Major changes in health-care management and payment are on the horizon, speakers said during the opening session of the 94th annual Utah State Medical Association meeting.

Speakers also criticized the proposed tax initiatives that will be on Utah's November ballots and called for mandatory continuing education for Utah physicians.USMA President Anthony W. Middleton said passage of the tax measures would further reduce Medicaid funding and compromise medical care for people who qualify for the state assistance. The resolution proposed spending $10,000 in USMA money to fight the initiatives.

Middleton also said the public would be better protected if doctors were required to upgrade their medical training.

The annual meeting is the main forum for Utah's doctors. More than three dozen resolutions are on the agenda for debate in four reference committees and new officers will be elected.

"These are certainly times of great change," said guest speaker Dr. James E. Davis, AMA President. Among issues facing physicians he listed a relative value schedule of charges, a nurse shortage and revamping of government-sponsored programs for the elderly and poor.

Although the estimated cost of reshaping the government programs at $24 billion, the cost to society will be much greater if no action is taken to revise, Davis said.

Regarding the nursing shortage, which is estimated at 300,000 vacancies in bedside nursing assignments across the country, he said, "Our nurses are overworked and hospitals understaffed. We have reason to worry if our patients are being properly cared for."

Third-party payers have an inordinate amount of influence on medicine today, he said, dictating what tests may be administered based on costs, rather than allowing the doctor the discretion to make such decisions.

Dr. Alan R. Nelson, Salt Lake internist and president-elect of the national association, said his main role as an AMA official is to battle efforts to establish a national health service.

The challenges facing medicine today could evolve into a publicly supported national utility that would reduce quality for everyone, he said.

"We as a nation aren't ready to ration services," he said. Patients at all levels must be assured care, he said.

Nelson said the current system of paying physicians is not equitable. Often, when a procedure is new and the costs of research are being recouped, a high price is charged. When the procedure becomes a common, accepted practice, the fee does not always come down, he said.

The AMA has supported development of a formula that would use four criteria for calculating a fee. The formula was developed by the Harvard University School of Public Health into a 2,000-page document that is to be released next week, he said.

The AMA will study the completed document to see if it meets association goals and if it is methodologically sound, Nelson said. In December, AMA delegates will meet and make their recommendations regarding the formula.