The ACP Advocate Blog

by Bob Doherty

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?

5 Comments :

Blogger PCP said...

Interestingly, I just read your article bob, then I read Daniela Drake's article titled "you can't yelp your doctor". As much as she appears to have rankled you and the ACP with her commentary, it appears to me that this is one person speaking truth without fear or political correctness considerations.
She is doing a wonderful job educating the public about some of the erroneous ways of our current system and how our profession's good name is being used by various interests.
The ACP's policies on the other hand appear to be aiding and abetting the current system and worsening our lot.
So In answer to your question, I think Daniela Drake and those like her are indeed a constructive part of the solution. Not playing in this political correctness world of DC politics and instead standing up for the profession.

May 26, 2014 at 12:40 AM  
Blogger Ed Volpintesta said...

ACP Advocate Blog

May 28, 2014







Surely, Dr. Doherty you can understand the harsh and pungent criticisms that Dr. Daniela Drake expressed. Comparing doctors to janitors in perfectly appropriate for her anger. I can’t think of anything better to make her point. Maybe not all doctors agree with her, but a good number do I am sure. Not many are willing to express themselves honesty as she, as evidenced by the small number of responses to your blog.



It is important not to focus on her words, but to focus on her “drift”. Like her many primary care doctors feel that they have become the beasts of burden of the profession and lead lives of drudgery because of the ever-larger amount of “scut work” that is placed in their laps because of regulations imposed by insurers, government, hospitals, and numerous health care agencies.



In addition, the average salaries you mentioned are misleading because depending on what career stage the may be the average salary will have great variation. Doctors in the late stage of their careers compared to those in the early and middle stages have slowed down and are making considerably less than $188,000. And to make that income one has to work at an inhuman pace and lead a life of isolation from family and neglect personal interests such as hobbies and participating in medical affairs at the level of the county and state medical societies. This is hardly an inducement to become a primary care doctor.



It wasn’t mentioned but I suspect that the amount of vacation time taken by specialists compared to primary care doctors is much greater.



I have practiced primary care for 40 years and I can say that Dr. Drake is not alone in her soul-weariness. Even medical students shy away from the specialty. That’s why there is a shortage of primary care doctors. It also explains why advanced practice nurses have been granted the right to practice primary care independently in over 20 states. Lawmakers are more aware than physicians are that as far as primary care goes, a serious problem exists.

ps. your blog is a great way to communicate with doctors



Edward Volpintesta MD

May 28, 2014 at 2:37 PM  
Blogger Ed Volpintesta said...



ACP Advocate Blog

May 28, 2014







Surely, Dr. Doherty you can understand the harsh and pungent criticisms that Dr. Daniela Drake expressed. Comparing doctors to janitors in perfectly appropriate for her anger. I can’t think of anything better to make her point. Maybe not all doctors agree with her, but a good number do I am sure. Not many are willing to express themselves honesty as she, as evidenced by the small number of responses to your blog.



It is important not to focus on her words, but to focus on her “drift”. Like her many primary care doctors feel that they have become the beasts of burden of the profession and lead lives of drudgery because of the ever-larger amount of “scut work” that is placed in their laps because of regulations imposed by insurers, government, hospitals, and numerous health care agencies.



In addition, the average salaries you mentioned are misleading because depending on what career stage the may be the average salary will have great variation. Doctors in the late stage of their careers compared to those in the early and middle stages have slowed down and are making considerably less than $188,000. And to make that income one has to work at an inhuman pace and lead a life of isolation from family and neglect personal interests such as hobbies and participating in medical affairs at the level of the county and state medical societies. This is hardly an inducement to become a primary care doctor.



It wasn’t mentioned but I suspect that the amount of vacation time taken by specialists compared to primary care doctors is much greater.



I have practiced primary care for 40 years and I can say that Dr. Drake is not alone in her soul-weariness. Even medical students shy away from the specialty. That’s why there is a shortage of primary care doctors. It also explains why advanced practice nurses have been granted the right to practice primary care independently in over 20 states. Lawmakers are more aware than physicians are that as far as primary care goes, a serious problem exists.

ps. your blog is a great way to communicate with doctors



Edward Volpintesta MD

May 28, 2014 at 2:38 PM  
Blogger Ed Volpintesta said...



ACP Advocate Blog

May 28, 2014







Surely, Dr. Doherty you can understand the harsh and pungent criticisms that Dr. Daniela Drake expressed. Comparing doctors to janitors in perfectly appropriate for her anger. I can’t think of anything better to make her point. Maybe not all doctors agree with her, but a good number do I am sure. Not many are willing to express themselves honesty as she, as evidenced by the small number of responses to your blog.



It is important not to focus on her words, but to focus on her “drift”. Like her many primary care doctors feel that they have become the beasts of burden of the profession and lead lives of drudgery because of the ever-larger amount of “scut work” that is placed in their laps because of regulations imposed by insurers, government, hospitals, and numerous health care agencies.



In addition, the average salaries you mentioned are misleading because depending on what career stage the may be the average salary will have great variation. Doctors in the late stage of their careers compared to those in the early and middle stages have slowed down and are making considerably less than $188,000. And to make that income one has to work at an inhuman pace and lead a life of isolation from family and neglect personal interests such as hobbies and participating in medical affairs at the level of the county and state medical societies. This is hardly an inducement to become a primary care doctor.



It wasn’t mentioned but I suspect that the amount of vacation time taken by specialists compared to primary care doctors is much greater.



I have practiced primary care for 40 years and I can say that Dr. Drake is not alone in her soul-weariness. Even medical students shy away from the specialty. That’s why there is a shortage of primary care doctors. It also explains why advanced practice nurses have been granted the right to practice primary care independently in over 20 states. Lawmakers are more aware than physicians are that as far as primary care goes, a serious problem exists.

ps. your blog is a great way to communicate with doctors



Edward Volpintesta MD

May 28, 2014 at 2:39 PM  
Blogger DrJHO7 said...

“You are either part of the solution or part of the problem”
Which one are you?

It is easy to fall into negativism (some would say realism). It has happened to me many times. As a mostly office-based general internist, I have daily opportunity to listen to the perspectives of my patients who are from all walks of life. Some are more negative than others, but one thing's for sure, all vocations have negative aspects (and positive). How we perceive our profession, and the way we communicate this to others, is a matter of personal philosophy and style.

As long as there have been humans who suffer with injury or illness, there have been healers, and there always will be. Those of us in the USA who signed up for internal medicine as a specialty had a sense of what we were getting into, and nobody said it was going to be easy. Some of us thought that it was the optimal way to be a healer.

Despite the fact that, since I entered practice in 1990, reimbursement has been relatively flat, practice expenses have skyrocketed, hassle factor has multiplied, medical liability milieau ever more hostile and expensive, respect as "PCP" has eroded, my patients still come to see me every day and ask me to listen to their stories, solve their suffering, and try to keep them healthy. Many of the complaints are mundane or difficult to solve, but the work remains fascinating, challenging, and yes, at times exhausting. There are days I feel demoralized, and there are days I feel blessed. So far, the latter is winning.

Am I adequately reimbursed for my training and efforts? No, but I have been able to find some ways around that. I don't make anything close to that "avg PCP salary" (would love to), but that was never really the priority. I try to remember that it is truly a privilege to have the opportunity to do what I do.

So, who's going to improve our lot? If we wait for private insurers or big pharma or government, we'll be waiting forever. Yes, I'm fairly certain that the future of our profession is in our own hands. We need physician vision, ideas, dialogue, courage and hard work. We will need the help of government, so we go to that table often. We need the advocacy of physician member organizations like ACP that organize and focus our efforts on the national front, on our behalf and that of our patients.

If my patients asked Bob's question, I'll have to say I'd like to be part of the solution.

John O'Neill, D.O., FACP
member, Medical Practice and Quality Committee, ACP

May 29, 2014 at 4:04 PM  

Post a Comment

Subscribe to Post Comments [Atom]

<< Home

About the Author

Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog

Email Bob Doherty: TheACPAdvocateblog@acponline.org.

Share/Subscribe

Bookmark and Share

The ACP Advocate Blog

Recognition

The 2009 Medical Blog Awards
Voted Best Health Policy/Ethics Blog 2009

Healthcare Bloggers
10 Healthcare Bloggers We're Thankful For

Blog log

Health Blog
The Wall Street Journal's blog on health and the business of health.

Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.

The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.

MD Whistleblower
Vignettes and commentaries on the medical profession.

The New Health Dialogue Blog
From the New America Foundation.

Kevin MD
Medical Weblog

DB's Medical Rants
Contemplating medicine and the health care system

EGMN Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.

FutureDocs Blog
A blog dedicated to medical education, news, and policy as well as career advising.

Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.

Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.

Powered by Blogger

Comment policy & copyright info