Why The FMA Is Off-Base On Reform

BRIAN KLEPPER and DAVID C. KIBBE

First Published in the Florida Times-Union

At an Orlando meeting last week, Florida Medical Association (FMA) members fumed that their parent, the AMA, isn’t adequately representing Florida’s private practice doctors. After talk of secession and forming a new group, they settled for writing a stern letter urging the AMA to straighten up.

The FMA dustup began with a resolution written by Douglas Stevens MD, a Fort Myers cosmetic surgeon – you can’t make this stuff up – complaining that the AMA’s support for recent reforms was “a severe intrusion in the patient-physician relationship and allows government control over essentially all aspects of medical care.” He wrote that it will “relegate physicians to the role of government employees…and essentially end the profession of medicine as we know it.” A St. Petersburg neurological surgeon, David McKalip, added, “Without (AMA) support, the whole thing (i.e., reform) would have died."

When Medical Care Is Financially Conflicted

This appeared on Medscape General Medicine

The Cleveland Plain Dealer recently ran an article[1] about a prominent physician who held a financial stake in a spinal procedure that he and his well-known clinic promoted. The procedure was more costly and surgically complex than another more proven approach for the same condition.

Ironically, the doctor sat on the clinic's Conflict of Interest Committee, and on its Board of Governors that last year ousted a cardiologist for failing to disclose stent royalties.

Financially conflicted care is not new or isolated.[2,3] We know that many doctors routinely increase income by delivering unnecessary or suboptimal services. But this article raised important questions about financial temptation, and about the dissonance between some physicians' self-images and actual behaviors.

Physicians have a sacred trust with patients. I believe most doctors see themselves as mission-driven and believe their decisions follow scientifically objective criteria.

Patients also see their doctors these ways. So when physicians' decisions are not objective, when they accrue at patients' expense to the physicians' financial benefit, patients are betrayed.

A profession succeeds by adhering to standards that protect the interests of the professionals and their charges. When care is conflicted without repercussions, when standards are jettisoned and individual interests take precedence, hasn't it become unprofessional?

Medical profiteering steers care away from what's best for the patient in favor of what's best for the doctor. That greed undermines the entire process: It compromises quality, increases cost, and erodes the patient-physician relationship.

Like all of us, physicians are susceptible to the financial conflicts that are inevitable in an entrepreneurial society. Clearly, professional self-regulation isn't working. Nor is the system yet transparent enough to discourage these behaviors and protect patients. So additional safeguards are required. Physicians must self-correct before an external force does it for them.

That's my opinion. I'm Dr. Brian Klepper, President for the Center for Practical Health Reform.