Physicians News » Opinion

Should Docs Use Email to Talk to Patients?

Physicians News — Mon, 23 Jan 2012 16:28:57 +0000

[caption id="attachment_3626" align="alignleft" width="255" caption="."][/caption] The Wall Street Journal today features a discussion about whether docs should use email to communicate with patients. There are many issues to consider including privacy, liability, exchange of accurate information, ability to "read" the patient, etc. WSJ featured two opposing views on the matter. The full article can be read here. Dr. Joseph Kvedar -- founder and director of the Center for Connected Health in Boston, which promotes the use of information technology to improve health care -- is a proponent of email: "Sure, privacy is a problem with email. But it's a problem with any communications system. Phone conversations can be overheard, patients' paper files can be misplaced or left exposed to the view of people who shouldn't see them, and so on. Emails can also end up in the wrong hands or be read by the wrong eyes. "But such fears are overblown. Privacy can be protected to a great degree by encryption of email messages, or by the use of secure messaging applications that are often a feature of a patient portal or the electronic medical-records systems offered by physicians and hospitals....What's more, I believe that patients understand the risks of email communication, and are willing to bear those risks in exchange for the more timely, useful and personal care that email can help bring about." "In my own experience, making myself available via email gives my patients a sense of direct access to me. It sends a message that I care and that I'm available to answer questions in a timely manner. It builds a bond between us that has tangible benefits for my patients' health....Email can also help doctors retain patients." Dr. Sam Bierstock -- founder and president of Champions in Healthcare, a health-care IT consulting group in Delray Beach, Fla. -- took the opposing view: "In short, email can be useful for certain very basic patient-doctor communications, such as appointment scheduling, prescription refills and questions about drug dosages. But it is no way to practice medicine." "Providing care includes an ability to interpret body language, facial expressions and other silent forms of communication that allow doctors to assess patient reactions to information about their health (apprehension, fear, anxiety) and the accuracy of their responses to questions. Online communications eliminate the ability to interpret these important signals." What are your thoughts?

A Challenging Road Ahead for America’s Physicians

Physicians News — Thu, 05 Jan 2012 15:20:33 +0000

By Louis J. Goodman and Timothy B. Norbeck This year promises to be a watershed year for healthcare in general, and for patients and physicians, in particular. No matter how the U.S. Supreme Court determines the constitutionality of the Patient Protection and Affordable Care Act (PPACA), 2012 will be a crucial turning point in the delivery of healthcare. [caption id="attachment_4511" align="alignleft" width="150" caption="Louis J. Goodman, Ph.D."][/caption] During the Congressional passage of the PPACA, White House advisors acknowledged that the economic forces in the legislation would accelerate physician employment by hospitals and larger physician groups. As mentioned in the “Roadmap for Physicians to Health Care Reform,” the “private” part of private practice for physicians is disappearing. Currently, more than 80 percent of visits to physician offices have been to practices with five or fewer physicians. That will change drastically as more physicians feel pressure to move into larger groups or become employed by hospital systems. Through October of 2011, there have been 71 hospital mergers. All of this will change the face of the delivery aspect of health care, but a question remains: will it be for the better or worse? Expert opinion is almost universal that there is a present shortage of physicians, especially those in primary care and those practicing in rural areas. This is a workforce problem that must be addressed now, but it seems to be lost in the debate over the PPACA. The Physicians Foundation recognizes the shortage problem and recently awarded a large grant to The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill to develop a dynamic web-based projection model that can be continually updated to track ongoing physician workforce needs across the country. Information gleaned from the UNC research will further enhance efforts to identify where physicians are most needed to support patients in a growing healthcare system. Thirty-six percent of practicing physicians are over age 55 and may retire by 2020. According to Physician Foundation surveys conducted by Merritt Hawkins in 2008 and 2010, fewer physicians are seeing Medicare patients or taking on new Medicare patients. With 10,000 baby boomers becoming eligible for Medicare every single day, the survey results do not bode well for access to care for Medicare patients. [caption id="attachment_4512" align="alignleft" width="150" caption="Timothy B. Norbeck"][/caption] Why do we have fewer physicians seeing Medicare patients at the very time that we need more of them? First of all, the Sustainable Growth Rate (SGR) used to pay physicians under Medicare, singles out physicians for financial punishment in the form of payment reductions when volume of service increases. With an aging population and increasing numbers of chronically ill elderly people, of course the volume of services continues to rise. However, unless Congress steps in and acts promptly, Medicare physician payments are scheduled for an average reduction of 27.4 percent effective January 1, 2012. The Physicians Foundation joins all other medical associations and the AARP in warning of the dire consequences on patients’ access to care should this massive and unwarranted reduction go through. The fatally flawed SGR must be fixed and the aforementioned 27.4 percent scheduled reduction must be stopped. Much has been said about the PPACA, some good and some bad. We would like to address the legislation from a physician’s point of view. Physicians are extremely happy to have the American public insured and are delighted to have an end to the discrimination against their patients with pre-existing conditions. They also applaud the new focus on preventive care which should help lead to a healthier public. As for the downside to the legislation, there was no SGR fix and no tort reform. The PPACA also assumes a planned 30 percent reduction in physician fees scheduled under the SGR over the next three years. Furthermore, and this is something that is largely overlooked when discussing the legislation, any physician’s office which mistakenly and by mere accident improperly bills too much for a Medicare visit, is subject to potential liability under federal fraud and abuse statutes. Before the PPACA, intent to commit fraud was necessary for a charge of fraud to be made, but now even an innocent error can result in prosecution. Finally, and also overlooked by many, is the “translation” fee which must be paid by the treating physician. If a physician treats a patient who doesn’t speak English and requires a translator, the physician is responsible for the translation fee. In other words, the translator’s bill would probably exceed the physician’s reimbursement for the office visit! These issues and other pressures on physicians help explain some of the survey results from the 2010 Physicians Foundation Health Reform Research Study, and the numbers only become bleaker when comparing the results from our 2008 survey. Only one-quarter of physicians surveyed said they plan to continue practicing as they are; while half reported that they would adopt a style of practice different from the traditional full-time independent private practice model. Hence, the “private” in private practice is going, going, gone! Clearly, increasing administrative burdens attributable to the PPACA requirements plus insurance, red tape and costly regulatory measures are having a likely negative effect on patient care. Sixty-three percent of physicians surveyed claimed that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said that the time they devote to non-clinical paperwork has increased over the past three years. Ask any physician what he or she enjoys the most about practicing medicine and the response will be: “seeing, helping and interacting with my patients.” The increasing amount of regulations and paperwork are becoming a more formidable barrier to the joy of practicing medicine. Add to that the declining reimbursements and difficulty in sustaining one’s practice, the constant threat of liability, decreased time with patients and low or no bargaining power with insurers, it is not surprising to note that general physician morale is low and getting lower. A recent Robert Wood Johnson Foundation survey of physicians indicated that four out of five physicians agreed that unmet social needs are connected to declining health for many Americans. By the same ratio, they also agreed that addressing patients’ social needs are just as important as addressing their medical conditions. An innovative Boston, Massachusetts organization called Health Leads interviewed local physicians about their needs in providing patient care. Many expressed frustration that they could not help their poor patients beyond simply providing medical care – with housing, nutrition (food) or other resources that could improve their health. Not only have these important issues been excluded from the health reform debate, they are largely ignored by policymakers. With a substantial grant from The Physicians Foundation, Health Leads has been able to expand their efforts to train college student volunteers in five cities to “assist” physicians to “prescribe” food, housing and fuel assistance, or other resources for their patients – just as they do medication. Patients then take those “prescriptions” to the Health Leads Family Help Desks located in clinic waiting rooms, where the volunteers “fill” them by connecting patients with those resources. Most of the student volunteers (64 percent of who are pre-med students) end up choosing to go into primary care – another plus! Generally exacerbating the overall workforce problem is the plight of medical students now coming into practice. Graduates, on average, carry a debt of 6,000 and payments of up to ,000 a month! According to the American Association of Medical Colleges (AAMC), each member of the graduating medical school class of 2033 will face a 0,000 debt! So what can be done to help physicians sustain their practices and have more time with their patients? An obvious place to start would be to fix the unfair SGR – and promptly! This Congressional and government inability to solve this problem reminds us of the late economist Milton Friedman’s observation on the inefficacy of government: If you put the government in charge of the Sahara Desert, he said, in five years there will be a shortage of sand. And so it is with the growing shortage of physicians. Congress should relieve physicians of onerous and time-consuming regulations and insurance red tape – which do not help patient care and only add to the cost of that care. It should create more incentives for physicians to go into rural areas and find additional ways for medical students to pay off their medical school loans. Build more medical schools and increase the number of the 25,000 residents and fellows completing their training every year. Of course, the big question is: Where do you find the money to do all this? Throughout America’s history, that question has been asked many times. The obvious answer: If you have the will you can find the wallet. America always has, if the issue is considered important enough. It won’t be easy but healthcare delivery and its workforce are being challenged in a major way today, and it will only worsen tomorrow without Congress stepping up and addressing it. As noted in Shakespeare’s Henry VI: “Delays have dangerous ends.” ### Louis J. Goodman, PhD, is President and Timothy B. Norbeck is CEO of The Physicians Foundation, which is a nonprofit 501(c)(3) organization that seeks to advance the work of practicing physicians and to improve the quality of healthcare for all Americans. It pursues its mission through a variety of activities including grantmaking, research and policy impact studies. Since 2005, The Foundation has awarded numerous multi-year grants totaling more than million. In addition, The Foundation focuses on the following core areas: health system reform, health information technology, physician leadership, workforce needs and pilot projects. As the health system in America continues to evolve, The Physicians Foundation is steadfast in its determination to foster the physician / patient relationship and assist physicians in sustaining their medical practices during this evolution. For more information, visit www.physiciansfoundation.org.

Resolutions Reflect the Changing Influences On Our Profession

Physicians News — Thu, 17 Nov 2011 14:59:06 +0000

By Lynn Lucas-Fehm, MD, JD

When the AMA was formed in 1847, the founders could not have imagined how health care delivery would change in the ensuing 150 years. The goals of the 19th century medical profession were ambitious but clear - to assure that the highest standards of excellence became the foundation for the practice of medicine. At the first meeting of the AMA, the delegates developed policies by introducing, debating, amending and ultimately passing resolutions. One example was the policy establishing the requirement for "gentlemen" entering the profession: Resolved, that this convention earnestly recommends to the members of the medical profession throughout the United States to satisfy themselves, either by personal inquiry or written certificate of competent persons, before receiving young men into their offices as students, that they are of good moral character, and that they have acquired a good English education, a knowledge of natural philosophy, and the elementary natural sciences, including geometry and algebra, and such an acquaintance, at least, with the Latin and Greek languages as will enable them to appreciate the technical language of medicine and read and write prescriptions. Today, resolutions affecting how we practice medicine are still introduced, debated, and voted upon in the same basic format as a century ago. Parliamentary procedure is aptly enforced by the speaker of the House of Delegates. When resolutions are passed, they are sent to the Board of Trustees for implementation while others are delegated to governmental liaisons who lobby politicians in hopes of favorable legislation. From October 14 through 16, I attended the annual meeting of the Pennsylvania Medical Society as a delegate. Over the many years that I have attended this meeting I find myself constantly looking for the changes which have occurred in the process and content of the event. What I have discovered is that the protocol has not changed but the issues that we address have persistently expanded to include government, political, business and legal issues which have taken control of our profession. Examples of this outside influence were quite apparent in the resolutions presented for consideration at the PAMED House of Delegates. A synopsis of the adopted resolutions taken from the PAMED website is as follows: Energy sources, risks to public health: Supporting energy sources that decrease environmental risks to public health and studying the state’s public health infrastructure State regulation of medical spas: Collaborating with state and national medical organizations to advocate for state regulation of medical spa facilities Professional liability coverage for physician volunteers: Seeking legislation requiring the state to provide free professional liability coverage in return for volunteering at free non-government clinics Medical Staff Code of Conduct: Adopting the American Medical Association’s (AMA) Model Medical Staff Code of Conduct Observation care codes; Medicare reimbursement: Advocate for an increase in Medicare reimbursement for observation care codes Physical fitness guidelines: Work with other organizations to develop a checklist to identify risk factors in patients starting physical fitness programs Water fluoridation: Working in conjunction with the Pennsylvania Dental Association to urge the state to adopt federal fluoride standards and apply them through legislative or regulatory initiatives Collective bargaining: Supporting federal legislation authorizing collective bargaining Several issues were referred to PAMED’s Board of Trustees for further study, which included consideration of Medicare as a public option, reforms to address problems with health plan pre-authorization programs that are outsourced to benefit managers, and controlling children’s misuse of prescription drugs. Resolutions affecting the practice of medicine have certainly evolved since 1847. Response to these adopted policies will likely be diverse. Healthy discourse is always good. However ultimately I hope that whether physicians agree or disagree with the resolutions that were passed at this year’s Pa Med House of Delegates, at least a few will be encouraged to get involved in the process. There is no question that we have little time to do anything except take good care of our patients while complying with the endless red tape that is necessary to run a practice. If we are lucky we find a little time to enjoy our family and friends. However, as the rules and regulations continue to increase, the need for all of us to be involved will be essential. For more information about these resolutions please go to the Pennsylvania Medical Society website at www.pamedsoc.org. ### Lynn Lucas- Fehm, MD, JD, is a radiologist at Abington Memorial Hospital and the 150^th President of the Philadelphia County Medical Society.

I Have Cancer. And I’ve Never Felt Better!

Physicians News — Tue, 01 Nov 2011 17:54:25 +0000

By Tracy Krulik In 1998 I wound up in a South Florida emergency room following a week of nausea, vomiting, and frail-octogenarian-like weakness. After a brief exam, an overnight stay in the hospital, and an endoscopy, the internist sent me home with motility drugs to combat his diagnosed cause of my problems -- gastroparesis. That was the start of my nine-year illness, which was misdiagnosed at every turn. Mine is a story of how I survived a medical odyssey that included a tumor on my pancreas as well as metastases to my liver and chest. During that decade I endured bouts of similar attacks as well as gallstones, hypoglycemia, a bizarre affliction of multiple trigger fingers, hives, and a laser of pain in the upper left quadrant of my abdomen. Doctor after doctor diagnosed me with gastroparesis, IBS, or functional dyspepsia and put me on motility drugs, proton-pump inhibitors, and Elavil to ease the pain. One attack in 2004 was so intense that my then-gastroenterologist sent me for an abdominal CT scan, which showed attenuation on my pancreas. I was immediately sent to the hospital with a diagnosis of pancreatitis. My doctor was heading out of town to celebrate New Year’s Eve in Las Vegas, so his partner cared for me in the hospital. (The old warning still is true: Don’t get sick over a holiday.) An MRI taken the next day returned normal, but the doctor had me stay in the hospital another night for observation and more time on an IV to help my pancreas calm down in case it was indeed inflamed. I went home the following morning. Increasing my Elavil from 25 mg to 50 mg got rid of most of the pain, so for the next two and half years I just stayed on my meds and tried my best to ignore any discomfort. During that time, about a year after my hospitalization, I decided to officially switch over to my doctor’s partner for care after my doctor asked me why I had been taking Elavil. Apparently he wasn’t following my care as closely as I would have hoped. By 2007 the pain overpowered the Elavil, so I visited the doctor once again. Not liking the word “pancreatitis” in my chart, my gastroenterologist wanted me to get a repeat CT scan to compare to the one from 2004. I fought against further testing. Frankly, I was sick and tired of being poked and prodded, but the doctor fought back harder. In the end I gave in, and I’m lucky I did. The doctor called me a week later to tell me that the mass that was on my pancreas two and half years earlier was still there. My response: “What mass?” When his partner sent me to the hospital in 2004 for pancreatitis, he didn’t tell me there was a mass on my pancreas; he said my pancreas looked swollen. Regardless, my doctor was pleased that the mass appeared smaller on the film than it had in 2004, so he didn’t believe it was cancer, but he still wanted me to get a follow-up test. On August 31, I underwent an endoscopic ultrasound with biopsy. The week of my 36^th birthday, I heard the results from my doctor: “You have cancer, but not really cancer.” What? By now, you in the medical community might have figured out what I have—neuroendocrine cancer, islet cell to be specific (just like Steve Jobs). The doctors assumed that I had an insulinoma given my bouts of hypoglycemia, and I was told that by removing the tumor, I would be cured. Luckily for me the tumor was located on the tail of my pancreas, which meant that I would not need a Whipple procedure. To be safe we also needed to do one more test -- an octreoscan -- to confirm that the disease had not spread. If it had there would be no chance for a cure, but I was told that it would be extremely rare for that to happen. If you don’t know, with an octreoscan, the patient is infused with Indium-tagged octreotide, which is a natural hormone that can be picked up by neuroendocrine tumors if they have a specific receptor. If my tumor had that receptor, it would show up under the scanner. As it turns out, my tumor did, and so did the mets that had formed in the right lobe of my liver and in my mediastinum. I went to an oncologist the next day. “If I were you, I’d leave the tumors where they are and just take a monthly injection of octreotide [to flood the tumors and stop them from secreting insulin],” the oncologist said. “You won’t live until you’re 80, but you’ll live a full life.” I started looking for a different oncologist as soon as I left the building. While other oncologists agreed with that doctor that removing the visible mets would not cure me due to the inevitability of micromets, no one else agreed that I should leave the primary tumor on my pancreas. It had made me incredibly sick for nearly a decade after all. Not only should I feel healthy again once it was removed, but with my body stronger, my immune system could be better equipped to combat the disease. In November 2007, I had a distalpancreatecomy with splenectomy, and the well-differentiated tumor was removed. I began receiving monthly injections of octreotide (Sandostatin LAR) two weeks later. The oncologist I selected at the Moffitt Cancer Center believed that I would soon need a stronger treatment such as targeted radiation therapy -- only available at the time in clinical trial in the Netherlands -- because the octreotide could only be effective (if at all) for a year or two at most. But when I underwent tests to apply for the trial, the CT scan could not pick up any mets. Octreoscan still showed some uptake, but that would not be sufficient to participate in the trial. My oncologist instead had me continue with octreotide and return every six months for repeat scans. I switched to an oncologist at Johns Hopkins in 2010, and he questioned the efficacy of octreotide for me. Because a three-day fast did not confirm the diagnosis of insulinoma, he didn’t believe that my tumors were secreting insulin, so the octreotide was probably of little to no value. He believed that my disease was simply indolent. I stopped taking octreotide that September and worried a bit that the tumors would begin to grow again, but they haven’t. Four years ago my life was completely upended, but when I recovered from the surgery to remove the primary tumor, I felt superhuman with newfound energy and strength. I felt so good that I sought out whole foods that were entirely plant-based to make me stronger and committed to training for long-distance cycling events. I am now in the best shape of my life -- with cancer. I’m not sure why my disease stopped growing, but it has. Was it because the primary tumor was removed while the mets were still extremely small? Was it my plant-based diet and a new addiction to cycling? Was it the power of a positive attitude and reduced stress? Was it a combination of all of the above? Or none? I don’t know, but I know that I’m not changing a thing. My body appears to be in balance, enabling my immune system to fight the disease on its own. I’m going to continue doing everything I can with my lifestyle choices to keep it that way. I’m not sure what aspect of my story is of most interest to doctors, but I do think there is a lot to learn from it. The next time you chalk up chronic abdominal problems to IBS or some other “un-provable” condition, ask yourself it there might be an unusual root cause. Had my doctors found the tumor before it spread, I would have been spared from a decade of illness and an incurable form of cancer. Ironically, I don’t believe that I’d be as healthy as I am today had my doctors found the tumor sooner. I wouldn’t be able to appreciate what “healthy” really feels like without seeing the other side. And for all I know, my healthy lifestyle is what’s keeping me alive. ### Tracy Krulik is a fourteen-year cancer survivor who didn’t know she had it for the first nine years. A freelance writer and self-titled CEO of her health, Tracy is putting the finishing touches on her memoir I Have Cancer. And I’ve Never Felt Better! For more information visit http://tracykrulik.com.

Watson: Extreme Evidence Based Medicine

Physicians News — Thu, 13 Oct 2011 14:44:46 +0000

By Lynn Lucas-Fehm, MD, JD Most of us recall the literary character Dr. Watson who served as the steadfast confidant, supporter, physician and assistant to the brilliant detective Sherlock Holmes. Now there is a new Watson in our midst, an artificial intelligence computer developed by IBM and named after IBM’s first president Thomas J. Watson. After handily defeating the formidable human Jeopardy champions, Brad Rutter and Ken Jennings, Watson’s developers have expanded the computer’s medical databases to create what may become the ultimate digital collection of medical information. However, what truly sets Watson apart is that it can analyze facts gathered in natural language and generate differential diagnoses. It even assigns a ranking to each diagnosis based on its understanding of medical knowledge in textbooks, journals, and case reports. At a recent demonstration for The Associated Press, Watson was asked to consult on a fictional patient with an ophthalmic disorder. As additional symptoms, medical history and personal information was presented — blurred vision, family history of arthritis, Connecticut residence — Watson’s suggested diagnoses evolved from uveitis to Behcet's disease to Lyme disease. It gave its final diagnosis a 73 percent confidence rating. Dr. Herbert Chase, a Columbia University medical school professor and Watson consultant commented that “You do get eye problems in Lyme disease but it’s not common… you can't fool Watson." [caption id="attachment_3626" align="alignleft" width="255" caption="."][/caption] IBM's Dan Pelino, general manager for global health care said possible future uses for Watson include allowing a doctor to connect to Watson's database by speaking into a hand-held device using speech-recognition technology with cloud computing serving as the database for the most advanced research. There is little doubt that Watson will help physicians with a major problem in modern health care: information overload. The potential to have immediate access to every resource of evidence based medicine is exciting. However, Watson developers and consultants will go a step further. Dr. Chase stated that anecdotal information — such as personal blogs from medical websites — may also be included. Chase remarked, "What people say about their treatment … it's not to be ignored just because it's anecdotal. We certainly listen when our patients talk to us, and that's anecdotal." This is where the issue of Watson’s involvement in medical practice becomes a slippery slope. Since Watson has the ability to interpret natural language will it be able to listen to patient’s complaints, analyze them and give a differential diagnosis? Watson could become the ultimate physician’s assistant. In fact, with the increasing reliance on “apps” one might wonder if Watson could truly become “Dr. Watson”. I have always embraced new technology, reveling in the acquisition of every new smart phone technology, iPAD app and software innovation. However, reliance on such technology to the exclusion of the human factor in the practice of medicine may lead to increased productivity but suboptimal patient care. A balance must be achieved in the upcoming decade where technological tools are utilized to provide the physician with the evidence based medicine to assist in accurate diagnosis while allowing the irreplaceable intuition, compassion and humanity only we as physicians can provide. ### Lynn Lucas- Fehm, MD, JD, is a radiologist at Abington Memorial Hospital and the 150^th President of the Philadelphia County Medical Society.

Dr. Smith Goes To Washington (Again)

Physicians News — Thu, 05 May 2011 14:26:00 +0000

[caption id="attachment_4056" align="alignleft" width="132" caption="Dr. Hal Scherz"][/caption] By Hal C. Scherz, MD Recently, I returned to Washington DC for the 11th time in two years, with a group of doctors from Docs 4 Patient Care. It was a very busy week in DC. As always, there were groups from around the country who came to Congress to advocate for their interests, including a large group of orthopedic surgeons. The most pressing issue that week was an impending government shutdown over the budget. You can imagine how distracted the Congressmen and Senators were with this potential disaster looming. In spite of this, we had no trouble getting in to see the elected officials or the legislative healthcare teams on our list. In fact, we had so many appointments, that we had to divide our team of 10 people into 4 groups at times. The highlight of our visit was a 30 minute session with Speaker of the House, John Boehner, in his office. No one else had the success that we had getting to speak with elected officials, especially Mr. Boehner. Why did we have such easy accessibility? Because we are different from other organizations and they know this. Groups regularly come to Washington with their hands out, asking for something. In contrast, we came to Congress offering something. We offered to them our help, our time, expertise, and resources. We did not send lobbyists to Congress to “soften them up”. We came ourselves, acting on our own behalf, as we have on prior trips to DC, as an initiative that we call "House Calls on Congress". We believe that it is far better to have personal relationships with members of Congress, and offer help in understanding complex medical issues which are difficult to fully grasp, than to delegate this role to others. We came with several messages. Most importantly, we wanted them to know that we can and are willing to help them. We wanted them to know that their healthcare message fails to stir the emotions necessary to rouse people to act. They heard from us about the resources that we have developed and made available to them so that they and their staffs could better understand complex healthcare matters which we instinctively know and take for granted. It was important to make them understand that it was not enough to keep saying repeal, without a clear plan to replace. We have such a plan and shared it with them. One of our objectives was to make them understand that the only way that they can hope to develop a plan that will make sense and be successful, was to bring doctors into the process- those of us who see patients daily and get our hands dirty, and stay up all night- not medical bureaucrats or ivory tower academicians who have not laid hands on a patient in decades. Finally, we wanted them to realize that we have a tremendous amount of influence amongst our patients; the electorate in this country. We shared stories about our experiences during the 2010 elections in which we helped get candidates elected to Congress. We are stronger and better organized for 2012 and will have much more success next time. Much to our amazement, the people that we spoke with, including Speaker Boehner, were already aware of these points that we came there to make, especially the last one about elections. What was just as surprising was the ease with which we got into see everyone and how well we were received. Only afterward was it clear why this was the case. We heard from most of the Congressmen and Senators that they need to hear from doctors and that they would like to see an organization of doctors that truly represents us and our patients. They appreciate when doctors come to Washington because they understand that we are sacrificing quite a lot to be there. They know that the AMA has failed to do its job, and that specialty societies have a limited focus and narrow interests. We believe that Docs 4 Patient Care can fill this void and we believe that they do too. These exchanges gave us hope for the future. Although there is a healthcare law that looms large and is shaking things up, everyone in Washington is unsettled. The fight is far from over, but the only way to get rid of this law which will have profound and negatives effects on patients and doctors is to change control of the Senate and White House. Only then is there a chance that we can throw this law out before it is too late. With the help of people like those who came to Washington with me, we can help to create and implement a plan that makes sense for the majority of Americans without destroying everything which is great about the American Healthcare system. ### Dr. Scherz is the Founder and President/CEO of Docs 4 Patient Care (www.docs4patientcare.org).

Obamacare One Year Later: Happy Anniversary, Doctor

Physicians News — Tue, 29 Mar 2011 13:36:24 +0000

[caption id="attachment_3980" align="alignleft" width="251" caption="The health care law recently passed the one year mark. Opinions are mixed. (Photo: SAUL LOEB/AFP/Getty Images)"][/caption] By Hal C. Scherz, MD Twelve months after the passage of one of the most controversial laws in American history, healthcare is still an unsettled issue. Never before has a president needed to go around the country to defend and sell a bill that he signed into law. America has been subjected to a law that over 1000 groups, representing 2.4 million people has been exempted from because they discovered that they could not afford the increased costs associated with it. This is before the law has even gone into effect. The bitter irony is that many of these groups who have received waivers were the most vocal proponents for this law, including the SEIU. This is cronyism at its worst and just a taste of things to come when the Federal Government, under the watchful eye of the Secretary of HHS decides what treatments doctors may deliver to their patients. As physicians, we are already beginning to see the profoundly adverse effects of the Accountable Care Act (ACA) on us and our patients. This year, the Medicare SGR (sustainable growth rate), which required a 23% reduction in physician reimbursement, was postponed 5 times. The final reprieve, resulted in Congress “kicking the can down the road” until January 2012, when the reduction becomes 29%. Meanwhile, the new Medicare fee schedule goes into effect in October, with across the board cuts of approximately 7%. During 2011, CMS (Centers for Medicare and Medicaid) withheld payments to physicians on TWO occasions, for as long as 45 days. This presented tremendous hardships for doctors whose practices are largely made up of patients on Medicare and where these payments represent a large portion of their income. Many doctors needed to take personal loans to meet payroll. Many doctors did not take home a paycheck even though they had provided services. Some doctors needed to down size, which meant layoffs of employees, and still others needed to close their practices. And thousands of doctors, who have been caring for Medicare patients for over 40 years, simply had enough and either stopped taking new Medicare patients or left the Medicare system entirely. And who could blame them? Any business needs to have some degree of predictability in order to survive, and Medicare has become too unpredictable to base future decisions upon. The losers are not so much the doctors as are the seniors. They have paid into a system during their working lives, and now many struggle to find a doctor. With 0 billion slated to be cut away from Medicare, the benefits that seniors will receive will diminish as well. The care that these seniors and others receive will not be as good as the care that patients currently get. One reason is that the ACA makes it easier for non- physicians to deliver healthcare. The new law emphasizes the concept of “medical homes”, which will be the gatekeeper in future healthcare delivery models. Nurse practitioners and physician assistants are elevated to physician status by virtue of this law. It is the attempt on the part of the federal government to convince the public that there is equivalency between all healthcare providers, but sadly that is just not so. It is the beginning of the attempt on the part of the government to condition the public for a lower standard of healthcare. This statement is not meant to be derogatory to this group of professionals, but simply stated, they are not doctors; they are physician extenders. It takes 7-15 years of education and training, long hours and personal sacrifice to become a doctor. A physician cannot simply be created by a legislative edict. Yet, this is precisely what is happening around the country. Clinical psychologists in California are being giving hospital admitting and prescription writing privileges, optometrists in some states are given eye surgery privileges, including laser surgery privileges in Oklahoma, and nurse anesthetists are designated as equals to board certified anesthesiologists. Pharmacists are lobbying for the ability to change prescriptions written by physicians not to generics, but to entirely different drugs, if they think that it is warranted. And nurse practitioners are now able to do an extra year of training and come out with a doctorate degree in nurse practice, so that they can call themselves “doctor” as they populate primary care clinics and medical homes. The HITECH Act which was actually in the Stimulus Bill of 2009, was essentially activated by passage of ACA, so that now, all doctors who wish to receive the highest levels of reimbursement for the services that they will have already provided, will need to have a health information system in place that meets federal standards. This is not an entirely bad concept, were it not for the fact that the systems currently available are not yet ready to accomplish the integration of clinical information between doctors, hospitals, pharmacies and other sectors of the healthcare spectrum. We will get there at some point, but to force doctors to spend money now on systems that cannot meet these goals is absurd. The systems are pricey, and the costs cannot be passed along, so doctors have to assume them all themselves. Consequently, less money will be available to spend on patients whether that means fewer personnel in doctors’ offices to care for them or less sophisticated tools available for the doctors. The systems that doctors are being forced to adopt will soon be surpassed by better systems that will be developed that can do what we expect from them, and then doctors will have to incur the costs to retool their offices once again. The problem is that when the technology is developed, every doctor will want to adopt it and not before, just because it has been decreed. The money that is supposedly available to doctors who implement these systems and who demonstrate “meaningful use” will barely cover the incurred costs, assuming that there is money available to begin with. The government and insurance companies are looking for alternative healthcare delivery models and the ACA supports one such model- the Accountable Care Organization (ACO). This organization is intended to be a vertically integrated healthcare delivery system consisting of physicians of all specialties working together, by following clinical protocols and best practice models, so that care can be coordinated and waste can be eliminated, while delivering improved care. This medical utopia would work with the hospitals as partners, but what is instead happening around the country is that hospitals are buying up physician practices at a record pace so that they can control as many patients as possible and hence control the medical market in their community. The physicians in this “super HMO” are employees and they then have to choose between doing what is right for their patients and what their employers instruct them to do. This is already happening in hospitals across the country, but will escalate as more physicians, especially specialists, leave private practice because they fear that their practices will have no value if the hospitals control the flow of patients to them. Besides encouraging the formation of ASOs, the ACA has other provisions which are aimed directly at doctors, in an attempt to destroy the private practice of medicine; a necessary first step to get to a single payer, government run healthcare system. Working with a willing accomplice, the American Hospital Association (AHA), provisions were put into the ACA that eliminates future physician owned hospitals and surgery centers, imaging centers and laboratories. The exemptions to these ventures occur when they are connected to and are a part of the physicians’ direct practice, but these exemptions are being challenged as well. The AHA is a very powerful lobby and as we have come to see, doctors have no effective lobbying group and are easy targets for every group that wants to push us around. Finally, the worst part of the ACA lies in the limitless power granted to the Secretary of HHS when it comes to healthcare matters. The Secretary determines what the clinical protocols are which doctors must follow if they wish to see patients who have insurance that is offered through the healthcare exchange. According to the ACA, there will be no insurance offered outside of the exchange. So if you want to see insured patients, you must follow the protocols approved by the HHS Secretary. If this wasn’t bad enough, the Federal Coordinating Council for Comparative Effectiveness, a 15 person board appointed by the President and with no Congressional oversight, will decide what treatments doctors may offer to patients and which cannot. Simply, this is the beginning of medical rationing, and if the issue of waivers bothers you, then this should really scare you. “trial balloons” have already been sent up in this regard. We have seen it with mammogram recommendations and with limiting Avastin for breast cancer patients. You can be certain that It will escalate as new ways to limit care are explored. ### Dr. Scherz is the Founder and President/CEO of Docs 4 Patient Care (www.docs4patientcare.org).

Doctors: Doing Nothing Is No Longer An Option

Physicians News — Wed, 23 Mar 2011 14:30:02 +0000

By Hal C. Scherz MD There is a truism that every physician needs to constantly remind themselves of; there is no healthcare without doctors. So why do so many of us feel so powerless and why are so many of us unwilling to do something about it? Most of us do what we do professionally because we enjoy helping people. That is our collective strength but also our weakness. What we do is special, but other entities have staked out their “turf” in our professional world; the government, insurance companies, and hospitals. They need doctors to remain an active player in this world, but have learned to exploit us in business matters, counting on the fact that our sense of morality and responsibility would supersede our fiduciary capabilities. For the most part, this is exactly what has happened and what said entities are counting on in the future. Simply look at the model under which most of us receive payment for services rendered to patients. In almost all cases, someone else pays us, whether it is the government or the insurance companies. To make matters worse, someone else has decided how much your service is worth, not you. There is no other business model in existence quite like this. Does anyone think that lawyers would allow someone else to set their fees and wait for someone other than the client to pay them, often having to fight for their reimbursement and having to continuously resubmit their claims to get paid because the payment form was improperly filled out? The healthcare industry is a vibrant and booming sector of our economy. Between 2008-9, when every sector of our economy was in recession and losing jobs, the only part of our economy (besides the federal government) that had added jobs was healthcare. It is not the “black hole” that politicians in Washington would have the public believe. Healthcare is an 0 billion annual part of the economy, which accounts for over 25 million jobs. So it should come as no surprise that lots of people want in on it. Doctors’ professional fees account for approximately 12% of the healthcare dollar. That means that 88% goes elsewhere -- pharmacy, hospitals, insurance, management, legal, etc. In difficult economic times, when everyone is getting squeezed, and when doctors are already perceived as pushovers in the business world, how do you think that they will fare? Couple this with the fact that all of the other players in healthcare spend billions on lobbyists and are well organized, while doctors have essentially no organized representation. The future looks bleak for doctors if we continue down this same path. It is interesting that talks about healthcare reform play to packed auditoriums. Doctors are eager to get news “from the front.” They want to know what is going to happen, and after hearing the news of what is in store for them, many will be motivated to act, but most will settle into the ennui that characterizes their professional lives these days as it relates to their business. There are basically five groups of doctors that I have encountered: those who are angry about what they hear and are stirred to action; those who are angry but are convinced that there is nothing that they can do; those who think that they can game the system and what is coming will not affect them; those who are looking for an exit strategy; and those who welcome the change that is coming (for whatever reason that may be). The average doctor spends less than 0 annually on advocacy for themselves, whether it is on a PAC, or some other group that is trying to defend their interests. Contrast this with trial lawyers who spend 100 times that amount. Most doctors will become defensive when confronted with this fact, claiming that they already give to their specialty societies and state medical associations. Unfortunately, that has failed to protect us from the sharks that constantly swim around us. The American Medical Association is perceived by the public as the lobby for doctors, but they have become part of the problem, looking out for their own special interests, and have failed doctors in general. We are a profession at a crossroad. The massive federal expansion over control of our healthcare system, and quite frankly, over doctors, is beginning to show cracks in the wall. Beginning with a shaky foundation, it fails to support the massive superstructure on which it rests. The mandate to purchase health insurance is being challenged in court and the entire law is at risk of being thrown out. The new majority in the House of Representatives is vowing not to fund portions of the law that require new agencies and expanded bureaucracies to function. However, there are parts of the law that will remain in effect. These provisions threaten to place more burdens on doctors and will limit our ability to remain economically solvent. Doing nothing and just hoping that this will go away or be acceptable is simply no longer an option. Doctors who are already struggling to keep their practices open because of decreasing reimbursement from insurance companies, or the constant threat of Medicare cuts to physicians (a new round of across the board cuts goes into effect in October, separate from the SGR postponement or “doc fix” due to expire in January 2012) are now facing further financial burdens. The mandate requiring health information systems in their offices means that doctors who have not implemented such a system will get lower levels of reimbursement from the government, if they get anything at all. Thus doctors are forced to divert money that could be spent on new staff or on salary increases for existing employees, and instead spend it on technology which is not currently configured to improve medical care, but to comply with government regulations. In fact, in many situations, these systems may negatively impact care. The new law contains provisions which favor special interests such as hospitals, who lobbied to get restrictions placed on physicians who own surgery centers, hospitals, and imaging centers, which limit or restrict physician ownership in these entities. And how are doctors responding to all of this? Too often, in fear and desperation, they are selling their practices to hospitals and relinquishing financial and professional control to entities whose only concern is the bottom line. These organizations have proven over the years that they desire to work with doctors, but only on their terms. We are now seeing the newest iteration of HMOs, the Accountable Care Organization, which is a group of doctors who get together to manage care and make it better by coordinating care, sharing information and driving the cost curve down. Payment is delivered in a lump sum for an episode of care, left to be divided by the ACO; frequently controlled by a hospital. The reality is that this is an attempt to have doctors manage risk, get paid less, take on liability, and allow insurance companies and hospitals to reap the financial rewards. As bleak as this may appear, the solution is closer than we may think. Doctors still control healthcare, and they are still the most respected profession in the eyes of the general public; 89% rate their doctors favorably in a Gallup poll in 2010, compared to 11% for politicians. Doctors need to consolidate their power into a single, strong unified voice that can deliver the message that things are not working well under this model. We need to begin to take personal responsibility for our profession because it has been, and continues to be, under attack. Doctors need to open up their pocket books and understand that it will take money to keep our profession safe from all of the intruders who want what we have. If we do not act soon, private practice medicine will be a distant memory and we will all be federal, state or hospital employees. There will be no one to blame but ourselves. Doing nothing is not an option. ### Dr. Scherz is the Founder and President/CEO of Docs 4 Patient Care (www.docs4patientcare.org).

Pennsylvania must move forward with health-care reform

Physicians News — Fri, 11 Mar 2011 00:48:13 +0000

[caption id="attachment_2631" align="alignleft" width="171" caption="Rep. Josh Shapiro"][/caption] By state Rep. Josh Shapiro (PA-153) With the enactment of the Affordable Care Act in Washington, the debate now turns to the states as we work to implement the new health insurance reforms effectively and efficiently, and to ensure the benefits flow seamlessly and affordable access is established for all Pennsylvanians. One of the requirements of the new federal law is the creation of state-based health insurance exchanges. I am a cosponsor of H.B. 627, which will create these exchanges in Pennsylvania. Under H.B. 627, the Pennsylvania exchanges will facilitate the purchasing and sale of qualified health plans to all individuals and small businesses. The exchanges will establish a standardized rating system so consumers can more easily compare the pricing and benefits of each plan. In addition, the exchanges will benefit low-income individuals by offering tax credits and reduce out-of-pocket expenses for those who qualify. Moreover, consumers will still be free to purchase plans on the private market if they choose not to participate in the exchanges and do not have a qualified health plan through their employer. In short, if you like what you have you can keep it, if not, you will have more affordable options under our bill. If Pennsylvania does not establish a health insurance exchange by 2014, the federal government will do it for us. That is why last month I was frustrated when the Republicans on the Pennsylvania House Health Committee, in a straight party line vote, approved H.B. 42, which effectively blocks the implementation of health insurance reform in our state. The majority members of the committee, who approved the bill without holding any hearings on the matter, have chosen to play partisan politics instead of working in a cooperative way to deliver affordable care to Pennsylvanians. Instead of partisan grandstanding, we must work together to implement health-care reforms that benefit Pennsylvanians and their health needs. Once they are implemented, the state health insurance exchanges will increase access, reduce costs, and ultimately aid consumers and employers make enrollment choices that are best for them. As we carry out this health insurance reform in Pennsylvania, I want to hear from you. Please call my office at 215-517-6800 or email me at JoshShapiro@pahouse.net with your feedback. ### Shapiro represents the 153rd Legislative District in Montgomery County, PA. For more information, please visit www.joshshapiro.org.

The HEALTH Act Brings Protection Back to Patients

Physicians News — Mon, 23 Jan 2012 16:28:57 +0000

A Challenging Road Ahead for America’s Physicians

Physicians News — Thu, 05 Jan 2012 15:20:33 +0000

Resolutions Reflect the Changing Influences On Our Profession

Physicians News — Thu, 17 Nov 2011 14:59:06 +0000

By Lynn Lucas-Fehm, MD, JD

I Have Cancer. And I’ve Never Felt Better!

Physicians News — Tue, 01 Nov 2011 17:54:25 +0000

Watson: Extreme Evidence Based Medicine

Physicians News — Thu, 13 Oct 2011 14:44:46 +0000

Dr. Smith Goes To Washington (Again)

Physicians News — Thu, 05 May 2011 14:26:00 +0000

Obamacare One Year Later: Happy Anniversary, Doctor

Physicians News — Tue, 29 Mar 2011 13:36:24 +0000

Doctors: Doing Nothing Is No Longer An Option

Physicians News — Wed, 23 Mar 2011 14:30:02 +0000

Pennsylvania must move forward with health-care reform

Physicians News — Fri, 11 Mar 2011 00:48:13 +0000

The HEALTH Act Brings Protection Back to Patients

Physicians News — Mon, 23 Jan 2012 16:28:57 +0000

Physicians News » Opinion

Physicians News — Mon, 23 Jan 2012 16:28:57 +0000

A Challenging Road Ahead for America’s Physicians

Physicians News — Thu, 05 Jan 2012 15:20:33 +0000

Resolutions Reflect the Changing Influences On Our Profession

Physicians News — Thu, 17 Nov 2011 14:59:06 +0000

By Lynn Lucas-Fehm, MD, JD

I Have Cancer. And I’ve Never Felt Better!

Physicians News — Tue, 01 Nov 2011 17:54:25 +0000

Watson: Extreme Evidence Based Medicine

Physicians News — Thu, 13 Oct 2011 14:44:46 +0000

Dr. Smith Goes To Washington (Again)

Physicians News — Thu, 05 May 2011 14:26:00 +0000

Obamacare One Year Later: Happy Anniversary, Doctor

Physicians News — Tue, 29 Mar 2011 13:36:24 +0000

Doctors: Doing Nothing Is No Longer An Option

Physicians News — Wed, 23 Mar 2011 14:30:02 +0000

Pennsylvania must move forward with health-care reform

Physicians News — Fri, 11 Mar 2011 00:48:13 +0000

The HEALTH Act Brings Protection Back to Patients

Physicians News — Thu, 05 Jan 2012 15:20:33 +0000

By Louis J. Goodman and Timothy B. Norbeck This year promises to be a watershed year for healthcare in general, and for patients and physicians, in particular. No matter how the U.S. Supreme Court determines the constitutionality of the Patient Protection and Affordable Care Act (PPACA), 2012 will be a crucial turning point in the delivery of healthcare. [caption id="attachment_4511" align="alignleft" width="150" caption="Louis J. Goodman, Ph.D."][/caption] During the Congressional passage of the PPACA, White House advisors acknowledged that the economic forces in the legislation would accelerate physician employment by hospitals and larger physician groups. As mentioned in the “Roadmap for Physicians to Health Care Reform,” the “private” part of private practice for physicians is disappearing. Currently, more than 80 percent of visits to physician offices have been to practices with five or fewer physicians. That will change drastically as more physicians feel pressure to move into larger groups or become employed by hospital systems. Through October of 2011, there have been 71 hospital mergers. All of this will change the face of the delivery aspect of health care, but a question remains: will it be for the better or worse? Expert opinion is almost universal that there is a present shortage of physicians, especially those in primary care and those practicing in rural areas. This is a workforce problem that must be addressed now, but it seems to be lost in the debate over the PPACA. The Physicians Foundation recognizes the shortage problem and recently awarded a large grant to The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill to develop a dynamic web-based projection model that can be continually updated to track ongoing physician workforce needs across the country. Information gleaned from the UNC research will further enhance efforts to identify where physicians are most needed to support patients in a growing healthcare system. Thirty-six percent of practicing physicians are over age 55 and may retire by 2020. According to Physician Foundation surveys conducted by Merritt Hawkins in 2008 and 2010, fewer physicians are seeing Medicare patients or taking on new Medicare patients. With 10,000 baby boomers becoming eligible for Medicare every single day, the survey results do not bode well for access to care for Medicare patients. [caption id="attachment_4512" align="alignleft" width="150" caption="Timothy B. Norbeck"][/caption] Why do we have fewer physicians seeing Medicare patients at the very time that we need more of them? First of all, the Sustainable Growth Rate (SGR) used to pay physicians under Medicare, singles out physicians for financial punishment in the form of payment reductions when volume of service increases. With an aging population and increasing numbers of chronically ill elderly people, of course the volume of services continues to rise. However, unless Congress steps in and acts promptly, Medicare physician payments are scheduled for an average reduction of 27.4 percent effective January 1, 2012. The Physicians Foundation joins all other medical associations and the AARP in warning of the dire consequences on patients’ access to care should this massive and unwarranted reduction go through. The fatally flawed SGR must be fixed and the aforementioned 27.4 percent scheduled reduction must be stopped. Much has been said about the PPACA, some good and some bad. We would like to address the legislation from a physician’s point of view. Physicians are extremely happy to have the American public insured and are delighted to have an end to the discrimination against their patients with pre-existing conditions. They also applaud the new focus on preventive care which should help lead to a healthier public. As for the downside to the legislation, there was no SGR fix and no tort reform. The PPACA also assumes a planned 30 percent reduction in physician fees scheduled under the SGR over the next three years. Furthermore, and this is something that is largely overlooked when discussing the legislation, any physician’s office which mistakenly and by mere accident improperly bills too much for a Medicare visit, is subject to potential liability under federal fraud and abuse statutes. Before the PPACA, intent to commit fraud was necessary for a charge of fraud to be made, but now even an innocent error can result in prosecution. Finally, and also overlooked by many, is the “translation” fee which must be paid by the treating physician. If a physician treats a patient who doesn’t speak English and requires a translator, the physician is responsible for the translation fee. In other words, the translator’s bill would probably exceed the physician’s reimbursement for the office visit! These issues and other pressures on physicians help explain some of the survey results from the 2010 Physicians Foundation Health Reform Research Study, and the numbers only become bleaker when comparing the results from our 2008 survey. Only one-quarter of physicians surveyed said they plan to continue practicing as they are; while half reported that they would adopt a style of practice different from the traditional full-time independent private practice model. Hence, the “private” in private practice is going, going, gone! Clearly, increasing administrative burdens attributable to the PPACA requirements plus insurance, red tape and costly regulatory measures are having a likely negative effect on patient care. Sixty-three percent of physicians surveyed claimed that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said that the time they devote to non-clinical paperwork has increased over the past three years. Ask any physician what he or she enjoys the most about practicing medicine and the response will be: “seeing, helping and interacting with my patients.” The increasing amount of regulations and paperwork are becoming a more formidable barrier to the joy of practicing medicine. Add to that the declining reimbursements and difficulty in sustaining one’s practice, the constant threat of liability, decreased time with patients and low or no bargaining power with insurers, it is not surprising to note that general physician morale is low and getting lower. A recent Robert Wood Johnson Foundation survey of physicians indicated that four out of five physicians agreed that unmet social needs are connected to declining health for many Americans. By the same ratio, they also agreed that addressing patients’ social needs are just as important as addressing their medical conditions. An innovative Boston, Massachusetts organization called Health Leads interviewed local physicians about their needs in providing patient care. Many expressed frustration that they could not help their poor patients beyond simply providing medical care – with housing, nutrition (food) or other resources that could improve their health. Not only have these important issues been excluded from the health reform debate, they are largely ignored by policymakers. With a substantial grant from The Physicians Foundation, Health Leads has been able to expand their efforts to train college student volunteers in five cities to “assist” physicians to “prescribe” food, housing and fuel assistance, or other resources for their patients – just as they do medication. Patients then take those “prescriptions” to the Health Leads Family Help Desks located in clinic waiting rooms, where the volunteers “fill” them by connecting patients with those resources. Most of the student volunteers (64 percent of who are pre-med students) end up choosing to go into primary care – another plus! Generally exacerbating the overall workforce problem is the plight of medical students now coming into practice. Graduates, on average, carry a debt of $156,000 and payments of up to $2,000 a month! According to the American Association of Medical Colleges (AAMC), each member of the graduating medical school class of 2033 will face a $700,000 debt! So what can be done to help physicians sustain their practices and have more time with their patients? An obvious place to start would be to fix the unfair SGR – and promptly! This Congressional and government inability to solve this problem reminds us of the late economist Milton Friedman’s observation on the inefficacy of government: If you put the government in charge of the Sahara Desert, he said, in five years there will be a shortage of sand. And so it is with the growing shortage of physicians. Congress should relieve physicians of onerous and time-consuming regulations and insurance red tape – which do not help patient care and only add to the cost of that care. It should create more incentives for physicians to go into rural areas and find additional ways for medical students to pay off their medical school loans. Build more medical schools and increase the number of the 25,000 residents and fellows completing their training every year. Of course, the big question is: Where do you find the money to do all this? Throughout America’s history, that question has been asked many times. The obvious answer: If you have the will you can find the wallet. America always has, if the issue is considered important enough. It won’t be easy but healthcare delivery and its workforce are being challenged in a major way today, and it will only worsen tomorrow without Congress stepping up and addressing it. As noted in Shakespeare’s Henry VI: “Delays have dangerous ends.” ### Louis J. Goodman, PhD, is President and Timothy B. Norbeck is CEO of The Physicians Foundation, which is a nonprofit 501(c)(3) organization that seeks to advance the work of practicing physicians and to improve the quality of healthcare for all Americans. It pursues its mission through a variety of activities including grantmaking, research and policy impact studies. Since 2005, The Foundation has awarded numerous multi-year grants totaling more than $28 million. In addition, The Foundation focuses on the following core areas: health system reform, health information technology, physician leadership, workforce needs and pilot projects. As the health system in America continues to evolve, The Physicians Foundation is steadfast in its determination to foster the physician / patient relationship and assist physicians in sustaining their medical practices during this evolution. For more information, visit www.physiciansfoundation.org.

Physicians News » Opinion

Physicians News — Mon, 23 Jan 2012 16:28:57 +0000

A Challenging Road Ahead for America’s Physicians

Physicians News — Thu, 05 Jan 2012 15:20:33 +0000

Resolutions Reflect the Changing Influences On Our Profession

Physicians News — Thu, 17 Nov 2011 14:59:06 +0000

By Lynn Lucas-Fehm, MD, JD

I Have Cancer. And I’ve Never Felt Better!

Physicians News — Tue, 01 Nov 2011 17:54:25 +0000

Watson: Extreme Evidence Based Medicine

Physicians News — Thu, 13 Oct 2011 14:44:46 +0000

Dr. Smith Goes To Washington (Again)

Physicians News — Thu, 05 May 2011 14:26:00 +0000

Obamacare One Year Later: Happy Anniversary, Doctor

Physicians News — Tue, 29 Mar 2011 13:36:24 +0000

Doctors: Doing Nothing Is No Longer An Option

Physicians News — Wed, 23 Mar 2011 14:30:02 +0000

Pennsylvania must move forward with health-care reform

Physicians News — Fri, 11 Mar 2011 00:48:13 +0000

The HEALTH Act Brings Protection Back to Patients

Physicians News — Thu, 17 Nov 2011 14:59:06 +0000

By Lynn Lucas-Fehm, MD, JD

Physicians News » Opinion

Physicians News — Mon, 23 Jan 2012 16:28:57 +0000

A Challenging Road Ahead for America’s Physicians

Physicians News — Thu, 05 Jan 2012 15:20:33 +0000

Resolutions Reflect the Changing Influences On Our Profession

Physicians News — Thu, 17 Nov 2011 14:59:06 +0000

By Lynn Lucas-Fehm, MD, JD

I Have Cancer. And I’ve Never Felt Better!

Physicians News — Tue, 01 Nov 2011 17:54:25 +0000

Watson: Extreme Evidence Based Medicine

Physicians News — Thu, 13 Oct 2011 14:44:46 +0000

Dr. Smith Goes To Washington (Again)

Physicians News — Thu, 05 May 2011 14:26:00 +0000

Obamacare One Year Later: Happy Anniversary, Doctor

Physicians News — Tue, 29 Mar 2011 13:36:24 +0000

Doctors: Doing Nothing Is No Longer An Option

Physicians News — Wed, 23 Mar 2011 14:30:02 +0000

Pennsylvania must move forward with health-care reform

Physicians News — Fri, 11 Mar 2011 00:48:13 +0000

The HEALTH Act Brings Protection Back to Patients

Physicians News — Tue, 01 Nov 2011 17:54:25 +0000

Physicians News » Opinion

Physicians News — Mon, 23 Jan 2012 16:28:57 +0000

A Challenging Road Ahead for America’s Physicians

Physicians News — Thu, 05 Jan 2012 15:20:33 +0000

Resolutions Reflect the Changing Influences On Our Profession

Physicians News — Thu, 17 Nov 2011 14:59:06 +0000

By Lynn Lucas-Fehm, MD, JD

I Have Cancer. And I’ve Never Felt Better!

Physicians News — Tue, 01 Nov 2011 17:54:25 +0000

Watson: Extreme Evidence Based Medicine

Physicians News — Thu, 13 Oct 2011 14:44:46 +0000

Dr. Smith Goes To Washington (Again)

Physicians News — Thu, 05 May 2011 14:26:00 +0000

Obamacare One Year Later: Happy Anniversary, Doctor

Physicians News — Tue, 29 Mar 2011 13:36:24 +0000

Doctors: Doing Nothing Is No Longer An Option

Physicians News — Wed, 23 Mar 2011 14:30:02 +0000

Pennsylvania must move forward with health-care reform

Physicians News — Fri, 11 Mar 2011 00:48:13 +0000

The HEALTH Act Brings Protection Back to Patients

Physicians News — Thu, 13 Oct 2011 14:44:46 +0000

Physicians News » Opinion

Physicians News — Mon, 23 Jan 2012 16:28:57 +0000

A Challenging Road Ahead for America’s Physicians

Physicians News — Thu, 05 Jan 2012 15:20:33 +0000

Resolutions Reflect the Changing Influences On Our Profession

Physicians News — Thu, 17 Nov 2011 14:59:06 +0000

By Lynn Lucas-Fehm, MD, JD

I Have Cancer. And I’ve Never Felt Better!

Physicians News — Tue, 01 Nov 2011 17:54:25 +0000