An Open Letter to America’s Physicians
June 25, 2009
Doctors of America,
Your profession is facing a certain death and only you can stop it – with your patients at your side. Congress and Obama are proposing to turn doctors into servants of the state, insurance companies, hospitals, and everyone except who matters most: the patient. We will be turned into bean counters, computer entry clerks, dutiful “providers” and will not resemble anything like a “professional”.
This letter is long, because there is much to report and much to say. But know this, as a physician, you will not want the kind of medical care that your junior colleagues will provide you when you need it. You must lead the way so our valued Medical profession can be rescued from this abyss and we can usher in a new golden age of medicine using genomics, cancer vaccines, implantable devices, nanotechnology, new pharmaceuticals and good old-fashion time with the patient!
I speak to you as a private practice neurosurgeon who is active in organized medicine and who has worked on the board of my state medical association and at the AMA for years*. I can tell you with certainty that there is one and only one goal of those who would “change” our health system: pay doctors less and force them to provide less medical care. That is why the President has put this item at the top of his goals for health system reform: “reduce costs”. How will Congress do this? They will create rationing boards that are unelected and unaccountable to anyone. Already the Federal Coordinating Council on Comparative Effectiveness has been created and given over $1 billion to spend. They have not one actively practicing doctor on the council and each one is a senior management Federal Employee. They will create so called “quality and efficiency goals” and force doctors to follow them through a “pay for performance” model. Those doctors who serve as dutiful servants to all third parties will be treated somewhat less badly than everyone else. Those who have the audacity to prescribe medical care to their patients based on their professional training and experience and in the best interests of their patient will be chased out of practice.
The bottom line is that doctors will be forced to do what they are told. Doctors will be forced to comply. One need look no further than your current practice environment and to ideas circulating in Congressional committees. Already we have seen “quality” (cookbook medicine) and efficiency (rationing) ratings for doctors that assign a star if you comply. If you are deemed a “good doctor” by the insurance company or the government, you will be paid a little more than another doctor. But at what cost? You must hire staff to make sure the quality measures are reported. You will be told to practice in a defacto capitated model where any dollar spent on patients above the arbitrary threshold of a government or corporate bureaucrat will lead you to be labeled “inefficient” – and penalized. You must buy an electronic medical record system to report your data to the government. Congress says they will give you up to $44,000 over 5 years to do so (if you are a “meaningful user”) but the actual cost is $120,000 over 5 years. If you don’t buy the system that will feed your practice data to bureaucrats – you will be penalized $42,500. I know I will take the penalty since it costs me less and keeps big brother out of my office (mission accomplished for the government – they just “reduced costs”).
Already, hospitals are hungrily pushing a “bundled payment” system so hospital based docs will be paid only if the hospital agrees! Hospital based doctors will be slaves to the hospitals. Global payment for management of chronic diseases are proposed so that a doctor will be paid once for a patient with diabetes and similar diseases. This is all occurring in Massachusetts where their health care reforms of 2006 (individual mandates, subsidized health insurance, state boards and health insurance exchanges) are failing more so every day. This is the model for national health system reform.
Congressman Tom Price is a doctor from Georgia who is fighting for patients and doctors in Congress now. He is right when he says we must not allow a “public option”, “mandates” or allow the “government to define quality”. America must empower our patients financially with good tax relief, health savings accounts, high deductible insurance. We should not grant further power to insurance companies and the government. The problems that the government and insurance companies propose to solve were created by them over the last many decades and we are being asked to grant them more power? Enough is Enough!
Now doctors are told they may “volunteer” to report quality data to earn up to an extra $1,000 from the government. Few have. Soon doctors will be told they must report data to avoid a cut in payment –as was done to hospitals a few years ago and 98% compliance was achieved. Then, as is currently done in hospitals, doctors will be told you must meet a “performance threshold” to avoid a payment cut. This is the same kind of “volunteerism” that was envisioned in “Animal Farm” when the dictator happily announced that people could volunteer to work the crops on Sunday and they were under no obligation to do so, but those who did volunteer could avoid a cut in their rations!
The problem is that this “Pay for Performance” model has been convincingly shown to produce no improvement in outcome for patient. What it does do is to force doctors to spend unpaid time in front of a computer to enter orders, respond to pop-up windows, follow protocols and help the hospital code better (so they get paid better on your work). It causes doctors to avoid non-compliant and high risk patients to ensure that they get a good “report card”. It has a disproportionately negative impact on low income patients and minorities who frequently have more complicated medical problems and will be avoided by doctors –just to make the grade. It turns out that compliance with these measures had been shown to do nothing to improve patient outcomes and has had many adverse effects when doctors over-comply and push bad medical practice on inappropriate patients – for a report card score.
Compliance with these so called quality measures is nothing more than an excuse to find a way to pay doctors less and to create a schism between patients and their doctors. This is not quality, this is cost control through bureaucratic overload. I was in the room at the AMA meeting June 13, 2009 when President Obama pointed out that we would not be allowed to have effective tort reform, but if we simply followed “best practices” then we would somehow find a way to lessen our exposure. He didn’t explain how this will work, but I will here. I was here when he said doctors should not be bean counters but should be healers, yet he proposes to turn us into the biggest bean counters around! This is how you will be treated less badly than your colleagues:
Comply. If you comply with reporting – you won’t be hurt as badly.
Comply. If you comply with government defined “quality” – you might escape a sanction..
Comply. If you comply with rationing protocols – you will be paid slightly more than another doc, but still far less than you should.
Comply. If you follow a so called “best practice” and are labeled a “meaningful user” and a good doctor – you might get a little tort relief.
Comply. If you do what you are told, and keep your mouth shut we may let you keep your licensee, your practice, and your participation on the provider panel - but not your dignity and not your profession.
Comply. Comply. Comply.
I am a professional. I will not comply with cookbook medicine and rationing to satisfy politicians who have made promises that can not be kept. Medicare has an $86 trillion unfunded liability. Instead of reform of that insolvent program, we are asked to ration care. We will be FORCED to ration care and deny valuable treatments to our seniors and to withhold life saving care in the hospital when the government determines they don’t meet the threshold for cost of treatment under a “quality adjusted life year” as is used in Britain now.
I am a professional and I will not be told how to practice medicine by a hospital administrator, a corporate CEO or government committee.
I am a professional and I will not be used as a rationing tool to save money for others.
I am a professional and I will set my prices and give my patients the time they deserve to make medical decisions that benefit them.
I am a professional and I can’t be replaced by a nurse practitioner or other provider that claims to be able to practice medicine at a cut rate.
I am a professional and I will work to make sure I hold my colleagues to the high standards we expect of each other and not accept sham peer review and “disruptive physician” star chambers.
But like you, I am also compassionate and will work to make sure that government and charity assistance is there for the needy – and not merely an economically unsustainable entitlement that benefits no one even though they are “covered”. I will provide charity when I can afford to stay in practice for those who are truly in need – not forced to provide free care to anyone the government chooses.
Because I am an American, I am rising up to stop this so called health system reform train. I ask you to join me, because as it turns out DOCTORS ARE THE MOTOR THAT DRIVES THE TRAIN – if we stop providing care, the train stops. If we call to our patients and tell them they are in danger, they will come to our aid. Now is the time for bold action and we must use the tools our forefathers gave us to do so: freedom of speech, freedom of assembly and freedom to petition our government. That is why hundreds of thousands of Americans are marching in the streets in July against government-run medicine. They need your help and your leadership.
So I am calling on you to join your patients, me and other doctors around our nation who want to save your profession from the bureaucrats, bean counters and politicians. Here is how you can help.
- Join the fight. Sign up to volunteer at TakeBackMedicine.com. Go to Teapartypatriots.org.
- Spread the word. Write a letter to your patients. Host a town hall meeting in your community together with local groups. They love when doctors come to speak and they will welcome you. Tools will be available for you to use at TakeBackMedicine.com.
- March on Congress in Your Community. There are “Healthcare Freedom Tea Parties” organized in Florida on July 2nd (nogovernmenthealthcare.com) and nationally on July 17 at Congressional offices (Teapartypatriots.org). Join up. Speak there. Bring friends.
- Keep the Pressure on Congress and in the Public all summer. You will need to call your Congressman and write them. You will need to write letters to the editor, op. ed. pieces and volunteer for radio shows. Our speakers bureau at takebackmedicine.com can help.
- Join the AAPS. The Association of American Physicians and Surgeons has fought since 1943 to protect the private practice of medicine (aapsonline.org). You should work to make sure the AMA stands up for private contracting and your rights as a physician, but the AAPS is doing it now by filing lawsuits and warning the public. You can make sure your local or state medical society or specialty society sends representatives to the AMA who will fight for your practice as well.
- Take Control of Your Medical Staff Officers. Tell them to stand up for your rights and true quality care. Tell them to stop allowing administration to place endless protocols, computerized work and nonsensical forms on your practice. Have your medical staff hire its own attorney – don’t use the hospital attorney. Incorporate separately from the hospital.
- Consider donating. I am writing for myself, so won’t be specific. But it is hard to win against a well funded political machine on blood sweat and tears. Find a group that supports this cause and help them financially.
- Consider dropping third party payer contracts and Medicare. At what point will you leave the medical police state? When you are fully chained and in control. You won’t be able to leave then. I have dropped United, Medicaid and am working to drop others – not for the money, but to avoid the control they would place on my practice.
This is your last chance. I hope you will join your patients, your fellow doctors and me and rise up to rescue medicine and usher in a new golden age of medicine that comes from a truly free market.
Then you will be able to trust your doctor when you need them, and your patients will too.
David McKalip, M.D.
*Dr. McKalip is a private practice brain and spine surgeon in St. Petersburg, Florida. He is the President-elect of the Pinellas County Medical Association, President of the Florida Neurosurgical Society, serves on the Board of the Florida Medical Association (FMA) and is on the Florida Delegation to the AMA’s key policy making body, the House of Delegates. He serves as the Chairman of the Council on Medical Economics for the FMA and lead the effort to write a health system reform plan for the FMA that focuses on individual financial empowerment of patients. Dr. McKalip founded Doctors for Patient Freedom and is working to ensure that individual savings, choice and competition create better and more affordable medical care for Americans. Dr. McKalip has written and spoken on the unintended consequences of expanded government and corporate control of health care financing and medical decision making including rationing, cookbook medicine, unsustainable economic models for government and unaffordable or unavailable private insurance products and financing options for patients.”
 Dr. William Plested, a liberty-loving past president of the AMA stood apart from many and pointed out the characteristics of our Profession in 2006.
- Long years of intensive education and training established by the members of the profession;
- Standards of behavior and ethics established by the members of the profession;
- Disciplinary procedures and actions that are established and enforced by the members of the profession and, The valuation of professional services established by the members of the profession.
 While an insurance mandate may sound good at first, it is soon to be followed by a mandate for doctors to take the insurance – no matter what it pays or what onerous regulations it imposes on medical practice. The state of Massachusetts now must spend $869 million to subsidize people to buy insurance, there are long waits for primary care doctors, the public hospitals are being paid less and there is intense pressure to impose cost control policies on doctors like bundling, global payments and efficiency measures!
 Dr. Ed Annis warned us of this when, the night after President Kennnedy gave the worse speech of his career in support of Medicare, in an empty Madison Square Garden he warned Americans about Medicare. “This Bill would put the government smack into your hospitals! Defining services, setting standards, establishing committees, calling for reports, deciding who gets in and who gets out-what they get and what they don't-even getting into the teaching of medicine-and all the time imposing a federally administered financial budget on our houses of mercy and healing. It will create an unpredictable burden on every working taxpayer. It will undercut and destroy the wholesome growth of private voluntary insurance and prepayment health plans for the aged which offer flexible benefits in the full range of individual needs. It will lower the quality and availability of hospital services throughout our country. It will stand between patients and their doctors. And it will serve as the forerunner of a different system of medicine for all Americans." Medicare was killed that year and was only passed on a slim margin in 1965 with President Johnson trading on the image of the “martyred President” and using his classic strong arm tactics.