First step to fairer pay is determining your value

AMA Leader Commentary. By William G. Plested III, MD, April 5, 2004.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from the chair of the AMA Board of Trustees, William G. Plested III, MD.

Judging by the responses to some of my previous articles, I can't help but believe that my concerns about the shocking state of physician reimbursement are widely shared. I certainly appreciate the fact that so many have sent letters and e-mails. The question asked most frequently -- almost universally, in fact -- is, "What do you recommend that we do?"

In general, I studiously avoid making such recommendations -- and will continue to do so. This is simply because of the peculiarly oppressive legal system that controls every facet of our professional lives. Today it is considered brilliant business strategy for giant insurers to merge to form what by any definition would constitute a monopoly. And then -- surprise -- they seem to adopt uniformly strict reimbursement policies.

By such maneuvers they can -- and do -- bludgeon physicians with any number of abusive practices. Yet at the same time, physician attempts to integrate their practices to achieve economic leverage have been met with universal hostility by the federal agencies charged with enforcing antitrust laws. These antitrust regulators have a misguided understanding of where marketplace power really resides in today's workplace.

Even the smallest evidence of concerted action by a group of physicians who are not legally affiliated would be met with immediate and crushing retaliation by federal regulators -- simply to send a message. Especially when that concerted action is one that demands fair reimbursement for physicians. This has actually been occurring on an increasing scale over this last year.

So with this in mind, I am understandably reluctant to suggest solutions that might even hint at concerted action. However, I am perfectly willing to describe in detail the inequities of the system under which we toil -- and present my opinions about how we got here.