SAN PABLO, Calif. -- It may be a good thing that Dr. Lonnie R. Bristow, the next president of the American Medical Association, is on the road so much.
His office is the size of a large-ish closet and equally as drab, a strikingly non-slick setting for the man who next week will hold the highest position in organized medicine.
A former college quarterback who dreamed of going pro, Dr. Bristow takes up most of the office when he enters. Squeezed into his desk beneath the one touch of glamour -- an autographed black-and-white photograph of singer Lena Horne -- Bristow outlines a populist vision of the AMA in which the group is as down-to-earth as his digs are.
Never mind that the AMA is one of the top 10 political action campaign contributors, and in 1993 gave money to 86 percent of the members of Congress. Or that critics say its leading concern is protecting doctors' incomes.
Dr. Bristow, 65, has a different perception.
"I'd love to see the day come when the people of America consider the AMA as their AMA," he said. "There is a long-standing misconception of what we're about."
In Dr. Bristow's vision, the AMA would close down the tobacco industry, sponsor health clubs for children and older Americans, and push for legislation to end so-called "managed profiteering" by corporation-run health maintenance organizations.
"His views are probably as progressive or more progressive than most AMA presidents," said Dr. Sidney Wolfe, director of the health research division for the nonprofit group Public Citizen. "He's also been around the AMA long enough to see the demise of a number of proposals put forth and never passed."
Dr. Wolfe, an AMA critic, said most U.S. doctors don't join the 295,000-member AMA because they disagree with the group's lobbying activities.
Howard Wolinsky, co-author of "The Serpent on the Staff," a book critical of the AMA, said, "They were in bed with the tobacco industry for many years. Why? Because they were trying to make deals with Congress members from the South to stop Medicare."
Another part of AMA history that many found distasteful was its reluctance to ban discrimination. In 1895, a group of black physicians founded the National Medical Association in part because they were not allowed to join the AMA.
Black physicians picketed the AMA annual meeting from 1963 to 1968 to protest the exclusion of blacks from many state and county medical societies.
Without membership in those groups, black physicians could not join the AMA and therefore could not obtain privileges at hospitals. In 1968, the AMA adopted bylaws banning racial discrimination and allowed black physicians to join directly, bypassing local societies.
As the first African-American to hold the top job, at a salary of roughly $250,000, Dr. Bristow reluctantly concedes that his election is a significant sign of progress. As AMA president, he will be the symbolic spokesman for America's doctors.
"The significance is that it means America is moving forward," he said, sounding weary at having to answer the question.
"I just wish the country would reach the point where it's no longer important. It will be a while before we do. Eventually we will."
"I'm in the position because of 20 years of hard work doing many things in the organization," he said. "The position was done on the basis of merit. It didn't have anything to do with race or gender."
Dr. Bristow recalled that as a boy growing up in Harlem, medicine appealed to him because it seemed a career open to blacks. As the 12-year-old son of a Baptist minister and an emergency room nurse at Sydenham Hospital, he had the task of picking up his mother when her shift ended at 11 p.m.
Before walking her home, he glimpsed inside.
"It wasn't lost on me that they were a multicultural group," he said. "There were black doctors and Hispanic doctors and Jewish doctors."
City College of New York and moments of local fame on the football field followed high school. After graduating from college in 1953, he went on to earn a medical degree from New York University in 1957 and eventually set up practice as an internist in this small city east of San Francisco. He rose through the ranks of the AMA.
Along the way he achieved several firsts: in 1981, he was the first African-American elected president of the American Society of Internal Medicine and in 1985, he was the first black elected to the AMA board of directors. Before being named president-elect in June 1994, he held the critical behind-the-scenes post of chairman of the AMA's governing board of trustees.
His focus, he said, has always been on improving the lives of his patients.
"You learn very early when you start to practice you can make a difference in individual lives," he said. "I can't tell you how rewarding that is. But you can only do one person at a time.
"If you want to make things better for your community or state," he said, "you need to have leverage you can mobilize."
This summer, Dr. Bristow is hoping that the AMA can use its considerable leverage to persuade Congress to adopt the AMA's so-called Patient Protection Act. The measure calls for health maintenance organizations to disclose what percentage of every premium dollar goes to provide medical care to patients.
For example, Kaiser Permanente, the large California HMO, spends 95 cents of every dollar on patient care, Dr. Bristow said; another large HMO in California, which he declined to name but said is publicly held by stockholders, spends 69 cents of every dollar on patient care.
In addition, the measure seeks to protect doctors who can be fired as HMO providers without cause.
"This is used as a weapon to keep physicians in line who have concerns about the quality of care patients are receiving," Dr. Bristow said. "They can de-select 600 doctors overnight -- bang."
Most vulnerable, he said, are doctors who care for low-income people, who are often sicker than other population groups. Corporations looking to cut costs will cut those doctors first, he -- said.
A version of the Patient Protection Act was attached to the health reform act and went down to defeat in Congress. Dr. Bristow said a bipartisan effort could make health reform a reality, someday. He'd like to see a "standard benefit package" for all Americans, even the uninsured. But he's firm that patients should be allowed to choose their own physicians, hospitals and health plans.
He predicts an intensified fight with the tobacco industry in the coming year, including the AMA's continued opposition to Joe Camel, the cartoon mascot for Camel cigarettes.
In his envisioned health clubs for schoolchildren and seniors, members would study and learn about the effects of tobacco, among other health-related issues such as how to get the most out of medical care.
"This is what I call a black flag war," he said of the AMA's conflict with tobacco groups.
"You fly a black flag when you mean, no prisoners. We're committed to running the tobacco industry out of town."