Letter to the Editor: Physician Autonomy: We Must Respect Ourselves

I read with interest Dr. Waldorf's, “Physician Activism: Why It Is Time to Step Up” (May/June 2015) and wanted to share a few of my thoughts with you and your readers. Having been in the Practice of Plastic Surgery for some 25 years—I am now retired—I have seen much of the complacency that you discuss amongst our colleagues with regard to governmental and societal forces that have adversely effected the practice of medicine. 

There are many reasons for this but I believe that salient issues are as follows. Physicians by training are essentially individualist, as you yourself mention, “we are the Captains of the ship”, we are trained to take responsibility and to act quickly and precisely, we are not trained to collaborate, to organize and have never understood the strength in numbers concept. 

Most physicians until recently had or have very little training or knowledge in the “business” of running a medical practice and in the early days made a good living despite this lack of business acumen. Physicians have also always been very good at inter-departmental squabbling and coveting each others “territories” because it has a certain comfort level, because it is something they know,—medicine. What they generally do not do well is to look outside of their profession and marshal their collaborative strengths toward the common goal of bettering the medical profession for all practitioners. 

So what to do and how to re-establish autonomy and regain the respect that the medical profession is due? While certainly your point that the “golden age of medicine” is long gone I do believe that there is hope for the future physicians. First, every medical school should incorporate some business courses in their training (the realities of running a practice) and courses in understanding and influencing the government regulations that are and will effect the practice of medicine. This training should continue with more CME courses focused on this issue. Second, our societies and medical groups should elect leaders who understand the importance of dealing with local political representatives and developing methods of having the voice of the medical community heard. Yes, this takes money—something again in my experience many physicians did not see the value of—but a good lobbyist is critically important in getting your voice heard by those who make and enact our laws. Third, reaching out to the business community, the large corporations who during the 1990's were instrumental in driving change and reimbursement due to high insurance premiums for their employees. Developing new and innovative ways to provide quality care at a lower price point is something CEOs, CFOs and Directors of Human Resources can get behind and sell to their Boards of Directors. Physician's groups have never learned how to reach out to the Corporate world and work collaboratively, rather they became our adversaries in many cases and that proved fatal. 

As you say, “Finding our voice” is exactly right, many physicians have been too silent for too long and the results have taken the art and practice of medicine—a once venerable profession—to nothing more than a job most physicians report to not because they want to, but because they have to. And that is very sad indeed. 

Finally remember, we are not caregivers, medical providers, or any other nomenclature the insurance industry has bestowed upon us. We are Physicians. Doctors. And so should we call ourselves and encourage our patients and sales representatives to do the same. Because one thing is sure: if we do not respect ourselves and our Profession, I can assure you that no one else will.

—Paul J. Vallone, MD
Mayor
Borough of Far Hills