America has a good health-care delivery system, but we still have to deal with the fact that there are 45 million people here without any health insurance, 85 percent of whom are working. Should a system be devised in which, like car insurance, health insurance is mandatory for individuals, or should we continue to depend on the traditional mandate that employers provide it? It seems to make sense to devise a program in which the insurance belongs to the individual--a portable plan--that can be taken from place to place as persons move or change jobs."

"Health care matters most when you or someone you love really needs it," Cady concludes, "and it's my mission in life. I don't get to preach sermons or hold evangelistic meetings. But if I can help to make certain that there is a competent doctor available when that phone rings in the middle of the night, and a reasonable way to pay for his or her services, I think I'll have done something useful to serve my world and my church."

_________________________
1 Ranking physicians is a subjective enterprise: Cady's rank as nation's top physician is supported by the fact of his election to the AMA's highest post by physicians themselves. Other candidates for "top doctor" include the surgeon general of the United States, a presidential appointee.
2 South Lancaster became a day academy (no boarding students) in 1965 when a new boarding school, Pioneer Valley Academy, opened in New Braintree, Massachusetts.

_________________________
Bill Knott is an associate editor of the Adventist Review.