NEWS Leah McCormack, MD Inaugural Speech 4/29/2010 Inaugural Speech of new MSSNY President Leah McCormack, MD As physicians, we are trained to diagnose and care for our patients. It does not take a master diagnostician to see that the profession of medicine is in critical condition. Doctors suffer from loss of autonomy, over-regulation by government and insurance companies, and interference with the doctor-patient relationship by 3rd parties. We cannot set our own fees for the services we provide. We are denied the ability to privately contract with our patients and balance bill without penalty. We are not allowed to collectively negotiate. The insurance companies continue their tricks to delay and to deny us adequate payments. We are overwhelmed by laws, and rules, and regulations. MSSNY recently commissioned a study on the Economic Impact of Private Practice Physicians in New York State. Of the approximately 70 thousand licensed physicians in the state, almost 61% participate in private practice. Aside from caring for the health of New York's residents, which is truly priceless, these practices contribute immensely to the state economy, employing over 300 thousand people and generating billions of dollars in income, sales, and tax revenues. Yet many physicians are struggling just to survive. Doctors are subject to price-fixing and receive such poor payments for services that we cannot afford to give our staffs raises or upgrade our equipment or facilities. We cannot afford our liability premiums. We cannot keep our practice financially viable. The costs of a medical education are so great, that students have lost hope of ever having their own practices and can no longer afford to choose primary care fields. The attitude of society towards physicians has changed. If there is a character in a novel or a movie who is a physician, invariably he or she turns out to be the villain. The media loves to print negative stories about physicians on page one, but all the good that we do is rarely publicized. Increasingly, patients have the attitude that their illness is somehow the doctors fault, and that any result short of a perfect outcome must mean that the doctor has made a mistake. Of course if the doctor is to blame, then the patient must be entitled to monetary compensation. There was a time when the doctor-patient relationship was paramount and we were able to care for our patients to the best of our knowledge and abilities and in the patients' best interest. Decisions regarding care and cost were made between the patients and the doctor. The relationship with 3rd party payors was between patients and their insurance companies. Patients accepted responsibility for their own well-being, for participation in their treatment and for the costs of their care. Physicians cared for their patients, putting the patients' needs first, caring for those who could not afford care, and rendering untold amounts of charity and uncompensated care. Wishing for a return of the things that were good about our profession is not an unhealthy nostalgia for the past but a rational understanding that this is what made American health care the envy of the world. We have seen how leaders from other countries, even those with nationalized care, come to America for treatment. We are tired of being told that the free-market does not work, when we all know that what we have now is not a free-market system. We are tired of practice schemes that are developed by bean-counters and social engineers. We live with the fear that a lawsuit will destroy our lives and that all we have worked for will be lost in a moment. We are denied the most basic tenet – that we are human beings, that we are capable of unintentional error, that we are not monsters who wish to harm our patients, and that we are deserving of at least the consideration of forgiveness. In the past, we have put others needs before our own and that is what we wish we could continue to do, but if we are to help others, we must be whole ourselves. I am reminded of the video that the airlines show before take-off where you are instructed to first put the oxygen mask on yourself before attempting to help others with their masks. It is time for physicians to reach for the oxygen mask for ourselves. No one else is going to help us. We need to do it. The Medical Society should declare this the Year of the Doctor and make a renewed effort to improve the lot of physicians. We must avoid divisions within our profession that weaken us. We cannot divide along lines of primary care or specialist or hospitalist, American or international medical graduate, employed or academic physician, or private practitioner. Even if some of us benefit, what is bad for any one of us, will ultimately be bad for all of us. Our enemies seek to divide us. We must not let them. This has been a difficult year and the debate over health system reform has been particularly contentious. Like the population in general, doctors are deeply divided on the issue. I would venture to say that the majority of practicing physicians are not happy with either the process or with the bill that was finally passed by congress. The partisan nature of its passage, the backroom deals and secrecy, the exemption of congress from being subject to the law, and the ignorance of what was actually contained in the bill was a disgrace. We appreciate the efforts of our AMA leaders to achieve the best results they could for physicians. Many are pleased that 32 million more Americans will have health insurance coverage, that there will be pilot programs for tort reform, and that Medicaid payments will increase. But many doctors are angry and disappointed with organized medicine and with the failure to achieve significant and meaningful tort reform, or a permanent fix of the SGR. Doctors are frustrated by the Pollyanna spin that has been put on the legislation. We are concerned that our AMA seems to be promoting the legislation and a partisan agenda. Our AMA has rightly indicated things in the law that need to be changed. Doctors want our AMA to be more out-spoken in advocating for physicians and challenging the negative aspects of the law. Those of us who deal with Medicare and Medicaid have justified apprehension of the independent payment advisory board. Doctors are fearful of government and its power to crush us. We dread the new bureaucracies created by this legislation. We are alarmed by the awesome powers that the Secretary of Health and Human Services will possess. We are concerned that the projected CBO cost may be a vast underestimation of the true cost, just as Medicare has been, and that ultimately the system and its programs will become insolvent and fail, leaving our patients in a worse situation than they are now. We do not want to be put in the position of controlling costs and rationing care instead of giving the best and most appropriate care to our patients. Doctors are disturbed that there is not more transparency in our AMA and in MSSNY. I have not left our AMA but I sense that our AMA has left me. There is an anger in the physician community. Rightly or wrongly, many doctors feel betrayed by organized medicine and membership is declining. I would ask anyone who is contemplating resignation to please remain a member and become more engaged. If you were unhappy with the decisions that were made, then tell your delegates to our AMA how you want them to vote. Tell your councilors to MSSNY how you feel about the issues and insist that they represent your viewpoint. Physicians are at a critical juncture now. Times of great change and upheaval are also time of great opportunities. We need to take advantage of theses opportunities to re-establish ourselves as those best suited to make decisions about our profession, and to make improvements for the benefit of patients and physicians. First and foremost, we must maintain our principles. Too often we have compromised and accepted changes that were not in the best interest of our patients or our profession in order to maintain a seat at the table. But too often physicians have been the main course. We should not support individual bills especially when the bill is likely to change into something we do not even recognize. Instead, we should make clear statements of what we support and what we oppose based upon our principles. We may not always win but at least we will maintain the respect of our member physicians and we will be more credible to our legislators. We must not agree to support legislation in return for empty promises from government that usually fail to materialize. We are told if we do not "go along with things" then it will be worse for us. We have been bullied by government for too long. The only way to deal with bullies is to say "enough" and push back. We cannot go along with legislation that contains items that violate our principles in exchange for a few items that are acceptable. We should stand upon principle and if we lose a particular legislative battle, then we have still won a victory. We may suffer for our ideals but at least we will not have been complicit in the destruction of our profession. Our members tell us that one of the main benefits of membership in MSSNY is advocacy. It is very difficult to successfully advocate when our state and federal capitols are in such a dysfunctional condition that we do not know from one day to the next if a politician will even still be in office. For over 20 years, I have traveled to Albany on legislative day, with mostly the same agenda that remains unrealized. We cannot keep doing the same thing and expect a different result. I believe we must change our tactics. Our physicians have also tired of the yearly trek to Albany, to listen to the same legislators, saying the same things. Rather than having our public servants lecture us, I propose we invite them to come to our offices, and hospitals and medical societies and listen and learn how they can best serve us. Or perhaps we should have a state-wide educational day when doctors can step out of their hospitals and clinics and offices and learn how to become more politically active. Our President believes we prefer to amputate feet for 50 thousand dollars, rather than treat diabetes, and that we prefer to do tonsillectomies needlessly because it pays more than if we just prescribe antibiotics. Senator Schumer thinks we bill patients four thousand dollars for waving to them while they lie on a gurney in the hallway. They think if only physicians were not crooks, billions could be saved. I do not believe these are unintentional misstatements. I think they are part of a concerted effort to undermine physicians and are designed to lead the public to be more accepting of less trained and less costly non-physician providers. Doctors need to work closely with our communications department to quickly respond to negative press and inflammatory statements made about physicians. No disparaging comments or untruths about physicians should be allowed to go unchallenged. In order to be successful, we must revitalize our PAC. We need to face facts. Although it is a nice sentiment, we are not naïve enough to believe that politicians are really our friends. We cannot continue to funnel our limited PAC dollars to legislators who do not support us. I propose that our PAC look at our legislators' stance on a few of our key issues, such as tort reform, health insurance reform, collective negotiation, ability to privately contract and balance bill without penalty, and health savings accounts. Then MSSNY should create and disseminate an annual report card on each elected official that we can use in making decisions about political support. Our doctors need to know what is really happening in Albany, what our governmental affairs staff is working on, and what bills are under consideration. We need to know what our members need to be doing at the grassroots level to help and we need to enlist our patients to join us in our causes. We need a policy section on our MSSNY website so that physicians can easily enter key words and quickly access relevant MSSNY HOD policy decisions. We also need to encourage our physicians to seek election to political office. We should create programs that help physicians develop their leadership skills and improve their public speaking abilities. Our AMA sponsors a candidate school; we should have one here in New York for our physicians. The election of physicians or other non-attorneys, may be the key to finally bringing change to Albany. We must seek and demand meaningful tort reform. As a result of federal health system reform, MSSNY hopes to obtain funds for pilot programs that will look at alternatives to the current medical liability system. We all know that the current system is broken; it is inefficient, flawed and unfair in its verdicts and judgments. We need tort reform in order to bring down the oppressive burden of our liability insurance rates. We must tell our legislators very clearly that another freeze is not an acceptable solution to the problem. We have had a long and close relationship with our endorsed insurance carrier, MLMIC, which was founded by MSSNY physicians in response to the liability crisis in the 1970s. We look forward to continuing to work with our friends and colleagues at MLMIC to achieve meaningful tort reform and a favorable insurance climate for our physicians. The coming year will bring its own set of problems and challenges. I ask for your help and good wishes and for your prayers. If we ever needed the blessings of Divine Providence, it is now. I may not be successful, and I only have one vote, but I do promise to give my best efforts for the doctors of New York State. When faced with making decisions, I have tried to ask: Is it good for patients? Is it good for physicians? Is it right? And is it good for liberty? Freedom is an essential health requirement for every human being. Patients and physicians must be free to make decisions about their lives and health without interference from government or insurance bureaucrats. We are standing at this moment in our place in the long line that stretches back across time to when the first human being selflessly reached out a healing hand to comfort and care for another. What has made our profession of medicine noble is our commitment to the patient-physician relationship and all that entails. Our responsibility to the patient is our chief duty. We must resist the idea that we have more of a duty to society, or to government, than to our individual patient. As the cost of health care increases, as we know it will, due to an increase in population, an increase in access to health insurance, advances in technology and an aging population, we may be asked to compromise this principle. We must beware of the slippery slope that suggests some lives are of more value than others. Every human life is of inestimable worth and deserving of our care with compassion and respect and human dignity. I will conclude with an excerpt from Alfred Lord Tennyson's poem, Ulysses, an appropriate allegory for the current state of our profession. "Come, my friends, 'Tis not too late to seek a newer world. Push off, and sitting well in order smite The surrounding furrows; for my purpose holds To sail beyond the sunset, and the baths Of all the western stars, until I die. It may be that the gulfs will wash us down: It may be we shall touch the Happy Isles, And see the great Achilles, whom we knew. Though much is taken, much abides; and though We are not now that strength which in the old days Moved earth and heaven; that which we are, we are, One equal-temper of heroic hearts, Made weak by time and fate, but strong in will To strive, to seek, to find, and not to yield." Thank you. Print Article · Back