By Jennifer Trottman, M.D.

President of the Montgomery County Medical Society

• Introduction
• Physician Unions
• Physician Organizations
• Physician-Owned Insurers
• National Health Insurance

• React to this article in the Discussion Forum.

In the previous essays, we have seen several opinions on how to make the practice of medicine worthwhile. I agree with most of what has been presented. Physicians certainly need to be entrepreneurs to practice medicine these days. Medicine is a billion dollar business and we need to have good business acumen and not take anything done to us too personally. We do not typically think in those terms and it will take a mind shift for us to do so. But we can (and must) do it since those of us who are not flexible will not survive.

The key to surviving appears to be focusing on satisfying our patients needs. The big three wishes for patients appear to me to be choice, quality and price. And given the chance, most doctors (who , after all, pride themselves on the ability to develop good rapport with people) want to maintain that much touted "doctor-patient" relationship. That is why ideas like developing managed care companies run by physicians is more of what we need. We need organizations that will show patients that they can get quality health care without having to resort to being part of a business whose first priority is to its shareholders and not to the care of patients. And we do have the advantage of, for the most part, being trusted by the public.

I have another bias, however. I believe that the practice of medicine would be ill-served if we all joined a union and yes, I can appreciate the difference between unionization and organization. As a young physician, I appreciate and agree with the need for us to organize. That’s why we should all belong to medical societies (they do call it organized medicine after all!) I think we can all agree that physicians are best equipped to act as ombudsmen to ensure the best health care for patients. The past several years have confirmed that administrators are less concerned with quality and more with quantity. I think that the only way we can preserve intact the physician-patient relationship is to truly "organize." We all need to be members of the organizations that are already in place. Not create anew what is not needed.

The concept of a universal health care system is one which, if done right, is something to strive for. As a palliative care fellow (having already completed training in hematology and oncology), I see a lot of gaps in our current system that are poorly managed. Our current view of medicine is that of diagnosing disease and then using all of our resources for treatment. And "treatment" apparently does not include adequate resource allocation to the most vulnerable populations, i.e., poor children and poor elderly, nor does it include good end of life care. With a shift in emphasis to preventive medicine, and palliative care finally being seen as being on the continuum of good health care, our patients would be much better off. And in the end, so would we.