Why Organized Medicine is Dying (And What We Can Do to Save It)

Read this and other articles in the new issue of the WCMS Bulletin!

By Sarah Michael

Sarah Michael Photo

When I arrived at the University of Michigan Medical School a year and a half ago, I was inundated by numerous student organizations with lofty goals and big ideas. Most eye-catching to me was our Medical Student chapter of the AMA. Ambitious and idealistic, I had just finished a year of service in AmeriCorps where I cultivated a rich appreciation and passion for patient advocacy. I knew I could make a difference in the care of people through advocacy and health policy. I signed up, paid my dues, found myself in an Advocacy Chair position. I finally spent the past year as our External Vice President. In this position, I served as the liaison between our chapter and our larger community of organized medicine.

In this short time, I have sat around many tables at many meetings when we progress to the next item on the agenda: membership in our organization, and more specifically, our dissatisfaction with the numbers. We ask ourselves questions like “What purpose are we serving our members?” and “How can we make membership more appealing?” I must admit that my focus in this past year has also shifted from my original desire to advocate for patients towards these questions that delve into the meaning and purpose of organized medicine. The question I ask of myself is how I went from being so optimistic to my now more cynical self in regards to organized medicine? I have a few ideas.

I believe it’s inherently difficult to obtain positions of leadership without schmoozing and attempting to please those who will influence your vote. I observed this first-hand at the House of Delegates last April, where even at the level of the Medical Student Section, alliances were formed between schools to vote for whoever had lobbied to them the best. The general interest in physician advocacy and patient care is lost when one must fight through the jungle of politics, weeded with self-serving individuals out to make a name for themselves. In these situations, people find the easier option is to the leave the job of advocacy up to those who are most political, not necessarily the person most qualified for the job. For if one is not aggressive enough, it is easy to be trampled in what has become a race for power and status. Like any group project, only 15% of the people will end up doing 85% of the work. The opportunity to be involved in organized medicine is tainted with political rituals that simply turns people off.

The year 2014 has been called the “digital tipping point.” At this point, the majority of health care providers will be digitally native, which means they have relied on digital interactions for their entire career. With the implementation of electronic health records and swift advancements in medical technology, there is a need to remain current and up to date in regard to these progressions. Many organizations desire a relevant technological presence in the form of websites and social media, but they struggle with uncertainty as to how to connect with those who come from a different generation of physicians. In this day and age where information abounds, organized medicine has yet to find its niche in regard to the technology that pervades medicine today.

In light of the increasing burdens on the practice of medicine, many physicians have what I like to think of as a “wish list” for reducing these burdens and optimizing care. I think we can all agree most physicians desire at least some of the following: autonomy in one’s practice, fair compensation for one’s work and years of training, to have a voice with legislators regarding healthcare issues, to direct and influence quality care issues, and tort reform (just to name a few).

Addressing these issues is difficult, especially given the trend toward increased specialization within the profession, leading many to belong to their respective specialty organizations in lieu of their local, state, and national medical societies. Challenges such as healthcare reform and the continuous use of Medicare’s SGR formula for physician reimbursement are two examples of issues affecting a variety of physicians. Collective action from members of all specialties is essential to tackling these problems. In isolation, no one specialty organization can address these issues as well as one larger organization can. The same concerns that motivate someone to join their respective specialty society should be the foundation for joining their larger community of organized medicine, as well.

The field of medicine and delivery of healthcare is a continuously changing landscape. The day and age where someone graduates from medical school, finishes their residency, and hangs a sign with their name on it to open their own practice is a fading dream for many. I am well aware that I will most likely be employed by a physician group when all is said and done. Physicians in these groups, especially those in academic medicine, may not necessarily be compelled to belong to organized medicine, as they feel they are already part of an organization of physicians. However, the issues and items on our “perfect practice wish list” are not within our reach unless we have strength in numbers. We cannot afford the luxury of un-involvement if we wish to seek change in the practice and delivery of medicine.

So, why am I still here you ask? Why have I taken the time to scrutinize my professional organization to pieces? Because that is how we move forward and progress. We must take a look within ourselves to remember who we are advocating for to avoid the political environment that dissuades many from becoming involved. Also, we need to assess our ever-changing field to remain current and useful. Finally, we must adapt by asking our members what it is they would like from us rather than assuming what we’ve done in the past is enough. There is no doubt that we need local, state, and national medical societies to organize and unify our profession in this time of rapid growth and change in health care.

WCMS Bulletin 1st Quarter 2014 Available Online

The 2014 1st Quarter WCMS Bulletin is now available online in turn-page!

To download to your iPad
1. Download the MediaWire app.
2. Go into the app. In the upper right corner is a button “Categories.” Tap on that for a dropdown list of all available categories. Select “Community Magazines.”
3. There may be several titles available, and since WCMS starts with a “W”, scroll through the magazine covers at the top until you reach Washtenaw County Medical Society Bulletin.
4. Below the cover will be available issues with an orange download button beside issues that have not been downloaded before.
5. Download, then the issue will automatically open to begin reading once it has loaded. Previously downloaded issues will remain in “My Library” (found in the middle of the home screen).

New AMA Medical Student Leadership Selected for 2014

WCMS welcomes the new AMA medical student officers for 2014. Leadership transition will take place in the next few weeks, with the new officers taking charge in mid-March.

Co-Presidents: Andy Zureick and Adriana Coleska
External Vice President: Vadim Rosin
Internal Vice President: Vince Pallazola
Treasurer: Jason Chan
Secretary: Sujay Paknikar
Alternate National Delegate: Maia Anderson

Washtenaw County Dental Clinic Opening 2015 for Patients with Medicaid or Low Incomes

Washtenaw County Public Health and Saint Joseph Mercy Health System announced plans for a Washtenaw County Dental Clinic, slated to open in January 2015. The Dental Clinic will serve residents who have Medicaid dental coverage or who are without insurance and low income. It will be located in the Haab Building at 111 N. Huron Street in downtown Ypsilanti. At full capacity the eleven-chair clinic will serve an estimated 6,000 patients per year with 15,000 clinic visits.

“With the help of our partners – we’re thrilled to see this project moving forward,” says acting health officer Ellen Rabinowitz. “The clinic fills a void, and the impact will be tremendous. Of course, we’ll see improvements in oral health among our most vulnerable residents, but, importantly, we’ll also see related improvements in physical health, employability, reduced ER visits and so forth.”

Washtenaw County Public Health will contract with Michigan Community Dental Clinics to operate the facility. Saint Joseph Mercy Health System is generously providing space in its Haab Building. The Washtenaw Health Plan is contributing to the startup costs – as is Public Health. As a local health department, Public Health will be eligible for additional federal funds to supplement Medicaid reimbursement rates, an opportunity that will sustain the clinic into the future.

The first floor space in the Haab Building was not being actively used when Saint Joseph Mercy Health System learned of Washtenaw County Public Health’s plans to open a Washtenaw County Dental Clinic.

“We’re so pleased to be able to contribute to this important community program,” said Michael Miller, Jr., chief mission officer, Saint Joseph Mercy Health System. “Increasing access to healthcare and working with the public health department and other community groups to promote the common good goes hand- in-hand with our mission.”

The full-service dental clinic will join the Neighborhood Family Health Center, a patient-centered medical home serving many underinsured and uninsured residents in the Ypsilanti community, making the Haab Building a one-stop destination for community health care.

In the coming months, contracts will be finalized with Michigan Community Dental Clinics, which operates 22 dental clinics on behalf of local public health departments throughout Michigan, and with Saint Joseph Mercy Health System for the use of the Haab Building. Renovations will begin in the summer and continue into the fall.

Jeffrey S. Kutcher, MD, to Speak at General Session on March 12, 2014

Jeffrey S. Kutcher, MD, to Speak at General Session on March 12, 2014

Dr. Jeffrey Kutcher is a sports neurologist in the Department of Neurology at the University of Michigan. He is the Director of Michigan NeuroSport, the university’s academic sports neurology program, where he oversees clinical care, education, and research activities. This academic year, his NeuroSport program began training the first fellow in sports neurology in the United States.

Dr. Kutcher is also a team physician for the University of Michigan and the USA Hockey National Team Developmental Program. He is also the Director of the National Basketball Association’s concussion program, Neurology Consultant to the US Ski and Snowboard Association, and has helped develop the concussion policies of the NCAA, as well as several college athletic programs and conferences. He co-led the effort to create the Sports Neurology section of the American Academy of Neurology and served as the section’s first chair.

Dr. Kutcher will speak on neurosport, head trauma and the connection between concussions and cognitive decline. The General Session will be held at the Ann Arbor City Club and is open to the general public. The evening will start at 6:00 p.m., and dinner will be served at 6:45 p.m. Dr. Kutcher will speak at 7:30 p.m. There is no charge for dinner for active WCMS members. There will be a $35 charge for retired members, non-members and guests wishing to attend the dinner. For reservations, please call the Society Office at 734-668-6241, or email the office as wcms@msms.org.

Doctors Get Together to Try and Stop Gun Violence Interview

WUOM interview with local physicians Andrew Zweifler and Jerry Walden on the topic of gun violence.


Alfred Meyer Comes to Michigan Monday, February 17, 2014

Michigan Physicians for Social Responsibility
Alfred Meyer comes to Michigan for a speaking tour
“Nuclear Power: What You Need to Know about Price, Pollution and Proliferation”
Dr. Jeffrey Patterson, former PSR President was originally scheduled for this speaking tour
and died of a sudden heart attack on 1.23.2013. We continue this tour in his memory.
Ann Arbor tour stop on
Monday February 17th
6:00pm – 7:30pm
339 E. Liberty at Ecology Center 3rd Fl. Ann Arbor, MI 48104
free street parking after 6pm)
for more information please contact sdernek@psr.org

Protecting Children from Gun Violence

The American Academy of Pediatrics has long advocated to end gun violence in children’s lives. In this video, pediatricians describe how the prevention of gun violence is a child health issue, and advocate to keep children safe where they live, learn and play.

SGR Repeal Legislation Introduced

Staff for the chairmen and ranking minority members of the three Congressional committees of jurisdiction briefed physician groups this afternoon on the results of their bicameral, bipartisan negotiations on repealing the SGR. The “SGR Repeal and Medicare Provider Payment Modernization Act of 2014,” which was introduced by Rep. Michael Burgess, MD (R-TX) in the House as H.R. 4015, addresses only the policy provisions related to eliminating the flawed payment update formula. It does not include financial offsets or any of the usual extender policies.

The AMA is still reviewing the legislative language in detail, but following are some of the main provisions:

· The SGR would be repealed immediately.

· Positive annual payment updates of 0.5 percent would be provided for five years.

· The VBP program has been replaced with a similar Merit-Based Incentive Payment System or MIPS, which includes prospectively-set performance thresholds and offers flexibility in the imposition of performance requirements that are inappropriate for some specialties.

· The effective date of the MIPS program would be one year later than the original VBP proposal, and will start in 2018.

· The MIPS funding pool was increased and is no longer budget neutral, and the phase-in of penalty risks for those who fall in the lowest performance quartile has been capped at a maximum of 9 percent (as opposed to the previous 12 percent).

· The 5 percent added incentive payment for physicians in Alternative Payment Models was retained.

· Funding for technical assistance to small practices of 15 or fewer professionals was doubled.

· Provisions similar to the Standards of Care Protection Act are included.

· Physicians who opt out of Medicare to engage in private contracting with their patients would no longer be required to renew their opt-out status every two years.

Members of the Congressional Doctors Caucus were heavily engaged throughout the negotiations until late last night, pursuing the policy goals they outlined in a letter last December.

The AMA greeted today’s developments with enthusiasm, congratulating House and Senate negotiators for taking this critical step. In addition, the AMA strongly cautioned against continuing the cycle of short-term patches by merely addressing the imminent 2014 cut without resolving the underlying problem caused by the SGR, characterizing that strategy as fiscally irresponsible.

How physicians are compensated—New study reveals payment methods

New data on physician compensation methods show that many physicians in non-solo practice settings are paid through a blend of methods, and salary was reported as the most common type of compensation.

The AMA’s new Policy Research Perspectives report summarizes the findings from a 2012 survey of physicians. The survey asked physicians to specify which of four methods determined their take-home pay: salary, compensation based on personal productivity, compensation based on practice financial performance or bonuses based on other factors.

According to the survey, about 53 percent of non-solo physicians received all or the largest share of their compensation from salary. At the same time, about one-third of reporting physicians received all or most of their compensation based on personal productivity, suggesting it may be difficult to align practice-level incentives that encourage judicious use of resources with physician-level incentives that do not.

The survey results highlighted differences in payment methods for practice owners and physician employees. Practice owners cited pay based on personal productivity more than other payment methods, but salary was not uncommon—almost one-third of owners received all or most of their compensation from salary. Nearly 73 percent of physician employees cited salary as their primary payment method.

Payment methods also varied across specialties, especially for owners. Productivity-based pay was of top importance for psychiatrist owners, with 64 percent in that specialty receiving all or most of their compensation from productivity-based pay. Conversely, less than 2 percent of radiologist owners said personal productivity was their primary compensation method. For employed physicians, all specialties reported a high reliance on salary.

“What is clear is that payment filters down to the physician in different ways that depend on the characteristics of a physician’s practice,” the report states. “Changed incentives at the practice level may be felt differently at the physician level, depending on what compensation methods are in place.”