First, as you see from the graphs of OncoCap, not all specialties have been affected in similar way. In fact, it seems the salary has increased for some of the specialties. It is likely that things look bleaker for you because your specialty was one of the hard hit ones. Second, when you see so much disparity among different specialties, it makes it harder for everyone to come together and act as a group.
You've hit on a big part of the problem. First of all doctors are not allowed to unionize, but even in the few ways we are allowed to weakly organize its difficult. It's a bit like trying to form a cohesive group between airline pilots and police officers. They will obviously have very different goals and any agreement would inevitably benefit one group more than another creating discord among them all. Personally I think the huge disparity between physicians who perform procedures and those who provide cognitive services needs to be rectified, but without a doubt the plastic surgeons, interventional cardiologists and radiologists will disagree.
my opinion, the solution, or at least part of it, depends on the doctors' ability to self-regulate their field, just like they do it in law.
I'm not exactly sure what your getting at but we are way beyond any hope of self regulation. Society has already decided that more regulation not less is the answer to all our problems. There are a lot of things already in place or coming soon that will increase the level of government and insurance company oversight. The era of self regulation is already a distant memory.
the disparity among different specialties and how individual and selfish some doctors can be, I don't see this problem being solved unless one governing body forces all the doctors to comply with the same rules and regulations.
There actually is some hope of improvement here for exactly the reasons you lay out. The government has decided that there are too few primary care docs and too many specialists with signs that its only going to get worse ( One quick scan of this forum certainly confirms that), and has started working towards a system that would pay more for primary care services and less for subspecialty work.
This is a very big topic to cover here, but you are right that there needs to be malpractice reform. There doesn't seem to be much political will yet to do it though.governing body should be made up of doctors and the implemented regulations should include codes of conduct and ethics. For example, there should be a general guideline as to what kind of life support options should terminally ill patients get or what types of diagnostic tests are enough to identify a certain types of diseases. This way if a doctor follows the guidelines and gets sued, the case will be dismissed. I think that there can be some basic regulations that can help both doctors and patients avoid litigation based on ambiguity of ethical procedures. There should also be a standardized cap on malpractice based on the specific type of injury.
This is a real problem. Currently if I want to argue with an insurance company to get a test approved I speak to someone who barely has a high school degree ( and in some cases its someone who speaks poor english sitting at a computer terminal in India). From the minute I get on the phone I am at a disadvantage. The meter is always running in business. Its only costing the insurance company $5/hr to put this poorly educated person on the phone to argue with me. During that same time I'm still paying $200/hr to keep my office open. Insurance companies should be required by law to put a doctor on the phone if a doctor wants to dispute something. The insurance companies would deny a many fewer requests and require far fewer pre-authorizations if that were a requirement.Right now doctors are forced to argue with clueless businessmen whether a procedure should be done or not. This process is so wrong that I can't even understand as to why it still exists.
You writing a letter to the government is not going to have as much weight as an organization writing a letter. AMA should either be disbanded and a new organization formed or the entire leadership there should be changed. The public opinion of doctors has been slipping and that's part of the reason why doctors have no support in congress. If the public is unaware of the problems, there will not be enough constituents to force the congress to act. AMA has completely failed in public relations aspect. It is probably run by those few egocentric students who did not mature after getting their degree and are now grumpy old demigods.Articles like this don't help AMA either. I don't know why that organization persists. Somebody needs to put it out of its misery. Macgyver, what is your opinion of AMA? I can't imagine it to be positive since you had to write those letters yourself. Did you ever think about getting into AMA and advancing in ranks? What does it take to become a leader in that organization?
The AMA has truly lost most of its power since its heyday in the 50's and 60's. Although it may sound like a bit of a cop out, as a solo practitioner, I haven't the time to become involved with the AMA in a way that would make a significant difference. I already wear too many hats. I honestly think at this point that my efforts have more of a chance of effecting things if I go it alone. If I thought the AMA was moving in the right direction I might put more of my efforts there, but its not. I would literally have to become president of the organization and force it to change course and I don't have the time or the political talents to do that. You are right about that article being problematic, but the AMA is right in trying to prevent Nurse Midwives from encouraging home births. They are dangerous. People forget in this day and age how many mothers and babies used to die in childbirth. The numbers are horrendous. An accidental home birth is one thing, but to intentionally encourage it is down right criminal in this day and age. People will die needlessly.