ACGME merger: AOA policies are striping my ability to do what I do

Dr. Chip writes:

Words cannot express my feelings on this. Actions can, however.

We have strived to evolve a discussion and develop an intelligent alternative solution set including compromise where possible except when Patients Come First is suggested to become a second place item.

In the absence of any commitment to actually begin this process, the membership and the unrepresented majority must take action.

This will be couched by the incumbents as a direct attempt at revolution or mutiny to those who are in the organization and revolution or terrorism to those outside it.

That will be their charges against anyone fighting them.

From inside the ranks of the unrepresented professionals will be the call of freedom fighters, saving the people, helping those who can’t defend themselves while the incumbents will labeled by this group transgressors, suppressors, greedy, exterminators, pro death panelists, etc.

The issue hear is that the truth of the matter will get buried in the hype and delayed from surfacing until great damage is done on both sides to peoples reputations, livelihoods and worse to the population of the United States.

This type of “war” has no winners. Only the people (patients suffer). All our efforts to avoid this have gone unheeded. Even the GAO has recognized the unsustainability of what has been proposed.

Every turn here so far has increased cost to the patient in decreased access and in out of pocket expenses without a single improvement in the actual receipt of healthcare delivery to them.

The above is the only point of true value. Its cost is to take money way from the insurance-government-pharma complex and give it back to the premium payer in either dollars or in services with access to them.

This is the real battle. The sides above are set on defending either, siding with the corporate complex, or siding with the patient. The AOA has sided with the corporate complex in their actions.

That cannot be lost in what will soon ensue as this path is continued upon.

Most of us have lost access to the largest portion of our patients. many important skills are no longer “covered” by health policies and our patient population has gotten sicker with each passing year because we cannot give them enough of our skills for the dollars that they have left after paying for their premiums, deductibles and co-pays. Many can’t even afford the drugs they need to keep disease in check much less cure.

The fact that we may have kept people at work or returned them to work after being out of work as long as 5 years has no influence on covering treatment. Remaining on public support due to the otherwise unsuccessfully treated conditions is not in the equation to solutions as they are now proposed.

The skills used to get these people there are no longer a central part of our curriculum (and in many cases has been all but removed from the curriculum) because of non-coverage, not because of ineffectiveness.

The treatise of first do no harm has become only a teaching point with no follow through in support of law in the defense of medicine.

The first rule of thumb in guiding students through the educational process once they become part of hospital training programs states “Do not treat the numbers, Treat the patient”. Still taught but no longer supported in actions do to regulations controlling delivery.

Treatment has returned to the 1900’s with an attitude that now supports technology first not education; “treat the symptom complex based upon labs and radiology first”. Simply because the technology is there to “support the diagnosis” as a symptom complex does not qualify the technology as the diagnosis maker. This has had huge effects on the “treat defensively mode of thinking” and increased costs astronomically.

As a result many providers have become re-entrenched in the “symptomatology method” which leads to treatment of an imaginary standard patient instead of treating the individual who sits before the provider. The provider is forced to receive directives on the treatment from insurance driven computer solutions not medical decision making.

Thinking about the causes for the problems after the treatment has failed has been deferred to the few physicians left that can take the differential diagnosis (that the computer is actually reporting as standard of care) and sorting through the nuances to arrive at a narrowly selected set of potential causes. This has denied rapid and early successful treatment to a large population that most often has expensive sequlae as a result of that time delay (also not in the equations of solutions for the insurance companies and hospitals). Keeping these people outside the treatment systems or re-naming the diagnoses for them, gets them into a state that can then be billed differently since they can now be called “outside the global coverage period” for a complication. Companies make money by delaying real physician individualized care and at patient expense in premiums, in health and in quality of life. They also have shifted the delivery model to a treat the disease model and not a maintain health model. In this way keeping people sick increases corporate income. Follow the dollar!

Making this sad loss of access to clear and educated thoughts dedicated to the individuals problem has become the way of delivery of today because the insurance companies say that this is the standard of care (computer driven and doled out by medically unqualified individuals who only read and relate what the Insurance companies computer says is allowed). This is a very expensive failure in understanding real healthcare delivery and is cost prohibitive in patient adverse events also not considered in the cost of insurance and government interference.

Don’t believe it? Look at the VA costs on paper for treatment failures. Of the ones that are in publication, they are extreme to the point that the department of defense has constantly attempted to deny coverage for the most expensive adverse events. Failure to identify and treat PTSD is just one such example now widely in the media.

Dr. Norman Vinn and the AOA machine continue to ignore the plethora of evidence against so many of the AOA policies being brought forward in the misguided attempt to stay on the winning side from a business perspective including ACGME merger, MOC, MOL, OCC, P4P and many others.

The most simplistic view of this is instructive and yet they ignore this at their peril and this imperils all of the rest of us as well, because we let them.

In the early to mid 1900’s there was a work ethic that said “If you do the work you do well, you will be able to support yourself and your family.” in the 1970’s there was an advertising campaign that asked “what would happen if you had to sign your work so that all could see who it was who did it?”

In each case we are clear to ask ourselves personally, is my work worthy of compensation? Is my work done well enough that others will want to utilize my services and/or products?

My work is that good. The AOA policies are striping my ability to do what I do as well as I have been able to do it.

Their failure to support that in us, is a failure to support us in what we do best, which is caring for patients.

This is their first duty, protecting us. It is part of their mission, their vision statement, their contract with their members and their very reason for existence.

We need to force them to take up that banner once again. If they cannot yield to this then legal action should be taken. Impeachment processes could begin simultaneously. Failing this the entire membership should collectively petition for a vote of no confidence in the existing Board (requires a 2/3 majority by Robert’s Rules and is protected in corporate law by precedence even if the corporate Bylaws attempt to circumvent this both in public and private sectors).

I do not like the vision of the future I see. Reasonable men and women should be working together to come up with solutions. The current AOA policy makers continues to work at divide and conquer techniques avoiding the simplest of issues by diffusing the focus.

Do they protect us in their actions (not their words) or not ? If you think they do not then what do we as a profession (members and non-members of the AOA combined) do next and how soon matters a great deal?

I move for actions since they have constantly failed to support my professional specialty, my profession as a whole and most importantly my patient’s access to quality health care delivered by qualified physicians who treat individuals at or above the standard of care.

Sincerely yours in service to the profession and to our patients,

Charles J Smutny III, DO, FAAO

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