Why Doctors Have to Organize Against Outside Forces

Every day I get calls from doctors who need to vent.

“I am not a provider,” a cardiologist from Pennsylvania said the other day. “I’m a physician.”

“I’m sick of playing how low can you go with insurance companies,” another doctor, an Atlanta otolaryngologist, called to say.

These doctors aren’t angry with me. I am not demoting them with euphemisms or squeezing them further on reimbursements. The system is, and they are getting sick of it.

Doctor are fed up and I don’t blame them. The climate is different today than it was even five years ago. Tired of being told how to practice medicine and how much they can get for what they do, and being lumped in as "providers" with others in healthcare field who have half the education, doctors are actively banding together.

All over the country groups of frustrated physicians are organizing and speaking out against a system that is demeaning their profession, undermining their authority, and intruding on their patient relationships.

Calling doctors "providers" is emblematic of the larger problem. Physicians, in general, are the most educated members of our society. They don’t take kindly to bureaucrats, insurance executives or healthcare administrators putting them on the same plane as nurses or nurse practitioners or physician assistants. No offense to those professions, it's a demotion.

When bureaucrats, insurance companies, and healthcare administrators call all medical professionals providers, it not only knocks doctors down a peg, but it also makes it appear less obvious when they slip in someone less qualified to deliver care.

“How did we go from being at the top to the food chain to being the food?” One doctor asked me lately.

Besides bristling at being dumped into the provider pool, doctors are railing against “Meaningful Use,” a euphemism that requires doctors to spend more time facing their laptops than their patients. They didn’t go to medical school to spend hours of their day filling in computer data for the government or 20 minutes of every hour jumping through payers’ hoops to get prior authorizations for patients.

They find it insulting when they have to get permission from an insurance company to do what they know is best for their patient. They went to school to treat patients, and they resent the growing number of demands getting in the way of that. “Before I can talk to my patient about a sinus infection, I first have to ask whether he has any firearms in his house, or whether he has ever thought about hurting himself, to please the government,” said Elaina George, an Atlanta otolaryngologist. Like many physicians, she finds the questions time-consuming and intrusive.

Doctors understand that they are partly to blame for letting this happen. They’ve been asleep at the switch. They’ve been busy getting more training, removing gallbladders and mending bones, while government, payers, and hospital systems have been advancing their agendas.

They are paying attention now. Proof lies in the number of organizations like ours, the Association of Independent Doctors (AID), which have been forming and growing and melding. In March, I spoke on Capitol Hill about a proposed doctor’s law. We’re trying to make a difference.

Besides AID, other groups have also formed after realizing that doctors are in critical condition. Their organizations are also fighting the regulations that are crippling them and the pressure to succumb to hospital employment.

Remarkably, while associations in the same industry often compete for members, we are not elbowing each other out of the way, we are linking arms.

For instance, the Association of American Physicians and Surgeons, which has been around since 1943, has shifted its direction. At the AAPS annual meeting in January in Orlando, the meeting focused entirely on the topic of opting out of Medicare and Medicaid, and even from some insurance plans, so patients pay directly for services.

Dr. George spoke at the meeting. Tired of the red tape, George, who has her own surgical center so can bypass the hospital, has opted out of Medicare and out of contracts with “payers who give me nothing but administrative headaches and low reimbursements,” she said. "When you cut out the middleman, it’s much more affordable for patients. Direct pay is the future.”

While the AAPS aims to liberate doctors from the tyranny of third-party payers, the American College of Private Physicians, looks to help them navigate the waters of direct practice or concierge medicine. Two years ago, Tom LaGrelius, a concierge physician practicing in Torrance, Calif., formed ACPP “to help doctors take back control,” he said. “This group picks up where the AAPS leaves off, helping members navigate the day to day running of a concierge practice.

LaGrelius estimates that 10,000 U.S. doctors are working this way in some fashion.

Last year, Let My Doctor Practice formed under the direction of Mike Strickland, an Ohio internist. “We believe in the sanctity of the doctor-patient relationship, and the autonomy to practice medicine without restraint imposed by overreaching government and corporate entities,” said Dr. Strickland. “Let My Doctor Practice is a movement to restore the voice of the doctor to the practice of medicine.”

That means working to stop the intrusion into the doctor-patient relationship by third parties, he said, “fighting ‘Meaningful Use,’ which is a degradation of the medical record, and not letting health insurers dictate care options over doctors’ recommendations.”

“It’s simple,” he said. “We all want to return the practice of medicine to those who actually practice medicine. We are sick of being told how to practice.”

Atlas is shrugging.

Marni Jameson is the executive director of the Association of Independent Doctors. You may reach her at marni@aid-us.org.