Tuesday, July 20, 2010

Physicians: The Need for a Messenger and a Message

This is my 1400th blog. This means, I suppose, that I’m in it for the long reform slog.

In my blogs, I have sought, not always successfully, to speak for physicians, a heterogeneous profession that shares common rites of passage: medical school, a common medical language, and a common goal - first do no harm.

What do physicians need to do to get back into the reform game? So far we been marginalized, in part because we represent a small voting bloc. We need a messenger and a message.

The messenger has to be a large organization, preferably non-profit, representing the joint interests of physicians and patients. For this purpose, I like The Physicians Foundation (physiciansfoundation.org). It represents physicians in state medical societies, most of America’s practicing physicians.

What is the messanger's message? The message is that the messenger must help physicians help physicians, and physicians mist help patients understand what’s at stake with health reform. The message must be balanced. It must put Obamacare in perspective.

Obamacare has good points and bad, half-dozen of one and six of the other. It is cumbersome and unwieldy. Some of it is necessary, but much of it is adverse and perverse.

Say what you will. The new reform law is consequential. It is the law of the land. It represents the political transformation of U.S. health care, and the potential remaking of the vast medical industrial complex.

Reform will occur in increments, many open to political challenge, over the next ten years, with the big changes coming in 2014. It is a work in progress, not a done deal.

What can the Foundation and America’s physicians do in this environment? What positive contributions can we make to modify the new health care law in the best interests of physicians and patients?

• With its resources, the Foundation can conduct thoughtful studies exploring and documenting the effects of reform on practicing physicians and highlighting the accomplishments of American medicine.

• The Foundation can take an activist role, as it already does, in issuing grants to help physicians improve care and patch up some of the deficiencies in care.


• It can encourage members to take more politically active and positive roles in the reform movement, through closer contacts with political representatives, by running for political office, by contributing to political causes, by writing letter to the Editor, by composing Op-Ed pieces, and even by blogging. Like it or not, health reform is political at its core. But, at the same time, the Foundation must recognize it is not a political, but an educational, organization.

• It can repeatedly make these points: America faces a looming physician shortage, current doctor graduation rates of 24,000 doctors a year are insufficient, primary care training programs must be expanded, the new law is woefully short in incentivizing medical students to enter primary care fields, and failure to achieve a permanent SGR fix is a blot on Congress and a disincentive to enter and remain in the medical profession.


• It can educate the public to the reality that America needs more primary care doctors and specialists, that there are primary care doctors who perform specialized procedures and specialists who practice primary care, that more nurses and mid-level practitioners are vital but will supplement but never replace medically trained practitioners.

• It can educate its physician constituents in how to use electronic media and to understand the interactive role the Internet and the social media will play in educating, informing, directing, and guiding patients . In the future, the Internet will be an essential and efficient means of connecting, influencing patients, and improving care.

The opinions expressed here are those of the author and not those of The Physicians Foundation.

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