Monday, May 19, 2014

Are you part of the problem, or part of the solution?

As I write this, I am with a group of committed and engaged internists who are doing their parts to be part of the solution to the problems facing U.S. healthcare rather than being part of the problem.  They are the members of ACP’s Medical Practice and Quality Committee (MPQC), which is meeting today to develop and recommend College policy on a range of issues—from reducing administrative complexities that take the joy out of practice, to improving payments for evaluation and management codes, to retail clinics—and much more.  Tomorrow, the members of their sister committee—ACP’s Health and Public Policy Committee—will meet to discuss, develop and recommend policies on issues ranging from behavioral health, LGBT access to care, electronic nicotine delivery systems, telemedicine, prescription drug and opiod abuse, and Medicaid reform.  Both committees will review and make recommendations on resolutions passed by the College’s Board of Governors.

One of the canards often leveled at ACP by people who don’t agree with us is that the physicians who make our policies are “out-of-touch” and “unrepresentative” of practicing internists.  Yet the MPQC members meeting today couldn’t be more representative of internal medicine.  The committee is chaired by Nitin Damle, MD, an internal medicine specialist physician in independent private practice in Rhode Island.  Other members of the committee include an internal medicine specialist (“general internist”) and self-described practicing “country doc” in a small rural practice in Georgia; a private practice internal medicine specialist from Alabama; a rheumatologist in a small independent practice in Connecticut; a private practice internal medicine specialist from a small group practice in Washington, DC; an internal medicine specialist who works as a medical director of a federal agency that manages health care benefits for millions of public-sector employees and their families; a private practicing oncologist in a large independent group practice in Texas; an internal medicine specialist from a large integrated group and salaried practice in North Dakota; an intern from Thomas Jefferson University in Philadelphia; a private practice internist from a mid-size independent practice in Maryland; an internal medicine specialist and hospitalist at the Cleveland Clinic; and an internal medicine specialist in a solo practice in Delaware.  Five of the 11 members of the committee are female physicians.  Some of the committee members and their practices are heavily engaged in innovative delivery models like ACOs and PCMHs, others less so.

I won’t go through the membership of the Health and Public Policy Committee, but it is comparably diverse and representative of the ACP membership.

Then, on Wednesday, some 340 plus ACP members from at least 46 states and the District of Columbia, will be in Washington, DC for the College’s annual Leadership Day on Capitol Hill.   More than 50 of them are medical students; another 80 plus are residents and fellows-in-training. They will learn from ACP staff, members of Congress, congressional staff, and independent policy analysts about the healthcare issues facing the country and ACP’s priorities.  Then, on Thursday, they will visit their members of Congress and present ACP’s legislative “asks” of them.  Our asks include: extending a program that pays primary care physicians and most internal medicine subspecialists no less than the Medicare rates for designated services provided to Medicaid recipients (which, if allowed to expire on December 31, 2014, will cause deep Medicaid payment cuts in most states); enacting legislation to permanently repeal the Medicare SGR formula; co-sponsoring a bipartisan bill to establish “safe harbors” from malpractice lawsuits for physicians who follow evidence-based clinical guidelines; and funding for workforce and Graduate Medical Education programs to address the growing shortage of internal medicine physicians.

The quote, “You are either part of the solution or part of the problem” has been widely attributed to Black Panther co-founder Eldridge Cleaver, although it appears that versions of it have been said by many others.  Whoever was the source, the quote captures the essence of effective advocacy. People who participate in an organized process (e.g. ACP’s Leadership Day, membership on an ACP policy committee) to achieve change are part of the solution.  On the other hand, people who cynically disengage from organized advocacy, or worse, disengage from organized advocacy while inaccurately, criticizing their colleagues who participate in ACP’s organized advocacy efforts as being “out-of-touch,” are part of the problem.

Today’s question: Which one are you?