Friday, August 19, 2011

Physicians and Health Reform: Practice Freedom and Constraints

America is about freedom.


Constraint – Limiting Factor something that limits the freedom to act spontaneously.

Dictionary Definition, Encarta World English Dictionary

August 19, 2011 – If I correctly read the tea leaves, health reform for physicians is about freedom.


• Freedom to choose one’s specialty.

• Freedom to practice where one pleases.

• Freedom to exercise one’s best clinical judgment.

• Freedom to accept patients one can afford.

• Freedom to freelance among one’s career choices.

• Freedom to set one’s fees in a free market.

• Freedom to accept cash without third party restraints.

• Freedom to own one’s own practice.

• Freedom to preserve the freedoms of private independent practice.


The last point is the central message of the Physicians Foundation (, a 501C3 nonprofit organization representing physicians in state medical societies devoted to improving practice for physicians and patients.

The Physicians Foundation does its work by conducting in-depth surveys of physicians attitudes towards reform; how physicians are likely to act under government and private economic pressures; by publishing a Washington Report on what goes on inside D,C.; and by issuing millions of dollars of grants to physician organizations to improve care, and to non-physician organizations, such as Health Leads, Inc., which permits physicians to “prescribe” social services to poverty-stricken families.

But, and it’s a huge but, physician freedom come with a price – exercising these freedoms within the constraints of society and the law. Rules and regulations are the price one pays for practicing within a civilized society.

Freedoms in a democratic society come with constraints .

• Constraints to follow the letter of the law.

• Constraints to do only what is clinically indicated.

• Constraints to do no harm.

• Constraints to do only what benefits patients rather to do what pads one’s wallet.

• Constraints to stay within what fits patients’ and society’s

It’s tough balancing act, but one never said democracy was easy. Government constraints, i.e,rules and regulations, tend to raise costs and stifle innovation, but they also curb "spontaneity," i.e. untoward activities. It's six of one, and half-dozen of the other.

Yet we must have faith in our system of government. As Sir William Osler (1849-1919) remarked, “Nothing in life is more wonderful than faith – the one great moving force which we can either weigh in the balance not test in the crucible.”

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