SEDMS: Us vs Me

by John Loofbourow, MD

It is not by chance that the writings of Plato are Dialogues. As Niels Bohr said, "Every great truth is one whose opposite is also a great truth." So it is with the reasons for, and against, joining an association of professional peers like our medical society. There are valid reasons for either position. Yet we don't live in a philosophic test tube, or in some timeless Socratic dialogue. We live here, now, in Sacramento, at a time when our profession is facing great change. We are forced to react to those changes, now, rather than in an abstract past or future. Surprisingly, physicians have been "out of the loop" of medical change. (Some might say that shouldn't surprise; Jenner, Semmelweis, Lister, Darwin, Harvey, and many others had to overcome eloquent and outraged rejection of their strange ideas. But the upheaval we face is not in scientific theory, but in political and economic practice. These changes, directed to the politics of medicine, will inevitably lead to changes in the practice of medicine, a fact which is arguably best understood and foreseen by practicing physicians. That is why I find it so surprising that we seem to be uninvolved.)

I make the case to you, my brother and sister physicians, that the mileau in which we practice here and now makes it critical that we come together, and work together, and reason together. We must do so with intelligence, and determination; with tolerance for our diversity, yet with an over arching determination that we are each able to respect the collective will of our professional family, without rancor. We can't allow ourselves temper tantrums when one issue doesn't go our own way. None of us is so prescient as to know all the right solutions to the problems we face, whether those problems are ethical or tactical or technical. I believe that the place for us to come together is within our own medical society, and that includes CMA, at the least. Together, we may, we will, make mistakes, to be sure. But by becoming re-involved, we will learn, and benefit from that involvement, and so will our patients.

There was a time, a long time, when we physicians did not need one another. Perhaps we didn't need anyone, at least professionally. We were captains of our medical ship; we were relatively independent. It was a good feeling, but those days are gone, and don't seem likely to return in the foreseeable future. The reasons are many, and most aren't within our control, as they are the logical consequence of technologic and economic developments. Can I, can you, sit back and remain a spectator while the rules are rewritten? If we become the de facto employees of a managed care plan, won't we become afraid to criticize, or object to the various edicts which affect our practice? If so, what can one do? Write to the "Bee", (name withheld); or appeal to those congress-persons? vote? Not very effective, I think. How about hiring a bunch of lawyers? That is like sheep hiring coyotes to control the cougars. No, we must be involved ourselves, and collectively so; if we do hire lawyers, or PACs, we are their teeth, and we must be able to bite, as well as bark.

Would it be better to start a union? I doubt it; closed shop and obligatory dues? CNA ( nurses) raise more from dues than CMA; no dues, no job. We physicians wouldn't want that, because we are professional, right? At least not yet. One can conceive of conditions where we doc-employees would also consider a union, although it is distressing to do so. SEDMS/CMA are optional, and too many of us opt out, leaving our only organization toothless. As a former delegate, I can attest that CMA is a serious, thoughtful, democratic body to which any member can introduce legislation. Locally, we are fortunate to have one of the most capable and conscientious executive directors in the nation. He is a person of conviction who expresses himself with clarity, yet is receptive to diverse or dissenting opinion (well, almost always!). We have the advantage of living in the State Capital, with a front row seat in California politics, felt by many to be a Good Thing. (It certainly is when one's testimony before some committee is, for tactical reasons, "put over" to another day.) While many of us find our income is less than a year ago, at about $25 per week our combined SEDMS/CMA dues are a bargain; even quarterly payments can be arranged.

Active membership in SEDMS/CMA is, never more than now, in our own professional, economic, and personal self interest. To the extent that our profession has been marginalized from the politico-economic medical care (r)evolution, I would suggest that we can best become re-involved by working together. So do bring a colleague who is not a member to the monthly meeting. Do participate in our committees and invite your nonmember guest. Do propose legislation to our CMA delegates. Do voice your concerns or suggestions by taking the risk of speaking up or offering a letter or an article to the Journal of the Sacramento -El Dorado Medical Society. It's very likely that if you express your considered opinion, or make your suggestion, you will find others who feel the same way. Sometimes that is enough to start a move toward constructive change. If not in Sacramento, where: Washington? Berkeley? or Little Rock? No. Here. Now.