Delivered by Alice A. Tolbert Coombs, MD, president of the
Massachusetts Medical Society at the 2011 Annual Meeting on May,
19, 2011.
Thank you, Mr. Speaker. This is a time of great
change, and physicians everywhere are stepping up to the challenge
of our times. Our influence as a medical society has never been
greater. But we must watch carefully what happens around us,
because there are signs of many more changes in the future.
These changes will impact the very culture of our profession --
how we work as physicians, and what we do for our colleagues as
leaders of this medical society. For example: I can remember
starting a practice with two other women in internal medicine 27
years ago, a time when most of our members were self-employed. They
took care of their patients, AND they managed their practice. Even
then, this was a very challenging mix. But today, more than half of
our members are employed. They work for someone else, not for
themselves. This affects what you need to know, what you need
to learn, and what kind of support you need from others.
For our experienced physicians, this may be a troubling
development. Running a practice is something they craved, and
something they loved. We must honor that. Autonomy is important,
and protocolized-driven medicine poses a constant threat to
tailored, individualized medicine. But many of our younger
colleagues want something else. Many want to be doctors and leave
the administration of health care to others. This is not better
than the old way … or worse … it's just different. There are
generational differences not only in priorities, but in experiences
and career morale.
Going forward questions need to be addressed: How does the
Massachusetts Medical Society remain relevant? How do we
measure the real Vital Signs of the organization? I would like to
propose a prescription for both resuscitation and optimal
maintenance of disorders that threaten our viability.
1. Addressing the needs of physicians who have cardiac
standstill (aka asystole) is crucial. We learned from the MMS 2011
Index Report that 46% of all physicians are above the age of 55.
Unfortunately, the song "The Way We Were" cannot be played.
So again, learning about the concerns and deficiencies of this
segment will help us with transitions.
2. Another group may have tachycardia … it could be ventricular
tachycardia or just a sinus tachycardia. They're very willing move
ahead with health care reform, aggressively investigating any new
innovation that will help. These Docs are excited, but will need
more comprehensive TOOLS - financial and business management; ACO
education and training.
3. Respiratory distress - Some doctors are waiting to be
intubated so as to let someone, anyone ventilate them. Maybe it is
out of frustration or maybe fatigue or even hopelessness.
Physicians in this group see all this change, and they want
support, and they want to be protected.
4. The Uninsured. Slightly more physicians are outside of
our organization than inside it. You could say that these are the
uninsured docs. They wait for an emergency before coming to
the society with their emergent needs. We want to help them, but we
also need them in the MMS network. They are important to us!
My challenge to you is this: We own this organization, so let's
make it stronger. Let's set a goal that each of us recruit at least
one new member next year. The MMS is better with infusions of fresh
thinking, just as an ischemic limb longs for reperfusion to
maintain viability. New voices allow us not only to diversify in
our thinking, but allow us to better relate to patients' needs in a
variety of clinical settings. Diversity in the physician workforce
in every venue is crucial!
Look at our medical schools. At least half of the students are
women. This has profoundly altered the culture of medicine in ways
that are both visible, and not so visible. Even men graduating from
medical school express different preferences than men of previous
generations. And while minority physician numbers have not
increased percentage-wise, the population is projected to be
greater than 50% minority by 2040. Our membership still does not
reflect this gender mix, or racial and ethnic diversity.
It may, in time, as modern medical students fill our ranks - but
only if we continue to address the concerns of this population, and
provide value to them.
We can do better - we must adapt. If we could see the society as
a human body - Some members function as the eyes, others the ears,
some as hands and yet others as vital organs such as the heart,
lungs and liver. Every organ has a role and is directly tied to
helping out and relieving stress and creating functionality. The
importance of each cannot be argued.
We must be more diligent in learning what we can offer this new
kind of physician, and do it quickly.
5. The Code 9 Team.
Let me take you back down memory lane to your medical school
rotation in Internal Medicine a few years ago. Perhaps you heard
Code red, blue or 9 - you arrive to see docs doing CPR, probably no
ACLS then (ha ha). There are the team leaders in the process and
there are those who stand on the sidelines whose role is to provide
support, but with no clear direct care of the patient. Now,
wouldn't it have been incredible if someone (in a suit) said "Give
phenlyephrine instead of norepinephrine, it's slightly cheaper," or
if they said, "You exceeded your hourly global budget on this
un-risk adjusted service patient." Of course it would have
been incredible! Once, in the not-so-distant past, you didn't talk
about money and medicine in the same sentence, at least not in
polite company.
Now let's go back to the real world. The most difficult debate
today is about the cost of health care. The advent of universal
coverage in Massachusetts has improved many things, but it hasn't
changed this: If a patient can't afford the medicine, they won't
pick it up at the pharmacy. If they can't afford the co-pay, they
won't even make it to the office. This has a direct impact on their
health and wellness. The truth is that the affordability
crisis has entered the clinical world. We cannot pretend anymore
that it is not our job. It is! This is not a comfortable discussion
for many physicians. It raises the idea of rationing, which is
repugnant to us. It introduces the ethics of business to medicine,
which is uncomfortable. In short, the affordability crisis
forces us to think about issues that go against our nature, and
have conversations that we'd rather not have. We'd rather not talk
about it. But we must.
We cannot leave the discussion of money and health care to others,
because we've seen what happens when we do. Imagine the reality of
the scenario I just cited. But making a commitment to have these
conversations is only the first step. We must know what to do
… we must know what to say … and we must develop solutions that
work for everyone. That's precisely the debate that we are having
today. We're talking about payment reform. We're talking
about Medicare and the SGR. We're talking about electronic health
records. We're talking about hospital-physician relations. As a
medical society, we're deeply involved in all of it - and we're
making a difference.
We know that we have already put our imprint on the payment
reform debate. The officers have permeated Massachusetts to discuss
payment reform, and more important to listen to you as you educate
the MMS about your concerns, about your experiences over the past
three years. We have advocated in DC and to our legislators, Sec
HHS, and the Governor. Our voice has been heard!
Thanks to our work, it is now widely accepted that liability
reform is a necessary pre-condition to true health care reform. And
people appreciate that a robust primary care workforce is
critically important to our future. They know that we must walk a
fine line between fostering our future health care system, and
ensuring the viability of those who "touch the patients" and
provide care today. As I said, these issues are already changing
our profession. But what we have seen so far is only the
beginning. I believe that while changes introduce a notion of
vulnerability, it is imperative that we lead in the navigation and
how it is done.
Our challenge will be to recognize the "intersection of
opportunity and responsibility."
We are physicians. We care for the sick. We advocate for those
who are sick. We support those who are troubled.
The future of our profession depends on our ability to capture
that essence of our lives.
The future belongs to the most adaptable - those who see the
future, create innovations, make it their own, and preserve their
essence in the process.
That is our challenge for the 21st century - as individuals, as
professionals, and as a medical society. I know we're up to
that challenge.Mr. Speaker, that concludes my report.
