Published 5/1/2010

Perspectives on healthcare reform, ED call

I would like to recommend a different approach to the healthcare crisis and our current dilemma dealing with Washington. I think that orthopaedic surgeons as a community need to develop the ability to say the magic word, which is “no.”

Our founding fathers had the courage to do this when they started throwing tea off the side of a ship in Boston many years ago.

The bottom line is that we talked to Washington, we tried to negotiate, and we tried to reason, but it was frankly an utter waste of time.

When will the orthopaedic community realize that we in fact are the ones with the ultimate power? President Obama and his staff, despite all of their powers, cannot complete a single simple prescription for a Keflex® pill. They cannot prescribe physical or occupational therapy. They may legislate health care, but they cannot practice medicine.

When are we going to stand up and realize that we are in fact the ones with the power to administer health care? This debate would come to a grinding halt if the [members of] the AAOS simply said, “No, we cannot do it any more and we can no longer practice under these conditions.”

Perhaps another alternative is to decrease the size of our training programs and produce fewer orthopaedic residents and fellows. After all, I think even President Obama would argue that there is some merit to supply-and-demand economics.

As long as orthopaedic surgeons as a group continue to take it and play with the cards we are dealt, we will continue to suffer miserably under any healthcare administration. It is time to wake up, smell the coffee, and simply say the word “no.”

Richard G. Schmidt, MD
Bala Cynwyd, Pa.

In the February 2010 issue of AAOS Now, the article “ED coverage: What are the options for orthopaedic surgeons in 2010?” once again raised the problem of continued lack of adequate orthopaedic coverage. The conclusions of that article showed nothing that we already did not know—that the only way to solve this problem is to correct the ongoing, and now potentially worsening, issues of lack of adequate reimbursement and liability protections. The article also stated that “Each surgeon makes an individual decision about his or her ability to provide ED coverage.”

We now have an article in the March 2010 issue, “Study questions ED transfers” that concludes that most injuries do not warrant transfer and it is “suggested” that the answer is “stricter enforcement of the Emergency Medical Treatment and Active Labor Act (EMTALA) laws.” First off, the EMTALA law deals with the management of unstable patients and does not apply to the majority of cases listed. Second, and more importantly, the conclusions of the two articles cannot coexist. Either the choice of which cases to accept lies with the individual surgeon or it does not.

I respectfully request that the Academy once and for all come out with a final position on this matter. Should orthopaedic surgeons be forced to treat injuries that they are uncomfortable with or do they have the final say? The position we take is going to be critical to the future survival of our profession, especially given the recent passage of health reform.

Thomas D. Guastavino, MD
Pottsville, Pa.

Setting Now straight
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