My letter to my colleagues

We were once different. At one time in the not so distant past, there were 3 professions known as the “learned professions.” These professions were revered and respected, where its members were looked upon to protect the most important aspects of human life. For the unparalleled hours devoted to intense training, we were trusted to self-regulate, to draw on the best resources the country had to offer to serve our fellow man, and to earn a fair living. The only other “learned professions” were theology and law. Through a series of cataclysmic events, the learned professions came under intense fire, with the exception of one- but it isn’t ours. Are we still professionals?

Self regulation is one of the major components of the learned professions. We’ve all been there: Daily rounds where we are mercilessly “pimped,” standardized tests so often it feels like we’re testing every month, and the dreaded “morbidity and mortality” conferences where every move is scrutinized to the smallest of minutia. Despite how it may sometimes feel, these are good things. Look instead at what is happening now. Five years ago, I walked up the Capitol steps to meet with my senator, Dianne Feinstein, regarding Tort reform. I argued it was a threat to our profession, it was bad for patient care, and would ultimately cause ruin in our health care system. Although I wasn’t the only one, the few of us who descended upon Washington, D.C. weren’t enough to reform the practice of suing without limits. Four hundred million dollars a year later into the pockets of trial lawyers, the health care system is in shambles, physicians are having trouble paying back student loans, the numbers in primary care have dwindled to a splattering, and we are under the assault from the nation and even the president himself. We are looked upon by our patients as sometimes uncaring and inconsiderate as we leave them waiting while we fill out endless forms. We have become relegated to “providers” as we now are checking boxes and performing algorithms. Even our own president accuses us on national television of banding together to cut out tonsils and cut off legs for more money. Clearly, we are no longer trusted to police ourselves.

Roughly 40 years ago in 1965, the program called Medicare started. About 35 years ago, the Health Maintenance Organization act passed in 1973. With the formation of these entities, the best resources the country has to offer became less at our disposal. Terms like “pay for performance,” “preauthorizations,” and “rationing of care” became household terms. Years before, I sat in my high school classroom reading 1984 and about medical ethics believing we would never get here, but here we are. “Death panels” may or may not be completely accurate, but is “allocation of scarce medical resources” really that far from the truth? Whether we believe the actual terms are correct, it is happening. The problem is, it is happening and we are sitting on the sidelines. Once regarded as a “holy sanctuary,” the exam room has been infiltrated by CEO’s and special interests. Our decisions are made by “defensive medicine” and reimbursement. We have lost our self direction and ability to use all America has to offer to help our patients.

In regards to making a fair living, I don’t believe I need to talk about diminishing reimbursements and increasing medical school loans. Rather, I will focus upon fairness. Legislation is in process which would penalize physicians who are in the top 10% of Medicare cost 5% of their reimbursement regardless of the reasons. What greater incentive would a person have refuse care to the sickest of patients in an effort to avoid being in that 10%? It is then upon our conscience to harm people so we can feed our families and pay our bills when we took an oath to the opposite. Furthermore, someone will be in that 10% no matter what. If they are doing what is right for their patients, do they deserve to lose 5% of their income? Also, pay for performance is making its way through the legislative process. If the government has its way, even if our patients refuse to make changes to improve their health, we will be penalized for it. We will see reductions in our reimbursements despite making the correct medical decisions. Additionally, if a patient doesn’t respond to our treatments and requires longer hospitalization than what has been “deemed acceptable,” their extended hospital stay will come directly from our pockets. Furthermore, the protections of the conscience clause are not being included in the health care reform bills. This means we are open to not being hired, being fired, being sued, or being forced to perform procedures we find morally, ethically, or religiously objectionable. To top it all off, a National Provider Database has been set up in which any adverse action taken against us becomes public knowledge whether or not it has any merit, or we actually become convicted of the charge. This means there remains incredible incentive to sue us, and then we have it affect our record whether or not it is true. Some states also have a “3 strikes” law in which three accusations against us results in disciplinary action regardless of the validity. Even child predators are granted due process under the constitution! Evidently, fairness is not a principle which legislators believe applies to physicians.

As you can see, our profession is being systematically dismantled as we stand by and watch. With all the publicity of the recent reform bills, this is our chance as physicians to take a stand for ourselves and our patients. Irrespective of your political viewpoint, I argue there is more we want for healthcare reform than what HR3200 currently gives us. Our greatest leverage is before a bill is passed. Once a bill passes, we may find ourselves in the same position as tort reform: standing around complaining about what should be. Please take the time to tell your friends, family, and patients your views when appropriate. After all, it is their healthcare, our healthcare, and all of our lives at stake. Never before in our lifetime have we had such an opportunity to make a difference in the lives of our patients, family, friends, and neighbors. Health care reform will pass no matter what because it needs to pass. When and what type of health care reform that passes I hope will be up to you. If you don’t make it your goal to be a part of the change, you leave it up to lawyers and legislators to do it for you. We have all seen what happens if we allow that to come to fruition. Please call the Capitol switchboard at 202-224-3121 and speak with your representative about what you, as a physician, want done in health care. We have less than 3 weeks to be heard, as HR 3200 reaches the House floor for vote in 3 weeks. When done, please forward this letter to as many fellow physicians as possible. If you do not know your representative, please go to https://writerep.house.gov/writerep/welcome.shtml.

Respectfully,
Johnny Do