Medicine "desperately in need of a clear vision" of where to proceed

Regarding "Finding the way back to the heart and soul of medicine" (Column, July 18): The commentary by J. Edward Hill, MD, in AMNews leaves no doubt, I'm certain, in any reader's mind why Dr. Hill was elected president of the AMA. He is articulate, compassionate, and charismatic. We, as physicians, have every reason to be optimistic, and a vested interest, in his success as AMA president.

As he noted, we are desperately in need of a clear vision of where we are to proceed as a profession, and what impediments need to be removed to arrive there. We lack not for encouragement, but rather for definition of the course of action most likely for success: We need a correct diagnosis and a treatment plan.

It appears to many of us in the trenches that the growing weakness of our position in regard to the third-party payers -- in the face of rising overhead expenses coupled with ever-decreasing reimbursements -- is not likely to improve without drastic action on our behalf. It needs to be publicized that the conflict is not at all between us and our patients, but rather between who will profit fairly from our hard work and dedication? Us, or health insurance interests? We cannot continue to work harder and harder for less and less and expect to remain the same.

We need to realize just how aggressive our competition is in dealing with us -- how very unfair the rules are stacked in their favor. We are not likely to improve our situation appreciably through legislative means. The massive lobbying force our competition musters is stronger than we are capable of overcoming, though we should continue to parry their thrusts when we see opportunity. Fortunately there is light in front of us, which could prove to be our sun if we are bold and aggressive in our efforts. We have had recent victories through settlement of lawsuits against health insurance companies. This is the way to parity with our competitors.

They will never, of course, voluntarily loosen the stranglehold they have on us -- it is not in their stockholders interest to do so. We must engage the brightest legal minds on our behalf and act aggressively to seek fair competition with these behemoths. We must also be adversaries on behalf of our patients to win back for them the constitutional rights that these companies have usurped. We have been reticent to take strong action against these monopsonies, but now we can see clearly how this competition will play out if we don't press our case: We will slowly be ground down to a subservient role in the health care system while others, less qualified, dictate to us and our patients; and profit exorbitantly from our toil and talents.

William J. Woessner, MD, New Orleans

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/09/12/edlt0912.htm.