Questions and Answers by One Physician on the Future of the Medical Profession in the Era of Health Reform

Philip Miller, head of communications for Merritt Hawkins & Associates, a national physician recruiting firm, recently sent me a list of questions. These are my responses.

Who now speaks for the medical profession?

The Physicians Foundation is a logical choice, for the simple reason it represents all doctors in state and a few local and county medical societies. Also it has conducted a survey of 300,000 primary care doctors on the status of their practices and another survey of 40,000 doctors on how they react to health care reform. No other physician organization has such a firm, objective grasp of how doctors feel and are likely to react to health reform. Finally, the Foundation has issued millions of dollars of grants to physicians to help them improve care. correct flaws , and fill gaps in the present system.


Why has the AMA lost membership/clout?

In seeking to be everything to everybody, including the Obama administration, ithe AMA has ended up pleasing few. The AMA failed to resolve specific issues concerning doctors – tort reform, simplifying payment, and the SGR (Specific Growth Rate) formula, which proposed to cut doctors’ pay 21% this year and more thereafter. These are some of things that have cut AMA membership to about 15% of all doctors. Add that to the fact that the AMA derives most of its revenues from coding and devotes few of its monies to doctor services. There is also physician unhappiness, particularly among primary care doctors about the AMA-appointed Reimbursement Update Committee (RUC), which, along with Medicare, sets fees for doctors . Put this all together, and you have a good picture of why doctors distrust the AMA and have abandoned it.


What has been the traditional role of state medical societies?

The traditional role of state medical societies has been to support and represent its members before public and politicians, including Medicare and Medicaid officials.


How is this role likely to change in the era of reform?

Given physician attitudes towards the AMA, state medical societies will have to step up and take a more activist role in representing doctors. Their members represent all specialties. This is a plus because medicine is a profession that includes all doctors.


What is the traditional role of specialty societies?

To represent the interests of individual specialties. This is fine and understandable. But there are 190 specialties, and a fragmentation of views is inevitable. The public and their political representatives, unfortunately, do not think in terms of individual specialties, but of medicine as a whole.


How is this role likely to change in the era of reform?

It is likely to be more of the same, for the role of specialty societies is to defend and support their members. The specialty societies, particularly such specialties as cardiology, orthopedics, and radiologists, and other high tech-high pay groups, will be under pressure to fight Medicare cuts in reimbursement, which are inevitable and already well underway. They will lobby intensely to protect their incomes and the quality of care. One constructive change would be for the proceduralist specialists to make peace with the generalist specialties, e.g. family medicine and general internal medicine, to avoid a public “food sight” between these specialty groups. Two likely changes, envisioned and encouraged by the government and the realities of the health care marketplace, are more hospital employment and more specialists and generalists joining together in accountable care organizations and larger groups.


What should physician organizations do moving forward to advance the state of the medical profession?

Tough question. Here are some thoughts.

• One, they should band together in a national organization with a national strategy that positions and brands the medical profession in the media as a positive and constructive force in health reform.

• Two, we should convince the public and politicians that it is in everybody’s best interest to have a robust medical profession.


• Three, we should warn the public that the present policies of health reform may drive doctors out of the profession, discourage bright young people from entering, and cause doctors to stop seeing Medicare and Medicaid patients because of burdensome regulations, low reimbursement, and misguided policies that purport to judge doctors and improve care.

• Four, it is important for doctors to highlight accomplishments of medicine, how many Americans receive better care with better outcomes for diseases such as osteoarthritis, heart disease, and cancer, and why our health statistics are just as good as our foreign counterparts but are obscured by our culture, i.e, if you remove violent and accidental deaths from the mix, our statistics are just as good or better than those of other Western countries.


• Five, we should encourage programs such as Project Health, which help poor families, community clinics, which serve the underserved and underinsured, convenience clinics, “free” clinics, manned by volunteer doctors . With these and other efforts, we can make crystal clear our mission is to serve and to heal, and to care for the sick and the disenfranchised.

• Six, we should innovate to bring lower cost care of equal quality to our citizens in lower cost settings. These innovations might include audio-visual communication with home-bound patients, telemonitoring of patients with diabetes and heart disease, using portable ultrasounds in primary care practices, evaluating patients with coronary and pulmonary disease with low cost, low risk, equipment measuring heart and lung function and administered by technicians in outpatient settings. Done correctly, the Internet and its myriad applications may lift all clinical boats. This can, however, be overdone which I believe to case with mandatory electronic health records.