Executive Vice President

Circle The Wagons!
Physicians are besieged on many sides

There may never be a more important time to be a member of organized medicine. There may never be a better way a physician could spend his or her money than by supporting organized medicine. There may never again be as good a chance as there is today to positively influence the future of the medical profession.

Physicians are besieged on all sides. I wish I were an editorial cartoonist so I could draw an overly simplistic graphic representation of a few doctors hiding within a circle of covered wagons, threatened from all sides by various foes on horseback representing an assortment of diverse threats. Psychologists wanting to prescribe drugs, including controlled substances. Lay midwives wanting to deliver babies without proper education, licensing, supervision or insurance. Advanced practice nurses wanting to prescribe all but Schedule I controlled substances. Pharmacists wanting to change the prescriptions you write.

And all the threats aren’t from individuals. Some are from groups, and companies. Imaging centers want to report direct to patients without reporting first to you, the managing physician. Pharmacies and grocery stores want to practice medicine in loose collaborative agreements that are basically unsound. Insurance companies (assuming they know more about the practice of medicine than physicians) want to tell doctors what anesthesia they may and may not use with certain procedures – endoscopies for example – putting cost savings for their companies ahead of patient convenience and plain old good medicine. Health plan providers now include so-called “most favored nation” clauses in your contracts.

Apart from private threats, the government is always circling, looking for a weak spot or gap between the wagons. The federal government is ready to dictate to doctors the technology and procedures they must use to keep patient records and require they spend the necessary money. Medicare threatens year after year to cut payments, while at the same time never keeps up with inflation. State budgets seldom keep pace and payments continue to lose traction against the rising inflationary costs to physicians. Government agencies, insurance companies and business consortiums continue to attempt to dictate pay for performance plans based more on price than on quality.

I could go on, but I think I’ve made my point. These are all real issues, and are all current problems – problems that exist right now. And they’re all problems that your Medical Society has dealt with recently and continues to deal with today. As EVP of your Medical Society, I see on a day-to-day basis the constant onslaught from many diverse threats which all have one common denominator. Everyone wants to either do your job, or tell you how to do your job, without going to medical school.

My position here with SLMMS sometimes makes a familiar tune ring in my head -- that song from the 70s, “Stuck in the Middle With You” by Stealers Wheel. And no wonder. We’re surrounded by the federal government, state governments, insurance companies, health care consortiums, and other professionals, lobbyists and groups of all shapes and sizes threatening to tell you how to practice medicine, or expand their scope of practice farther and farther into your realm. And they’re relentless – they simultaneously poke and probe at every weak spot in organized medicine on a daily basis. Protecting your turf has never been more important.

“Protecting your turf” is a term that often has a negative ring to it. But in this case, we’re not talking about selfish protectionism; more important, we’re talking about your patients’ best interests. And it’s a cause that requires some time and attention from each of you.

Recently we put out an urgent call for a couple of physicians to testify against the new legislation that has moved successfully through the state Senate and is now in the House. It will give advanced practice nurses greatly enhanced authority to write prescriptions for controlled substances. We believe this is not in patients’ best interests. We also believe it is not in your best interests. In such cases, physician testimony is critical. When that doesn’t happen, the legislators hear only one side, and assume because no physicians appear with anything negative to say about it, the legislation must be okay. Unfortunately, we here at SLMMS were unable to come up with even one physician to testify. Fortunately there were a few physicians from around the state who testified, but not as many as we needed, and that legislation is now moving ahead with growing potential for passage.

Every physician has a role to play in organized medicine. It is no stronger than its individual pieces. The Society’s role is to put those pieces into play. Having more of your direct e-mail addresses would help us do our job more effectively. Recently we sent out nearly 500 e-mails to members in an attempt to find physicians to testify. It sounds like a lot, but our e-mail glass is only one-third full. It means there are still about a thousand of you who did not receive the call because we didn’t have your e-mail address. Help us help you. Send me a quick e-mail with your personal e-mail address so we can add it to our database, or simply call our receptionist and give it to her. We’re confident more of you want to get in the game.

Having said all that, we know that our members are busier practicing medicine than they’ve ever been. That’s why we’re here, and that’s why we’ll continue to circle the wagons on a regular basis and defend your right to practice medicine untethered and your patients’ rights to receive competent treatment from qualified physicians. We accomplish small things every day, and occasionally have big victories, but the work goes on and the challenge remains constant and unyielding. That’s why your Medical Society is so important to you, and with your continued support and involvement, we will continue to work on your behalf.