Medicine is a house divided: It is time to unite on common goals

If you put ten physicians in a room, you will get nine different opinions.  It doesn’t matter if you are discussing policy, diagnostics, or politics.  Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being.   We battle our fellow physicians, administrators, and insurers.  You can argue the pros and cons of siloed thinking, but there is no denying the reality of the barriers that we have built around ourselves.  One wonders if a house divided against itself can continue to stand.

There is no doubt that the external threats to the stability of this profession are growing by the minute.  Politicians wrangle to define quality and best practices.  Allied health professions push to expand scope. Lawyers fight to police a group that is reluctant to police itself.  The alphabet soup grows in scary and threatening ways: ACA, ACO, MU, MU2, HCAPS, just for starters.  As our heads spin in dizzying circles, the physician voice fades into the background.  Nay, it is absent.

We criticize ourselves, we disagree, we reproach our own louder than all those silly little voices that encroach on our freedoms by and by.  This is who we are.  We rarely agree.  In some ways, I believe this is our greatest strength.  We are not afraid of infighting.

Our own disorderliness, while internally nourishing, proves impotent when faced with external threat.  We are lousy mobilizers.  As much as we fight for our patients, we are poor defenders of ourselves.

The battle lines have been set, and I believe time grows short.  The window to effect policy will only be open for so long. The practicing clinician, those wading through the mud of actual care, can and must have their voice be heard.  We cannot do this, however, if our words continue to be so glaringly disparate.

A common ground must be illuminated to the masses.  I suspect our failing point in the past was biting off far more than we could chew.  We picked the largest most contentious issues.  It’s time we chose a more narrow focus point:

  • meaningful use
  • maintenance of certification
  • face to face visits for home health
  • SGR

I am fairly certain that 90% of practicing clinicians (not administrators, health care policy wonks, or non-practicing MDs) can agree on these issues.

They need to be abolished.

Can we find a way to work together on this?

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

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  • NewMexicoRam

    That’s a start. But that’s all it is.
    How to look unified and actually take action will not be easy. In fact, I really believe it will take a nation-wide work stoppage to bring any change.
    Whoops. I just threw another contentious element into the works that doctors will not be able to agree on.
    So much for that idea.

  • QQQ

    “A common ground must be illuminated to the masses. I suspect our
    failing point in the past was biting off far more than we could chew.”



    Here is the 2700 page Obama Care condensed to 4 sentences…..

    And it seems to be working, this is according to the plan!


    1. In order to insure the uninsured, we first have to uninsure the insured.

    2. Next, we require the newly uninsured to be reinsured.

    3. To re-insure the newly uninsured, they are required to pay extra charges to be reinsured.

    4. The extra charges are required so that the original insured, who
    became uninsured, and then became reinsured, can pay enough extra so
    that the original

    uninsured can be insured, free of charge to them.


  • doc99

    When the Bob Doherty’s of the world join with the Craig Wax’s of the world, the House of Medicine will again be whole.

    • Dr. Drake Ramoray

      You forgot Dr. Sisinksy and her joy of practicing medicine.

      • James O’Brien, M.D.

        Priorities have to change. There is another thread with over 100 responses (I’m a hypocrite I admit, I joined in) about the term “mid level provider” and the term “provider” which is an insurance designation.

        So clearly offensive words are more important to us than offensive actions, like prior authorization, EHR, Prop 46 in California, MOC, patient satisfaction surveys, etc.

        Call me old fashioned but I am much more offended by a punch than an insult.

        That realization is step 1.

        Step 2 is findings the biggest bully in the bunch and punching back.

        And I don’t see physicians doing that.

        • T H

          Step 2: We suffer from a wealth of targets.

  • James O’Brien, M.D.

    AAPS is the only major organization that gets it. First obvious step is give up AMA membership and direct the funds to people who are actually fighting for us.

    • Dr. Drake Ramoray

      AACE recently wrote a follow up letter to the ABIM after it appeared that their first official complaint was essentially ignored. In it the president of AACE is very professionally telling the ABIM to take a hike and that the field of Endocrinology may develop it’s own certification program. I believe they are meeting later this month.

      We already have our own programs for ultrasound and nuclear medicine certification. AACE is not only contending MOC but is now also raising issue with the 10 year exam. A broadside to the ABIM. I couldn’t be prouder of my own organization.

      I agree on joining AAPS. And the if the AAFP isn’t representing you then drop them. Same for the ACP. It can work through the right societies and the AMA, ABIM, ACP, and AAFP are not only not helping but usually actually working in opposition to the interests fo the physicians they claim to represent.

      • James O’Brien, M.D.

        Do you have a link to the letter?

        Never mind I found it:

      • rbthe4th2

        Certain items that patients might want to support (getting paid for EHR, phone calls and internet/emails to patients, providers, peer to peer) could be a bridge to joining with patients as a push from both ends that would benefit those of us in the “trenches”, maybe some of these groups should take a look at those?

  • buzzkillerjsmith

    Your last question is a softball. No, we can’t find a way to work together on all this. So we will continue to get hammered.

    Next case.

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