It's not too late for physicians to regain control of their profession
"When I was a resident, they actually made us work," laughed my mentor as he greeted me at the National Orthopaedic Leadership Conference (NOLC) in Washington, D.C. It was the second national meeting in as many months where I had chanced to run into him. I was attending in my capacity as a member of the executive committee of the Resident Assembly—part of the governing structure of AAOS.
His comment was obviously in good fun, as he was pleased to see me involved in state and national leadership. But in light of the purpose of our D.C. visit, it gave me pause to think. Perhaps the ability to take time off from clinical duties for national resident leadership is a new phenomenon. Perhaps, if that had been the standard in years past, our profession would not have some of the struggles it faces now.
The purpose of the NOLC is, in part, to learn about and lobby Congress on important policy issues affecting orthopaedic surgery. In a sense, we seek permission from the government to do what is right for our profession and our patients. There is something fundamentally wrong with that concept, but of course this is not the only venue in which physicians must negotiate with other powers.
One does not have to look very far to see where nonphysicians hold the reins in medical care. I am not referring to scope-of-practice issues, but to politicians, bureaucrats, and administrators. Many experienced physicians realize that somewhere along the line, they have lost control, and they may wonder when it happened. Perhaps it was back in the days when "they actually made us work." Perhaps as physicians many of us have been so focused on learning disease and treatment, we failed to notice the systematic encroachment on medical practice.
There is no utility in one generation of physicians placing blame on another, but there may be lessons to be learned. In the entire field of healthcare delivery, there are only two parties who hold both a detailed and full-scope view of medical care: the physician and the patient. Ultimately, those two parties are the most capable of determining what constitutes high quality and low cost. It's erroneous to suggest that the alphabet soup that defines modern health care (CMS, MACRA, ACA, AHCA, HHS, MIPS, ACOs, DRGs, CPT, ICD-infinity, IPAB) is always in the best interest of patients. I believe that it is also erroneous to accept this condition as irredeemable. Recovery will take much work and sacrifice. It may pull our focus away from building a practice or caring for patients or retiring early. And in the short-term, it may seem like we are wasting time and money. But avoiding the issue has landed health care in its current state.
The message to my generation is to start now. Learn about healthcare administration, study the health policy process, connect with legislators, and initiate the habit of donating to a meaningful political action committee (PAC). Even if you can't take the time to participate, support those who do. It will pay off.
My message to prior generations is thank you. Thank you for supporting the efforts of residents to get involved in advocacy. Your foresight in developing our awareness is vital to our survival as a profession. Please continue to expand that partnership in years to come. And please share with younger physicians the lessons you have learned through the years.
There is no crossroads of medicine, no grand moment when we can succeed or fail, unless it is every moment. We improve our patients' lives through the healthcare delivery system in the same way we do it through direct treatment: learning, working, and caring a little bit more every day. Sometimes we have to stand up for them, far from the operating room, hospital, or clinic.
Advocacy does not begin and end in Washington. The NOLC is not the only time or place to invest one's energy. One can join state and local societies, specialty societies, and the AAOS at any time. This engagement supplements the care we provide our patients. Ultimately, it may be the best thing we can do for them.
Ryan M. Eggers, MD, MA, is a member of the Resident Assembly Executive Committee. He can be reached at firstname.lastname@example.org
Additional Tips to Kick-Start Your Advocacy Effort
Follow the AAOS Office of Government Relations on Twitter. The @AAOSAdvocacy Twitter handle regularly tweets on issues of importance to the orthopaedic community. Followers can take action on legislative alerts or simply retweet messages to help AAOS spread the word.
Advocacy Now Newsletter
Advocacy Now is produced by the AAOS Office of Government Relations to keep members on top of important legislative and regulatory issues. Visit www.aaos.org/dc for more information or email email@example.com to sign up for the biweekly newsletter.