Tuesday, June 10, 2014

Being Part of the Solution (continued)

My last blog post argued that physicians who participate in the public policy and advocacy activities of ACP (or for that matter, other professional advocacy organizations like the AMA, Alliance for Academic Medicine, subspecialty societies, SGIM, state medical societies et al) are part of the solution to what ails American medicine, while those who criticize from the sidelines are part of the problem. One comment on the post, from ACP member John O'Neill, stated the case for engaging in ACP policy and advocacy far more eloquently than I did. This is what he said, in its entirety:

"You are either part of the solution of part of the problem"

Which on 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 milieu 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, ans 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

Today's question: if your patients asked the same, what would you have to say?

1 comment :

Harrison said...

There is a quote I ran into on Facebook, shared by a friend, and attributed to Buckminster Fuller. It was long but it basically indicated that innovations in today's world and economy generate fabulous wealth, and we need to get to a point in society where we don't use our economy to force people to toil daily in increasingly meaningless jobs just to prove that they have worth and can continue to eat and live in a shelter and wear clothes.

It is an interesting point.
What makes my 40 or 50 or 60 hours per week worth more than the 40 or 50 or 60 hours that my wife works managing a child care center?

And if I didn't worry about tying my work to wealth, then what would I do with my time?

I know for sure my wife would not manage a child care center. It is way too stressful.
But would I continue to be a primary care physician?
It is a privilege to work with people to figure out when they ar sick and why and to help them overcome acute and chronic illnesses.

I don't know how to structure the economy or the health care economy.
I think that the ACP is right to focus on our patients, and advocate for us by choosing that as our priority.

I think that my patients would want me to do that.

We can make our lives as physicians better by advocating for policies that make our patients safer and healthier.