This is written with great love and concern for all who have devoted their lives to serving others, particularly rural docs, schoolteachers, faculty, government officials, and our nation. I truly believe that our form of government is the best one, the one that provides the most opportunities for all, and the most equitable. If we do not believe that "we the people" can work together and form a government to meet our needs, then we are truly in trouble. This means health care needs also.
Our nation and government is not perfect. The civil war and civil rights were the result of imperfections dating back to the birth of our nation. Most of us feel that it is significantly flawed in situations where courts do more than other branches of government. I think this gives us a clue as to the problem.In the elected positions in administrative and legislative branches, we have a bunch of politicians and egotists who allow themselves to be surrounded and influenced by those who do not have the best interests of the United States at heart, especially future generations of Americans as noted in last nights State of the Union message.
Example: Cuts needed in mental health and later in prescriptions. States turn to business entities without heart or feeling who are out of state and virtually untouchable, to do the dirty work quietly and without supervision or observation. This makes no sense because it takes money out of the state, steals jobs from states in need of jobs, and does things to people that would not be done if the local situation was understood better.Physicians are part of the problem. Physicians and government have been locked in conflict for over 4 decades, to the detriment of all. The primary failure regarding physicians is their failure to communicate health care problems that cause problems for patients. A second area of concern is that we have failed to illustrate and avoid the problems resulting when profits and business practices dominate health care. Many of us have actually "turned to the dark side."
Example: When I was involved in an antitrust lawsuit between an insurance company and a large not-for-profit physician clinic, there was a memo by the officer in charge noting that they should give up indigent care. This would have impacted a 7 county area where no alternative was available. Fortunately the clinic changed its mind, but not because it was the right thing. It was because they would have lost more federal and state dollars due to this decision. The reason that I think that the rural list serve is an important venue, is that FP docs and especially docs in rural and underserved areas have a great role to play in restoration. The following is the beginning of my recent address to the rural docs at the annual meeting of the Canadian family physicians:"My main topic today is restoration and I do believe that rural family physicians have a great role to play in restoration in the world today. Rural practice taught me that everyone had to cooperate to make things work, doctors, administrators, and community leaders. I ask therefore that you all dedicate yourself to working with each other, doctors, teachers, associations, schools, programs, and government, to work together. The time for arguing, competing, and glory seeking is over. There is too much at stake in your nation and mine and in the world."
I could have added profiteering to the list but otherwise would not change it. The failure of rural health systems, governments, etc., is the failure to cooperate.Example: In West Virginia the state told the 3 medical schools there that a) they were not meeting the needs of the state and b) one would have to close. The three medical schools found a way to cooperate with government and rural communities and rural practitioners in a way that has not been seen before. By working at the middle school and high school levels and rewarding hard work in education and training, I am certain that the state will reap great economic, health, and educational rewards for generations to come. This low cost program can also do what decades and billions have failed to do, distribute physicians where they are needed. If you want more of how rural docs matter and examples of restoration, see http://www.ruralmedicaleducation.org/restoration_with_links.htm
In my presentation above I refer to President Kennedy's speech to a Joint Session of Congress. It is interesting to contrast this with Bush's State of the Nation. This is my intro to the Kennedy piece, directed specifically to rural docs:"This is not about war or peace or Great Society or political spectrum. It is about leadership and vision and calling people to sacrifice and accountability. I am hoping that you see your role in restoring the nations. I am frustrated because I feel that those who are most dedicated to serving the nation, especially schoolteachers, physicians serving the underserved, civil servants, and others who prioritize service over self are not receiving the respect that they deserve. Sound familiar? Some would say that better pay was the issue, but I tell you that it is not the salaries that matter, it is the fact that these people chose to make a difference in the lives of those around them. The worst thing that you can do to a person who makes such sacrifices is to inhibit their work by lack of support, cutting off the resources that they need, or ignoring them. More importantly nations are at risk because they ignore these concerns."
An educated American people who believe in themselves and in their government and who care for others in their own country and in other countries cannot be defeated.A selfish, uncaring, lazy American people cannot and will not make the effort to make democracy work in this nation and in others.
Government is a partnership between people who know, people who care, people who hold others accountable, people in need of help, and people who can lead and make hard choices.
Doctors are granted the privilege of knowing much about health and people. Doctors are indeed people who care.
I would urge you to step forward to work with government to insure that health resources are used wisely and effectively.
Those who question the effectiveness of government are only doubting their own abilities as a people.
Businesses, insurance companies, and governments may tell us that it is better to ship decisions to other states or locations, but we know that the best decisions are made in health care settings or by groups with significant physician involvement. The role for physicians includes reminding legislators and officials that the hard decisions are theirs to make.
Cohen at AAMC notes: Closing the Gaps by Working Together
Robert C. Bowman, M.D.
I was watching Ken Burns piece on PBS on the Shakers and their contributions
to America from the 1800's and he quoted John Wesley (roughly), true religious
practice is difficult to maintain, because as people work together, they become
more prosperous and this makes it difficult to maintain true religion.
This is an interesting thing to reflect on in practice vs family vs community or
Family medicine as advocacy or as a business, etc. or
underserved as advocacy or as source of jobs....
This may be judgmental on my part but the difference between the "us" people and
the "them" people is perhaps experiences throughout life and our reactions to
them based on our personalities. Of course it is the successful dialog between
"us" and "them" that makes things run well. There has to be a balance between
passion, vision, need, etc and the ability to manage, delegate, confront etc.
Therefore we can fail in only two key areas, 1. not to communicate, 2. not to
respect each other and what each brings to the table
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I've had personal experience with rural (and urban) physicians refusing to treat patients with Medicare health insurance because it doesn't pay them enough. In rural (and urban) areas, physicians are among the highest paid people in the population. Refusing to treat patients with Medicaid is another story.
In 2001, 13.5% of households in the US had a household income of $75,000 or more (source U.S. Census Bureau).
Darryl Leong, MD, MPH, CMCE
UHP Healthcare
Watts Health Foundation