After 18 months of hibernation, the California Medical Association House of Delegates awakes next month in Sacramento to debate issues facing California physicians. Because we confront daily challenges to providing patient care, we need a voice to express our concerns about the financing and regulation of our profession. The HOD beckons, "Come and be heard!" And usually more than 800 doctors answer the call.

Orange County enters the HOD with elation and pride this year. Our own Richard Frankenstein, MD, current speaker of the house, steps forward to seek the CMA presidency. The Orange County Medical Association announced his candidacy for president-elect at the prior HOD in March 2005. This is only the second time in the 150-year history of the CMA that an OCMA leader will take the helm. Those who know Richard recognized early on his commitment to our profession and his determination to develop the negotiating and communication skills necessary to lead the largest state medical organization.

We anticipate that this HOD will end Richard's excellent four-term oversight of the house as speaker. But will this HOD offer him an easy transition? I think not! I suspect the debates will reflect lots of pent-up frustration from many practitioners as they seek to influence the policies of the CMA.

What topics loom before us? Cuba Gooding Jr.'s line got it right: "Show me the money!" The right of physicians to bill for services rendered in emergency care, also known as balance billing, will return for new debate. A physician's right to charge noncontracted patients whatever the market will bear remains a sore spot in our dealings with the Legislature.

The CMA policy supporting the billing rights of noncontracted physicians received a boost from the appeals courts. When Prospect Medical Group tried to force noncontracted physicians to accept Prospect's below-market fees as payment in full, the physicians billed the patients. The appeals court appropriately looked at contract law. If there is no contractual relationship between the physician and the insurer, then the only contract is between the person seeking services and the provider of service. Hence, the physician's right to bill the patient and the patient's ability to seek restitution from his insurance company remain contract law.

Still, Gov. Arnold Schwarzenegger has spoken out against the practice. And as the Legislature learns about egregious cases where physicians' bills to patients seem excessive, it could offer legislation to prevent physician billing as well.

What about members of the CMA who have at-risk contracts to provide care? They become enraged by physicians who bill excessively for minor services. So the debate lurches forward. This single issue will be tantalizing enough to attract delegates to attend.

Where do you fit in all this activity? Even though the process for offering resolutions ended Aug. 29, the resolutions require an open assessment by all members. The CMA's Web site gives you access to review them. You can also give testimony at reference committees. Contact any OCMA delegate. Participate in the debate. And celebrate with the Orange County delegation in wishing Richard success as president of the CMA.

Lytton W. Smith, MD, editor for the OCMA, is a physician practicing family medicine with the St. Jude Heritage Medical Group in Yorba Linda. Dr. Smith welcomes feedback on his articles and can be reached at editor@socalphys.com.