This call to action was written by physicians.  It is addressed to other physicians; it is taken from the President's Page in the August edition of Sombrero, the monthly journal of the Pima County Medical Society.  For more information, contact: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Leadership is ours

Your Executive Committee (doctors Lindsey Inouye, Tim Fagan, Alan Rogers, Mike Hamant, and I) wants PCMS members and the healthcare community to help define and disseminate principles for healthcare reform. We want that help now. 

Earlier this month the Arizona Medical Association had its annual meeting.  One of our own, Dr. Eve Shapiro, advanced a resolution urging ArMA to articulate general principles of healthcare reform upon which we all might agree.  Her resolution passed unanimously. It stated:

 That the Arizona Medical Association continue the process of articulating principles on health reform and share those principles with the membership. 

An effort to do this at ArMA started last year, and by passing this resolution, ArMA is committed to producing something for us this year. We believe that this may be the most important thing our medical association has done since we have been in Arizona. PCMS needs to play a role and send its thoughts to ArMA by the end of the summer. 

Furthermore, we want PCMS to develop and articulate its vision for healthcare reform to the local community, because as Atul Gawande said in his New Yorker article referred to by President Obama recently: “Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can.” 

It is time for physicians to demonstrate effective leadership in the healthcare “reform” arena. We did not act appropriately to the intrusions of managed care 25 years ago. We stand on the brink of the second restructuring of the healthcare system and we cannot afford to make that mistake again. 

As Dr. Davis has advocated in the February 2009 President's Page (“Health care reform in America: We are not ready to sweat the details"), healthcare must be healed from the inside out. We require a clear vision of the healthcare system we want to create, and that vision must resonate with both physicians and the public. In order for this to happen, physicians must lead. We must find and exploit common ground with the general public—common ground that finds core principles of change in our healthcare system to which all can agree; common ground which will guide change in healthcare policy over the coming years. 

Lobbying through the political process will not be sufficient. Clarity of purpose is necessary to prioritize reform efforts – including those that make up the President’s “three pillars” mandate - and insulate them from the special-interest politics that would derail them. 

We submit to the membership that we as a Society should focus on helping the Nation formulate general principles of healthcare reform as opposed to debating specific tactics, and that we publicly assume the role of visionary leader rather than healthcare reform engineer. This is a role that our patients are already comfortable with—physician as guide, as the person who will help them understand what is happening.

We want to fuel the discussion with some of our ideas, ideas that transcend the detailed, rule-making focus of the current finance and insurance reform debate.

This is a principle that translates to the public as “more quality time with your physician.” Reform will come one patient, one disease, one decision at a time—or it will not come at all. 

You already know that the beating heart of a good healthcare system is good decision-making at the point of service, and that good decision-making at the point of service is the core product of a good healthcare system. This is how value (better care at lower-cost) is generated. It follows that value in healthcare is not something Congress or a President can legislate or mandate, because value is created in doctors’ offices, nurses’ offices, physical therapy offices, and mental health professionals’ offices. 

This will also put a burden on us as physicians. Managed care and a runaway tort system have distorted the medical decision-making processes, and we are the ones who have to repair it—because no one else will, and in fact, and in fact, no one else could. We will have to change in a way that will inspire the public and politicians to have faith that physicians will in fact work with their patients toward making the best decisions for the patient. 

Specifically, closer cooperation among physicians, and between physicians and allied healthcare providers is required in order to assure that each patient is presented with the full range of treatment options in an unbiased, evidence-based, personalized process. This will require a reversal of the managed care- inspired trend toward the isolated specialty based practice. Medical training, reimbursement schemes, and healthcare information technology will need to develop in a direction that supports team-based healthcare decision-making. We have not found a member of the public who reacts with anything but enthusiasm to these ideas.  

2. Medical decision-making must relentlessly promote increased value – better quality at lower cost. 

Finally, we have to start somewhere, so we propose this third principle:

3. Restore primary care to the status of a specialty that young physicians find desirable. This is the only way that we will have quality primary care readily available to Americans. This is principal is subordinate to the concept embodied by the first principle.

3.   The public will be extremely sympathetic and eager to participate if our initial focus is on primary care reform.

In summary we should point out that everything we suggest here is consistent with the past 10 years of efforts of the Pima County Medical Society and Arizona Medical Association. We are not proposing a deviation from the past.  Tort reform and our efforts to mitigate the adverse effects of the health insurance industry would have the effect of restoring decision-making to physicians and patients. Our support of the University of Arizona Medical School and graduate medical education program is based in part on our understanding that the medical school is crucial to supplying physicians in primary care specialties to Southern Arizona, particularly to the rural areas. This support is an effort to maintain quality primary care services in Southern Arizona.

Your leadership wants to see the Society develop a sophisticated, inspiring, engaging, and accurate "summary statement" of what we stand for, a statement that speaks to immutable, self-evident values that will help us relate better to the public, so that we might together begin the process of healing healthcare from within.

We want the leadership of the Medical Society to begin planning how we might better engage, educate, and motivate the public to become effective participants in healthcare reform in this next year.  This is our start. We welcome your ideas.