By Robert Sklaroff, M.D.

• React to this article in the Discussion Forum.

Prominent among the proposals to be weighed during this year’s meeting of the PMS House of Delegates will be the Bucks County resolution to permit deunification of the county and state medical societies, just as was done in 1995 when the PMS deunified membership with that of the AMA. Dr. Greco responds by noting the need to continue efforts to alleviate inequities through activities of the Civil Justice Coalition. What seems to be evolving is a multifaceted set of medical groups (state, county, specialty, and issue-oriented), each grasping for any sort of victory to buoy the spirits of practicing physicians.

Even as one such independent group, the Cincinnatus Society, sues to abolish mandatory insurance, the PMS Board joins its efforts to "kill the CAT" immediately; such an agreement was made between the leaders of the two groups (Dr Greco and Louis Meier, MD) brokered by the Philadelphia County Medical Society. Healing a decade of grievances won’t occur overnight, but this reflects the ability of disparate groups to recognize the need for and to achieve commonality of purpose.

The last portion of the article dealt with unionization, even as were published (in this same issue) numerous News Briefs on what’s occurring nationally in this arena. PCMS President Raymond J. Lodise, MD has convened four eight-county meetings during the past six months to address this issue, which is also being studied intently by the PMS. Would prominence of such an entity eclipse traditional professional societies? If there is a coordinated division-of-labor among heterogeneous bodies, each entity could benefit. But each must do its job, "loyalty" must be distributed among physician organizations, and none will succeed without active support from member-physicians.

As has been recorded periodically in these pages during the past year, the PA Society of Internal Medicine (and myself, as its President) has been suing to undo the merger of PA Blue Shield and Blue Cross of Western PA. This effort exemplifies what can be done by doctors who recognize the public health impact of insurer-monopolization and social mission abandonment. We were granted standing by the Commonwealth Court expressly because we were viewed in a unique light—members of the PMS corporate body—and not because we are providers or subscribers. As we await its verdict, we draw satisfaction from the fact that our traditional patient-advocacy role was recognized judicially.

This is the charge to physician organizations that emerges from your article. I feel we must focus upon the need for mandatory retroactive consideration of periodic damages payment, for example, as the mechanism by which a dramatic reduction in the CAT Fund liability could immediately be realized. Others would push for recognition of Collateral Payments, despite the Governor’s opposition to this idea. Whatever is done, its impact may be secondary to our ability to convey to physicians the worth of recalling the principles which prompted us to choose this occupation. Then will the value of the dues-dollar be appreciated; then will the physician community—practicing and retired—make it a personal priority to become educated regarding such problems; and then will doctors be empowered to act to regain some control over the practice of medicine.