Advocacy, activism: No longer a choice

AMA Leader Commentary. By Duane M. Cady, MD, April 3, 2006.

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, Duane M. Cady, MD.

In eight hours on March 14, eight of our country's most powerful leaders spoke from a single podium at the AMA's National Advocacy Conference in Washington, D.C.

Topic: Medicare payment

Four were Republicans. Four were Democrats. Some were liberal, some were conservative.

As I listened to the speeches, I was pleased but not surprised to hear members of both parties denounce the broken Medicare physician payment formula. We heard the same statement time and time again: The formula must be replaced.

AMA and AMA Alliance members hammered that message home. Medical students, physicians and their spouses canvassed Capitol Hill, asking Congress, at the very least, to stop the cut slated for Jan. 1, 2007.

The data are in. A new AMA survey shows that 45% of physicians say they will decrease or stop accepting new Medicare patients with the first cut alone. Suffice it to say that our seniors deserve better.

The eight speakers also gave proposals for fixing our broken medical liability system and expanding coverage for the uninsured, two other top priorities of the AMA.

In those two areas, there was less agreement, but overall, the daylong dialogue was a healthy one, with opportunities for physicians and medical students to ask tough questions.

In my opinion, though, the common thread among all the speakers wasn't how they stood on any particular policy. What struck me most was that each of them talked about how important it was to get physicians involved in finding answers to all of our country's health care woes.

For example, Sen. Hillary Rodham Clinton (D, N.Y.), kicked off the day by saying, "If our health care system doesn't work for doctors, it doesn't work for anyone."

Later, Rep. Tom Price, MD (R, Ga.), said, "The altruism of physicians is the only thing that holds our system together."

Also, Rep. Edward Markey (D, Mass.), whose wife is an AMA member, said that MD doesn't just stand for medical doctorate. "It also means Making a Difference," he said.

In other words, physicians are on the front lines, and when our system shows signs of weakness, our country's leaders increasingly turn to us to help craft and implement solutions.

That's why physician activism is no longer a choice. It's a demand placed on us by legislators and their constituents, all 295 million of whom are our patients.

Increasingly, we all feel the tug to take action.

We feel it when more and more of our patients ask how they're going to pay their bill because they're uninsured. We feel it when seniors come into our offices confused about the Medicare prescription drug program. We feel it when our system illogically sacrifices investments in prevention and health education to shore up costly emergency care. As a result, we see unhealthier kids, and our older patients come to us with problems that have built up over decades of destructive behavior.

Every day, we address these immediate concerns as best we can. That's physician activism on the smallest level. Taking the next step is a little harder, but I hope we're all beginning to realize how important it is.

First of all, become active in the AMA grassroots network. From time to time, the AMA simply asks you to send an e-mail or make a phone call to your U.S. representative.

Second, encourage each of your patients to join the AMA Patient Action Network. Patients trust their physicians to make the right decisions for our health care system, but many of them feel like there's nothing they can do about it. Tell them we need their voice to advocate for reform.

Third, I'd encourage you to consider running for political office. As AMA President J. Edward Hill, MD, said when introducing Dr. Price, we could definitely use "a few more white coats mixing in with the dark suits."

Here are a few more ideas for simple steps you can take to get more involved:

Invite your representative to visit your office or hospital. During this election year, they'll be spending a lot of time in their home districts. Take advantage of that. For example, show them why you enjoy serving seniors, despite the fact that Medicare payments aren't keeping up with costs. Or show them why you enjoy delivering babies, even though your medical liability premiums have become almost impossible to pay.
Write a letter to the editor of your local paper about the strain that the uninsured population is having on your office or local hospital. Describe how your patients feel locked out of the traditional, archaic, employer-sponsored health care system.
Get involved in your local school board. Tell them that healthy kids go to school and learn better than unhealthy kids. Ask them to limit access to junk food. Explain to them why health education and physical education should be the last things, not the first, on the chopping block.
And finally, make plans to attend next year's National Advocacy Conference. And make sure your spouse knows he or she is welcome to come, too, as part of our AMA Alliance Day at the Capitol, which was inaugurated this year.

In summary, there is always a bigger step you can take as an advocate for our health care system and our patients. As physicians on the front lines, we have a duty to prepare a viable future for the next generation of physicians and patients alike.

Dr. Cady, a general surgeon who was in private practice for 35 years in Syracuse, N.Y., was chair of the AMA Board of Trustees during 2005-06.