Legislative Approaches: Why Not Break the Mold?

Congressional staffers in recent studies as well as observations regard
physicians very lowly. Most see us as pocketbook issue people.

There are two ways for physicians to approach critical issues involving
health care. You can do it directly as reimbursement issues, thus falling
into the traditional trap and the way that physician organizations are
usually seen, or you can approach it throught the impact on patients.

Changes in Medicare and Medicaid have devastated patient care for the
indigent and those dependent on federal programs.

Not only is this bad, but a restructuring of health care is almost certain
and we are about as weak as we can possibly be.

I am not sure that family medicine or AAFP or AMA can be effective in these
areas without years of changing attitudes and actions.

To get action now, and also reposition ourselves to be able to be a part of
restructuring health care, we need to express direct examples of how
legislative actions or non-actions are impacting the care of our patients.
We need to work through associations and organizations that cannot be seen
as pocketbook defenders. These include the National Rural Health
Association (who can be against better rural health or doubt the need for
improvements) or a variety of organizations involved in inner city and
underserved care or geriatrics.

When we created the rural medical educators group, the initial concept was
a Doctors Ought to Care approach where funds came from a variety of sources
and the various families of family medicine and other organizations. The
efforts of the new group would be to coordinate efforts and make them more
efficient even though limited. The major focus would be to impacting care
for the underserved by impacting on medical school selections, curricula,
and other choices.

AAFP sponsored the meeting, but did not send a high level rep. STFM and
NRHA sent top people. STFM had no funding but was supportive in past and
present NRHA came forward with support, but has its own limited
resources. It also does not have the contacts to be able to effect change
in medical education. A few years later the impact is limited to a few of
the newer schools and a few faculty and programs. Better support and
leadership could have made much more difference.

Now the crisis in primary care and particularly for underserved areas is
worse and medical associations are no better positioned to effect solutions
or modify some bad legislation, appropriations, and policies on the state
and federal level. Instead of embracing the underserved efforts that might
have unified various organizations and concentrated efforts, much time and
effort and dollars have been spent studying what went wrong and lamenting
our situation.

I say again, build coalitions that will take the higher ground of impact on
patients and that will be defended against dismissal as pocketbook whining.
In order to get what we all need regarding better care for patients, less
hassle factors, more authority, etc. we will have to work more and more
with patient-associated groups and organizations if we hope to ever have
impact.

The sad fact is that we know how to get physicians to go and do what we
need for this nation, we just lack the political will to get this done.

Robert C. Bowman, M.D., Co-Chairman
Rural Medical Educators Group of the National Rural Health Association
UNMC Department of Family Medicine Director of Rural Health Education and
Research
983075 Nebraska Medical Center
Omaha, NE 68198-3075
(402) 559-8873 or fax at -8118
Email: rbowman@unmc.edu
http://www.ruralmedicaleducation.org  or
http://www.unmc.edu/Community/ruralmeded/