Working Together

By Jay E. Shankar, M.D.

This is my last President's Page. In my eleven previous columns this year I have tried to share my thoughts and concerns about our practice of medicine. It's a tough time for medicine. Costs are rising, the ranks of the uninsured are swelling, and the population is aging. Medicare and Medicaid are budget breakers on the national and state level. At the same time, consumer-directed health, pharmaceutical innovation and more advanced information technology are bringing the promise of unprecedented business opportunities, demonstrating new service models and pushing the envelope on practical healthcare delivery and financing. It's a challenge to keep up.

Today we are bogged down under the third party handicaps that are now in place, and physicians are severely hindered in the delivery of efficient and timely quality care. We are frustrated and question whether anybody cares. SBCMS does care. Doctors care. But we must speak out, but in an appropriate and calculated manner. We need to convince all physicians, medical groups, IPAs and hospitals that we must work together, and it starts right here in SBCMS. We have to keep fighting for actuarial sound capitation and fees to provide adequate care for our patients and the ability to bargain collectively. We should continue to educate our legislators so they do not keep passing legislation without adequate funding (unfunded mandates).

There are also strong indications that the trial lawyers are preparing for another attack on MICRA. During the recent primary elections, the trial lawyers spent $3 million to support assembly and senate candidates who would support their goal of eliminating or increasing the MICRA cap and introduce anti-MICRA legislation during the legislative session. They came close to achieving their goal during their last attack on MICRA in 1999. If we lose the MICRA fight, the average physician would pay an entire lifetime of SBCMS and CMA dues every year in increased malpractice insurance costs. Many more California physicians would be forced to stop seeing Medicare patients, since their reimbursement would no longer cover the cost of care with the increased malpractice insurance rates factored into their practice expenses. This would represent a very real crisis in availability of care and access for California's elderly population. We can't let that happen.

The SBCMS had its beginning in 1878 and continues to be one of the most outstanding medical societies in the state. This is due to the dedication of its membership and its staff. You can be proud of your Medical Society. As was the case 124 years ago - and will be the case 124 years from now - there are innumerable conditions and situations in healthcare that need our attention and a remedy. The delivery of healthcare is a continually evolving system, and like any evolving system, problems will occur. Our profession needs to be continually vigilant of changes that need to be corrected. Our Medical Society was created to do that, but we must remember that we are the Medical Society and without our participation and involvement, there is no oversight, no action, and there will be no remedy.

I urge you as I have done before not to be complacent but be proactive in the forces that will shape medicine in the coming years. Many physicians are unhappy with the changing doctor-patient relationship and the loss of the special bond we once enjoyed. We've lost a great deal as a profession in this changing world. Much of it revolves around freedom and autonomy in our practice, but it is the rise of impersonal care and the loss of the physician-patient bond that hurts the most. The key toward effecting change is that physicians must put aside their differences and work together for a better future for our patients and our profession.

Working together, we can influence the legal and regulatory environment at various political levels and make a positive impact on the health of our patients and enhance the individual doctor-patient relationship. This is what organized medicine is all about. Physicians who fail to participate in the necessary work of organized medicine are doing a disservice to their patients. Often organized medicine's impact is measured in what was prevented-which is never very obvious to either members or non-members. I ask every SBCMS member to explain the importance of organized medicine to non-member colleagues and encourage them to join us in this important work. We need the participation of every member. Those of you who did not write to your legislators have given up your right to complain. We no longer have the option to remain silent.

Finally, I would like to thank the many people who have helped SBCMS throughout the year. The Executive Committee and the Board of Directors volunteered hours of their time to examine the issues and make difficult decisions. Our CMA and AMA Delegates and Alternate Delegates spent many hours representing SBCMS at District II Delegation meetings and at the CMA and AMA House. The Medical Society staff, under the leadership of Executive Director Linda Stratton, work diligently and with dedication on your behalf. My special thanks to you, our faithful SBCMS members who support the Medical Society by paying your dues on time, attending our seminars and meetings, making phone calls and writing letters to our legislators, and volunteering your time to serve on our commissions and committees. This is not a "good old boys club." This is an active, creative Medical Society geared and poised to meet the medical needs of our community. But your participation in the activities of SBCMS must be an integral part of your life in order to maintain the quality of medical care you want for your patients and your family. I hope that you have gained something of value from your SBCMS membership. I know that I have. Together we can win and continue the great tradition that has been passed on to us by our predecessors.