Why don't doctors unite?

[docB]

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our biggest challenge is a lack of knowledge in this realm for most medical students and MDs. the second biggest challenge is a lack of organization.

so the simple answer to your question: organize & educate.

here's a possible roadmap.

1. start an organization geared toward educating medical students and docs about issues pertaining to trends in healthcare delivery, issues pertaining to the business of medicine and how the status quo is deteriorating the doctor-patient relationship and physician autonomy. the end goal is to cultivate more physician leaders who are concerned enough about the future of the field to take action.
the first few steps in starting this organization:
- get the mission hammered out
- use SDN to get a student rep from every medical school to help start up a chapter.
- prioritize the work that needs to be done and come up with 3 projects to execute in the next 6 months.

These are great points. Let me play Devil's advocate for a moment and raise some questions.

Your first point about organizing and starting in med school is a valid one however the attempts at this up to now have been failures. Take AMSA for example. They illustrate the point nicely. Before you can organize you need to have consensus among a large group which is tough to find in medicine. AMSA advocates socialized medicine and thereby alienates a huge segment of their supposed constituency. We have to agree on some things before we can really organize and move forward.

2. have a similar approach focusing on MDs. (on the backburner because students tend to have more flexibility and interest in being a part of the creative process - if only for CV boosting reasons.)

How will you overcome the inter-specialty issues? I know that as a group EPs support PMDs but when it comes to CMS we have a history of telling the budget cutters to stick to anyone but us if they want their ERs to stay open.

I am quite cynical (for those of you who did not know). My fear is that it will take some huge catastrophe in the medical profession such as socialism or a 50% CMS cut or the like to ever motivate us to unite and fight. By then it will be too late.

 

[U4iA]

the algorythm looks something like this:
challenges > organization > professional awareness > public awareness > positive change

if you're too busy discussing what "positive change" is.. you will be totally defeated because there is no general awareness of the challenges we face. there is no argument surrounding the fact that we are heading in the wrong direction - these challenges are real and need to be known.

you get around all these issues by not focusing on solutions... and instead focus on educating people in the medical field about what is going on. show them the record profits being made by folks taking care of 'the business of medicine'... show them the consistently declining wages and increases cost burden on physicians, call attention to the fact that the doctor-patient relationship, the key to good medicine, is being severly threatened by current trends.

let people conclude on their own how best to approach the solution. that is not our problem for now. step 1 is to get organized.. create a voice out of all of the chatter.

the problem is that 90%+ people in medicine do not understand ANY of what is happening to our field... this is akin to having a cancer somewhere in your body... and not doing anything, only to watch the cancer slowly take over the host. complaining of the symptoms as the disease slowly progresses - taking no action.

the action we need to take now is to get people in our field to think about what is happeneing and realize that we have a collective interest in eachothers successes and that ultimately it is our responsibility to make sure our patients are getting the care they deserve.. not some CEO who is only interested in his 36 million dollar bonus.

we can't start talking about solutions when medical people do not understand the problems.

lets focus on getting these many incredibly intellegent people to utilize some of their intellect to come up with their own perspectives. the alternative is to let the infighting and worse yet, the ignorance, continue until we are ALL practicing a style of medicine that we would not have chosen, our patients are recieving suboptimal care; the cancer wins out.

 

[sirus_virus]

These are great points. Let me play Devil's advocate for a moment and raise some questions.

Your first point about organizing and starting in med school is a valid one however the attempts at this up to now have been failures. Take AMSA for example. They illustrate the point nicely. Before you can organize you need to have consensus among a large group which is tough to find in medicine. AMSA advocates socialized medicine and thereby alienates a huge segment of their supposed constituency. We have to agree on some things before we can really organize and move forward.



How will you overcome the inter-specialty issues? I know that as a group EPs support PMDs but when it comes to CMS we have a history of telling the budget cutters to stick to anyone but us if they want their ERs to stay open.

I am quite cynical (for those of you who did not know). My fear is that it will take some huge catastrophe in the medical profession such as socialism or a 50% CMS cut or the like to ever motivate us to unite and fight. By then it will be too late.

Awesome post. These are not very unlikely scenerios either. It is unfortunate that physicians have to sit and wait for these kinds of catastrophes to emerge before taking action. Even though I might have confused the thread a bit with the residents union thing, I think that is the right place to start. Forget the whole hospital by hospital union, I am talking big time national union backed by the entire physician workforce. Residents are the right group of people to go on strike if need be. They are underpaid, often overworked and could arguably be the most abused workers in the free world. The public is not going to be upset at residents anytime soon for threatening to strike, or in fact going on strike. Ofcourse they can strike over any issues including all this midlevel dogshow, malpractice, and hell even reimbursements. The trick here is to get resident to be 1) comfortable enough with the concept of activist union, and ofcourse attendings and programs need not victimize them for being active 2) Get the whole concept of "just passing through" out of their system and start fighting for the profession from that level.

 

[U4iA]

for example... if we were organized.. we could use our numbers to call more attention to issues such as these.

House to Vote on Physician Payment Bill

Call your Representative NOW!

FACT: Just SIX DAYS AGO the Centers for Medicare and Medicaid Services (CMS) began taking steps to implement the 10.6% cut to Medicare physician payments.

FACT: In LESS THAN TEN DAYS the largest single cut to Medicare physician payments will go into effect; this 10.6% cut translates into more than $30,000 per physician on average.

FACT: Congress has been in session for MORE THAN 180 DAYS THIS YEAR; they have yet to even debate the issue.

FACT: For the past SEVEN YEARS Congress has failed to enact legislation to reform the Medicare physician payment formula.

FACT: More than 7,900 BABY BOOMERS turn 60 each day; many of whom won't be able to find a physician when they are 65.

ACT NOW: CALL YOUR REPRESENTATIVES ON MONDAY, JUNE 23 and tell them to VOTE YES on the "Medicare Improvements for Patients and Providers

Act" (H.R. 6331) and preserve patient access to physicians under Medicare.

1. Dial 877-262-9400 from any touchtone phone.

2. You will be connected to your Representatives through a by entering a your zip code.

3. When the office answers, identify yourself as a physician and the town and state you are from to demonstrate you are a constituent.

4. Tell the House to preserve Medicare beneficiaries' access to physicians and vote 'Yes' on "Medicare Improvements for Patients and Providers Act" (H.R. 6331).

5. Hang up and call your colleagues and urge them to do the same!

 

[U4iA]

AMSA has so many issues it tries to address. it cannot be an efficienct vehicle for the type of process we are talking about.

a few posts back someone was basically saying that we need to de-stigmatize the whole process of being an "activist" ..the best way to get there is to provide people with the materials to understand how to make good decisions.

as long as physicians and student-doctors do not understand what is happening to their field and what power they actually have, they are powerless.

 

[fab4fan]

I've never understood how they can say what 'advanced practice' nurses are doing is still considered nursing practice... does anyone know if there have been lawsuits against NPs or CRNAs for practicing medicine without a license? Might be something interesting to look into... Of course, since the BONs are run completely by nurses, they can make their scopes of practice anything they want and pretty much get away with it, since there is very little-to-no oversight of the whole process.

I forgot that you were a nurse in a "former life."

I don't know what state you're from, but have you ever played the game called "Call the BON and try to get a straight answer on scope of practice?" I have, and it's not fun. They won't tell you anything where I'm from. Oh, they know the answer--in fact, they'll even tell you that they know what the answer is, but it's up to you to figure it out.

Them: "We are not here to advise. It's up to you to interpret what the BON has described."

Me: "But what if I don't interpret it correctly?"

Them: "Then your license could be subject to disciplinary action."

Me: 😕

I shudder to think about dealing with "advanced practice" license issues. Having a regular old RN license seems to be too much power already for the old biddies that run the BON of the Commonwealth.

 

[tr]

White-collar workers have never been able to unionize effectively. The reason is that their personal identities and loyalties are too bound up with their jobs.

Labor organization requires that the workers use the only bargaining chip they have available: the power to supply or withdraw their own labor.

This works fine when the laborers don't have a strong personal investment in the success of the company. That's why blue-collar workers have such a long and successful tradition of unionization.

Professionals can't do this because they can't let go of their personal investment in the quality of their work. (This is not a value judgement, merely an observation.)

This goes double for doctors because of the moral repugnance of walking out on sick people who need help.

A bunch of surgeons tried to strike in W Va a few years ago
http://www.cnn.com/2003/HEALTH/01/01...ice/index.html

Even then it was kind of a half-strike (they were still doing emergencies, just not routine/elective procedures), and still the backlash of public opinion against the idea of striking doctors was so strong that nothing came of it, they just gave up and went back to work.

 

[sirus_virus]

White-collar workers have never been able to unionize effectively. The reason is that their personal identities and loyalties are too bound up with their jobs.

Labor organization requires that the workers use the only bargaining chip they have available: the power to supply or withdraw their own labor.

This works fine when the laborers don't have a strong personal investment in the success of the company. That's why blue-collar workers have such a long and successful tradition of unionization.

Professionals can't do this because they can't let go of their personal investment in the quality of their work. (This is not a value judgement, merely an observation.)

This goes double for doctors because of the moral repugnance of walking out on sick people who need help.

A bunch of surgeons tried to strike in W Va a few years ago
http://www.cnn.com/2003/HEALTH/01/01...ice/index.html

Even then it was kind of a half-strike (they were still doing emergencies, just not routine/elective procedures), and still the backlash of public opinion against the idea of striking doctors was so strong that nothing came of it, they just gave up and went back to work.

Thanks for the psych tutorial but I will go ahead and remind you that the physicians that were forced to strike in Isreal years ago when they started making significantly less money than nurses were "professionals" too. When your nuts are trapped in nutcracker, all this white, blue, purple, orange collar theory of yours will fall apart and striking will become a knee jerk reflex.

 

[docB]

if you're too busy discussing what "positive change" is.. you will be totally defeated because there is no general awareness of the challenges we face. there is no argument surrounding the fact that we are heading in the wrong direction - these challenges are real and need to be known.

you get around all these issues by not focusing on solutions... and instead focus on educating people in the medical field about what is going on. show them the record profits being made by folks taking care of 'the business of medicine'... show them the consistently declining wages and increases cost burden on physicians, call attention to the fact that the doctor-patient relationship, the key to good medicine, is being severly threatened by current trends.

let people conclude on their own how best to approach the solution. that is not our problem for now. step 1 is to get organized.. create a voice out of all of the chatter.

Ok, I get it. Educate now. Activate later. I'll buy that.

I would also agree with you that med school would be an ideal place to start. There we're up against the fact that during the really formative pre-clinical years when students might still have time, stamina and 2 ounces of give a crap all the education is done by non-clinical PhDs that don't even know what CMS is. How do we get classes put into the programs that aren't just electives that no one shows up for? Med school deans tend to be clinical but academic. Will they agree with the need to educate their students about such matters?

 

[DeLaughterDO]

I forgot that you were a nurse in a "former life."

I don't know what state you're from, but have you ever played the game called "Call the BON and try to get a straight answer on scope of practice?" I have, and it's not fun. They won't tell you anything where I'm from. Oh, they know the answer--in fact, they'll even tell you that they know what the answer is, but it's up to you to figure it out.

Them: "We are not here to advise. It's up to you to interpret what the BON has described."

Me: "But what if I don't interpret it correctly?"

Them: "Then your license could be subject to disciplinary action."

Me: 😕

I shudder to think about dealing with "advanced practice" license issues. Having a regular old RN license seems to be too much power already for the old biddies that run the BON of the Commonwealth.

fab4fan;

That's exactly right. I got my nursing degree in Texas and the majority of my practice was in that state. While I was there, the BON published their scope of practice for nursing every year. It was the biggest convoluted mess that I have ever seen. I don't know how anyone could be expected to parse out what EXACTLY a nurse (at any level) is supposed to be able to do. I think, if you look at the Tx BON website, they have the SoP posted, from LPN/LVN all the way through to APRN. It's so cross-referenced and vague, they can basically make it mean anything they want it to - which is what the BONs are doing every day - to advance their own agenda.

Problem is, there is no other oversight of the BONs. Basically, they write their own blank check, and so long as they can push it though the legislature, it is law. This is how the BONs are getting independent practice pushed through. There are no physicians on probably > 95% of BONs, and so they make a decision that independent "nursing" practice is now in the Nursing SoP for APRNs, their huge PAC pushes it through the state legislature, and voila!! they have independent practice. I read somewhere that 23 states now have independent practice for NPs, and they are not even 'doctor' yet...

I've not played the game with the BON specifically; I played it with my nursing professors, though. I think they like to keep it as vague as possible and never give a straight answer so they can play "push the envelope" whenever they get the hair up their as$ to broaden it.

Ok, I get it. Educate now. Activate later. I'll buy that.

I would also agree with you that med school would be an ideal place to start. There we're up against the fact that during the really formative pre-clinical years when students might still have time, stamina and 2 ounces of give a crap all the education is done by non-clinical PhDs that don't even know what CMS is. How do we get classes put into the programs that aren't just electives that no one shows up for? Med school deans tend to be clinical but academic. Will they agree with the need to educate their students about such matters?

I agree that med students are the place to start - unfortunately, docB has it right. Even if we did have the classes available, and students actually attended, med students are still pretty naive, and for the most part see being a physician as "all noble, and stuff." Very much like adolescents, they think "that'll never happen to me..." and so will not take any action.

As far as physicians go, there is a movement to change things, and some momentum is growing. You may see some news coverage in the next week or so about an "Open Letter from America's Physicians" from a group called Sermo. If you are a physician, or even if you are not, I would recommend that you check it out. This is not an advertisement, just a link to more information about it - Sermo Open Letter Campaign. There is a VERY active discussion on that site about the problems in healthcare and an attempt to come up with ways to fix/improve them. A very interesting read.

 

[Faebinder]

As far as physicians go, there is a movement to change things, and some momentum is growing. You may see some news coverage in the next week or so about an "Open Letter from America's Physicians" from a group called Sermo. If you are a physician, or even if you are not, I would recommend that you check it out. This is not an advertisement, just a link to more information about it - Sermo Open Letter Campaign. There is a VERY active discussion on that site about the problems in healthcare and an attempt to come up with ways to fix/improve them. A very interesting read.

Speaking of which, can you join sermo if you had a temporary license or a training permit as a resident or do you have to be fully licensed?

 

[frantic983]

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[frantic983]

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[tncekm]

I have no idea if doctors can or cannot legally strike, but you can imagine typical joe blows reaction to doctors striking to say they dont make enough money?

Don't strike over money, strike as patient advocates. If you're striking because big business / government is trying to make health care more affordable at the expense of patient safety then people will be behind the profession, you can guarantee that.

 

[Taurus]

As Obama's campaign has shown, the internet is a powerful medium to reach out.

Not only do many physicians and aspriing physicians read SDN but it also gets returned a lot in google searches. So lawmakers, the lay public, etc read the posts on SDN.

That's why I spend time on SDN posting links and comments. It's a great place to start informing and educating. 👍

 

[U4iA]

Ok, I get it. Educate now. Activate later. I'll buy that.

I would also agree with you that med school would be an ideal place to start. There we're up against the fact that during the really formative pre-clinical years when students might still have time, stamina and 2 ounces of give a crap all the education is done by non-clinical PhDs that don't even know what CMS is. How do we get classes put into the programs that aren't just electives that no one shows up for? Med school deans tend to be clinical but academic. Will they agree with the need to educate their students about such matters?

I would also agree with you that med school would be an ideal place to start.
i think so... the ultimate goal is public awareness. students are best equipped to call attention to the issue and advocate for their patients and the future of the field without seeming selfish.

How do we get classes put into the programs that aren't just electives that no one shows up for?
a student organized group at each medical school with just 1 or 2 people who are passionate about their field on the macro level is all we need. they will be able to speak to the students at their school who give a $hit.. it's better than what we're doing now... right? i mean, it's a start. who knows... the cause may gain traction.. get news coverage.. public awareness will grow.. etc. it's far better than the alternatives we've already described.

Will they agree with the need to educate their students about such matters?
honestly, i don't think they need to. there are pro-choice student groups and pro-life student groups. one of the two sides of the coin have to conflict with the administrations point of view. this is a matter of free speech.

keep playing devils advocate..

 

[DeLaughterDO]

Speaking of which, can you join sermo if you had a temporary license or a training permit as a resident or do you have to be fully licensed?

Faebinder; I have an institutional license through my residency, and I am a member 👍

 

[docB]

How do we get classes put into the programs that aren't just electives that no one shows up for?
a student organized group at each medical school with just 1 or 2 people who are passionate about their field on the macro level is all we need. they will be able to speak to the students at their school who give a $hit.. it's better than what we're doing now... right? i mean, it's a start. who knows... the cause may gain traction.. get news coverage.. public awareness will grow.. etc. it's far better than the alternatives we've already described.

It sounds like you're talking about creating a orginization like AMSA but not AMSA and not tied to another parent group. I'll buy that. There's precedent for it. In EM the founders of AAEM disagreed with the existing orginization (ACEP) over what they felt were factors that were destroying the specialty and started a whole new org.

Now I suggest that just doing this in the med schools is not good enough. We would need a way to do as you've outlined AND reach out to practicing docs. We would essentially need to take on the AMA.

That begs the question would we be better off working for change within the AMA, an orginization that despite it's reluctance to take a stand is a large, well funded and recognized group, instead of trying to start from scratch?

 

[docB]

This is the truth, docs would have to be willing to withhold supply of work in non-emergent situations.

I think docs striking and not doing any non-emergent services would never work. I can tell you from my daily experience that when people can't get what they want out of the primary care system they just go to the ER and turn their non-emergent issues into emergent ones.

 

[Geri_Gal]

I would argue that the AMA has been an ineffective advocate for us in recent years.

I agree with DocB in that we need to create an organization outside the AMA (free of the history and bureaucratic inertia associated with it), open to residents, practicing docs, and medical students alike.

 

[U4iA]

It sounds like you're talking about creating a orginization like AMSA but not AMSA and not tied to another parent group. I'll buy that. There's precedent for it. In EM the founders of AAEM disagreed with the existing orginization (ACEP) over what they felt were factors that were destroying the specialty and started a whole new org.

Now I suggest that just doing this in the med schools is not good enough. We would need a way to do as you've outlined AND reach out to practicing docs. We would essentially need to take on the AMA.

That begs the question would we be better off working for change within the AMA, an orginization that despite it's reluctance to take a stand is a large, well funded and recognized group, instead of trying to start from scratch?

Now I suggest that just doing this in the med schools is not good enough.
I totally agree.. but there needs to be a foundation.. in accepting anything new, there are always early adopters and the slow to warm crowd. in the next six months it would be easier to organize a large number of students then attract physicians to the cause than vice versa.

obviously, if there are docs that want to help shape this, their contributions would be welcomed.. but in my experience docs tend to drag their feet because they can't see what is possible, they've been beat down too hard.

continuing on the earlier poster who used obama as an example, his "movement" would have never taken place if it wasnt for the youth and youthful coming out in large numbers.

the AMA is a joke.. trying to get in to the organization and change the entire focus of their mission would be... impossible. to quickly call attention to the issues that we are talking about in this thread we could more easily create a new organization "from scratch" but it wouldnt have to be difficult. it would certainly be more difficult to redirect the AMA.

the real question is... do we have the energy to spread awareness in our field? do we care about this enough to take the next few steps to do something about it? it depends on how may people actually care right now. if we can reach a critical mass, it becomes a lot easier to move forward.. the slow to warm crowd jumps on the band-wagon.