by Matthew DiPaola, MD
When the country was first founded, about 10 percent of national representatives cited medicine as their profession. Since 1960, only 1 percent of Congress has been made up by physicians. Historical differences in training duration aside, those numbers alone should tell you who is driving the Washington version of reform. It ain’t doctors.
In medical school, we were fortunate enough to have a pretty extensive public health block. It really opened you up to the systems nature of the field. I remember one day a policy-type guy came into the class and he got into some of the politics of medicine. It’s a subject that is not talked about that often: we’re too busy learning about knock-out mouse models and Perkinje cells most days. I hardly remember what the speaker said that day, but I do remember being very bothered by one of my classmate’s comments. She said something to the effect of, “I feel like I am not qualified to even talk about those issues [health policy].”
As if to say that since she didn’t have an advanced degree in government, she couldn’t speak on it.
This really bothered me. There are many people who don’t have a tenth of the education that my classmate had, and with zero connection to the field, who are willing to take ownership of it. Her comment felt like a capitulation. “If not you, then who? You are the profession!” I wanted to say. Don’t get me wrong, she was a fantastic student and, I’m sure, a fantastic physician today.
But I think medical education socializes us sometimes to defer only to the super-specialist – to believe that we are not qualified to speak on something unless we have a string of eight years of A-pluses under our belts on the matter. Hopefully the internet will change that to a degree. It has given a voice to a lot of MD’s out there who are not politicians.
Doctors, it’s time to take ownership of your profession. Before someone who cares much less about it than you does.
Matthew DiPaola is an orthopedic surgeon who blogs at Matthew DiPaola MD.
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{ 13 comments }
You hit the nail on the head. We absolutely need to take back control of our profession. No more zombie docs forfeiting control to pencil pushers.
As you pointed out, doctors are conditioned to think before we speak and defer to the “experts” in a given field. In training, we are held accountable for our actions and accountability breeds caution in some. But, we are the experts on health care. It is time to hold the health care imposters accountable.
Kevin, HOW can we take “ownership’ of our profession when so many now in control of it do not adhere to our code of ethics . . . do not play by any rules . . . suffer no accountablity . . . and think that we (with our years of training and multiple degress) are “a dime a dozen”?
I’ve been in this blogosphere SIX YEARS screaming about what happened to me because of those very things. I played by EVERY rule while everyone else did not. WHERE is the AMA? Where is JCAHO? WHERE is the Medical Board? WHERE is DHHS WHERE are state and Federal law enforcement?
Why haven’t I gotten an invitation to testify before Congress?
Take back the profession? TELL ME HOW.
Interesting post — I certainly think it’s a great idea for doctors to take control of the medical profession. However, the more critical question is — which doctors should take control of the medical professions?
I’d prefer that my representatives recognize the importance of subspeciality care and prevent resources / reimbursements from being reallocated into primary care. Just to add to the wish list, I’d also like the National Center for Complementary and Alternative Medicine to be disbanded, fibromyalgia to be discredited as a formal disease process, and pigs to fly.
Dr. Johnson writes, “Kevin, HOW can we take “ownership’ of our profession when so many now in control of it do not adhere to our code of ethics . . . do not play by any rules . . . suffer no accountablity . . . and think that we (with our years of training and multiple degress(sic)) are “a dime a dozen”?
How? Well, not by continuing to do what hasn’t worked! Throw the “rules” out. Desperate times call for desperate measure- gorilla tactics are needed. Work slow downs are a legitimate and ethical form of protest. According to AMA code of ethics- “In rare circumstances, individual or grassroots actions, such as brief limitations of personal availability, may be appropriate as a means of calling attention to needed changes in patient care”.
It’s not a question of HOW?, rather WHO?, who has the courage to take off the gloves and do what is necessary!
Puhlease, Christophi, given that most of my colleague are spineless mice when it comes to saying what they really think, I was under the impression that being in the blogosphere signing my own name – and naming names – WAS a bit of a gorilla tactic.
My case (as I’ve found out, actually not so “rare”) SCREAMS for intervention on a state/Federal and JOURNALISTIC level. Again, where are all of our so-called advocacy organizations – the ones that are supposed to be there to protect us? Where are the news organization that boo-hoo when Conan bumps his head?
The people that are in power now have ZERO RESPECT for physicians – and very little comprehension of what most of us do and endure on a day-to-day basis. Some of it is our own fault (or rather a previous generation of MD’s fault) because we let them devalue what we do . . . and gradually herd us – like reluctant cats – to our respective cages. Now we are only here to do their biding . . . so they can satisfy the masses who now feel entitled to a whole lot of expensive something for nothing.
Someone somewhere else in another comment thread on this blog NAILED it. ENTITLEMENT IS THE PROBLEM!!! It is the elephant in the room. Is our President addressing that in his grand plan for “reform”? No. He is FEEDING it.
You might recall that, just a few posts ago here on Kevin’s, we talked about medical schools clamping down on what medical students say and do outside of their professional lives. In JCAHO’s eyes (and apparently the AMA’s – please don’t get me started on “which doctors” have been in control), anything a doctor might say or do to fight back against arrogance, ignorance, ineptitude and greed on the part of a hospital or its administration is “disruptive”.
I’ve been fighting the equivalent of a lone gorilla war for eleven years. I’m heartened to see some of my colleagues finally waking up. But it’s probably way too late.
Purkinje, not Perkinje.
Otherwise, good points.
What happened when we had a physician at the very top of the power hiearchy? Bill Frist, a cardiovascular surgeon, was majority leader of the Senate for years and nothing was done to help the medical profession and patients.
Dr J. I agree most M.D.s are spineless mice too busy to be bothered, or worse, advocates for the status quo. But, with all due respect, your venting in the blogosphere won’t get you out of your cat cage. As long as we continue to march in line the power broker puppeteers get what they want, our brain power. We need to make it clear that our brain power is not another entitlement! We have what “they” need, a medical degree. We are not a dime a dozen. PAs, NPs (and FMGs) can’t do it all. If we withhold our intellectual property we will be in a power position.
“Guerilla”, not “gorilla”. Unless you meant the big monkeys.
Otherwise, good points.
Chuckle, typing fast, thoughts ahead of words. Punctuation and spelling suffer. Sorry to the “not MD’s”.
Of course, when you are talking about the folks I’ve been fighting – or the ones in government, regulation & law enforcement who’ve been pretending I don’t exist – big monkey tactics (as in business) sounds good too;)
Senator Bill Frist. Now there’s an interesting subject. Probably shouldn’t be talking about cats around him. And from Wikipedia (the short version because links on my long-ago posts are dead): “Frist has a fortune in the millions of dollars, most of it the result of his ownership of stock in Hospital Corporation of America, the for-profit hospital chain founded by his brother and father. HCA paid over $1.7-billion in criminal penalties for Medicare fraud.”
In point of fact, Christophil, to a large degree, blogging openly and signing my name has gotten me out of my cage. Eleven years of college/training, followed some time later by a good solid three years of legal pummeling (and about 9 awful years of eeking by) had beaten the ME out of me. I lived in absolute fear.
Blogging at least changed that. I do have a much better sense of what my time & expertise is worth (especially in certain situations), and I don’t put up with garbage anymore. Moreover those who contract and work with me know it.
And those who wronged me are now the ones living in fear . . . i.e. when will the other shoe drop?
“First, you get the money…
then you get the power….
then, you get the women” ie patients.
Tony Montana, Scarface
Excellent post. Political representation may be the only way to get a toe hold into preserving our interests. I agree that growing divisions within the House of Medicine will make it harder. The fact remains that it must be done.
Great apes, not monkeys, big or small.
Yes, entitlement is a problem: entitlement to have someone else pay for the medical services and then also to have someone else pay for the insurance policy that pays (sort of but not really) for the medical services.
So is the failure of the insurance industry to actually become a market. It behaves like a cartel.
The medical profession behaves as a collection of varied interest groups with sometimes common and sometimes opposing interests. Pitting specialists against generalists by suggesting one has to take from the other, opposite; supporting a government option or even single-payer insurance reform bill, common (surprisingly, 80% regardless of practice type.)
Sadly, not so long ago, a resolution to “Take Back The Profession” came before the AMA House of Delegates. It was defeated. Sic transit gloria mundi.
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