llins Edward.gif
James B. Rickert, MD, wrote a provocative “Sound-Off” in the May 2011 AAOS Now. Although I agree with the author’s admonition that it is time for America’s orthopaedists to make a choice, with his intelligent definition of the problem, and with his statement that America can do better for the elderly, I couldn’t differ more radically from his recommendations on the course orthopaedists should take.


Published 8/1/2011
Edward J. Collins, MD

Change without confrontation is unlikely

Edward J. Collins, MD

Talk to Congress?
Dr. Rickert suggests that we, as orthopaedic surgeons and physicians in general, can make recommendations to Congress to change our system for the better. Has he been to the National Orthopedic Leadership Conference or visited Capitol Hill recently? For several years, orthopaedic surgeons have made recommendations on how Congress could change medicine for the better and could resurrect Medicare from failure. We’ve pleaded for our patients’ access to care and yet, nothing has changed. I wouldn’t expect anything to change at this point either.

The only bipartisan effort I have seen in the last several decades has been to strip us of our profession and keep us powerless to change anything. Congress has done a wonderful job of destroying the healthcare system. Those behaviors are more than likely to continue. We can bet that Washington’s solution to the Medicare crisis will be disastrous for our patients and ourselves.

To think that things will improve if we make financial concessions is like a victim of domestic abuse compensating the abuser because “maybe I did something to deserve this.” Don’t count on it.

Playing the guilt card?
The author suggests that orthopaedic surgeons in this country have an average income of $440,000. This appears to be the guilt card. He states that this is a more than modest income. What he doesn’t note is that, if one did a cost benefit analysis on what orthopaedists provide society, I believe our reimbursement would be quite modest compared to those benefits.

The drivers of increasing healthcare costs are utilization and the costs of technology. As healthcare providers, our remuneration is only 15 percent of total healthcare costs.

Who’s in control?
Dr. Rickert further states that if we are unwilling to compromise and feel that our income is inviolable, then we will be relegated to a system where medical care delivery is controlled by politicians and bureaucrats.

The last time I looked, our income is currently quite violable in that we essentially have no control over it other than entrepreneurship. Our system of care is currently controlled by politicians and bureaucrats. To make concessions in the face of this situation is ludicrous.

If we think clearly about this, the ones who really control access in this country are physicians, because we have the ability to say “no.” If we look at our current system of health care, the two groups that are the least happy in my view are physicians and their patients. Those who are most happy include insurance companies, drug companies, medical technology companies, and trial attorneys. It is clear that something is wrong with this picture.

The real choice?
In my view, our choice is clear. We must begin to plan where to draw the line. In my view, neither negotiation nor advocacy is appropriate now. Activism is necessary.

Our message to Washington should be: “Give us our profession back and we will then sit down at the table with you. Give our patients easy access to medical care and make practice conditions conducive to easy, efficient practice, and then we will make concessions.”

History has proven this to be true. Change without confrontation is unlikely.

Edward J. Collins, MD, is an orthopaedic surgeon in private practice in Marathon, Fla.