Cover: Finding a way forward

Saturday, November 01, 2014 12:00 PM

Tamaan Osbourne-Roberts, MD
CMS President

It is a very challenging time to be a doctor here in Colorado.

Part of the reason for this stems from national policy trends. The multiple changes in health system delivery and financing wrought by the Affordable Care Act have brought new health insurance coverage to millions of Americans, at the same time as practices are struggling with issues of physician undersupply and the new administrative burdens wrought by the very same law. The rise of electronic health records has the potential to improve the care of many patients, while at the same time decreasing physician efficiency and contributing to physician stress. The national conversation on cost and quality promises to revolutionize the way patients understand, receive, and pay for care … while contributing substantially to doctors’ uncertainty about the profession’s future, and sharpening the divide between physicians, payers, and hospitals.

National social and economic trends also play a role in the difficulties our profession faces. The Millennials – that tech-savvy, financially-disadvantaged, wide-eyed youthful generation – promise to bring countless new health care consumers into the market, who will demand flexible new models of care and physician access to suit their lifestyles (including many models of care that haven’t been invented yet). And their huge numbers will drive the very nature of our industry … at the same time as their low incomes, and the increasing wealth gap in the U.S., will provide new challenges to the viability of current practice business models.

Of course, local political concerns, as always, play a role in physician malaise. As the public (and legislators) in our freedom-loving, politically independent, purple-but-always-slightly-libertarian state engage in increasingly sharpened debate about reevaluation of provider scope, we find ourselves continuously needing to remind our patients of the unique skills we bring to bear as a member of their health care team. And, as always, some wings of the legal profession continue to make challenges to the stable liability climate here in Colorado, at the very same time as other parts of the legal profession continue their excellent and tireless defense on behalf of doctors.

The problems are substantial. The question, of course, is how do we solve them?

There was a time when, given all that our training demands, sheer grit and determination would have led us through all of this on an individual basis. Indeed, just to find our way into our profession sometimes seems to take near-Herculean effort and persistence. Organic chemistry, the MCAT, medical school interviews … gross anatomy, residency applications, the multiple steps of the USMLE … internship, residency, board certification exams … and of course, those first few unsteady steps through the hospital or clinic door as independently practicing physicians (and the busy days, sleepless nights, and heartache that come along with the privilege of tending to the sick and dying) all represent a very long, very hard road. The very act of physician practice itself speaks of years of dedication, strength, empathy, toughness, and sheer will. For years, the lessons learned from this have held our profession together, bonded us, and given us what we needed to make it through the daily ups and downs, in both our practices and our lives.

But the evidence, rather alarmingly, is mounting that this hard-nosed approach is no longer enough. The rate of suicide amongst physicians is amongst the highest of any profession. Multiple national surveys show that the majority of doctors would not recommend their profession to their children. Tell-all books about the difficulties and vagaries of daily practice are proliferating … and flying off the shelves, into the hands of physicians and the general public. And the AMA-Rand study on physician satisfaction published last year is just one of many showing that physician job stress has reached epidemic proportions, with some specialties reporting more than 50 percent of practitioners dissatisfied with their practice, while other studies show similar numbers of physicians displaying signs of clinical burnout.

So then, how do we get through? How do we find our way forward?

The answer is that we do it together.

It is our nature, as doctors, to bear all of our burdens on our own; this is a habit that most of us learn very early on in our training. We bear witness to tragedy on a regular basis, but hold it in so that we can continue to serve the people counting on us. We function as part of a team, but are told, repeatedly, that the only correct approach is “trust but verify.” We go home at night to the people we love the most … and understand that they very well may be the people least able to relate to the many difficult things that we’ve seen, or done, that day. Ironically, for one of the most humane of the professions, our profession is also one of the most isolating.

But these habits cannot continue. The problems are too large, and the need to overcome them too critical, to stand alone when our combined force is what is needed to steer this wave of changes, to keep moving forward, to shape our profession and the whole of the health care industry into something that makes the world both better for our patients, and for our profession.

And it is my firm belief that, as a means of bringing the physicians of Colorado together and providing the tools and forum we need to advocate for ourselves and for our profession, there is no more powerful or effective force than the Colorado Medical Society (CMS).

Indeed, CMS already provides multiple investments in such. CMS invests in our grassroots, through support of our component societies, and the physicians they represent; it also sows seeds for new support, through the creation and rejuvenation of new components, such as the recently re-established Chaffee County Medical Society, which is anticipated to join the other components in January of 2015. CMS invests in physicians’ health and professional success, through initiatives such as the Physician Wellbeing Toolkit, developed and recently released for use by all the doctors of Colorado, and through its continuing support of partners such as the Colorado Physician Health Program and the Center for Personalized Education for Physicians. CMS invests in the leaders of medicine’s present, through programs such as the Advanced Physician Leadership Program, which will be producing its second class of graduates in the upcoming months. And CMS invests in the leaders of medicine’s future, continuing to support our medical students, residents, and young physicians and bring them into the family of our profession.

But staying put is not enough; we must find our way forward. To this end, the CMS Board of Directors has approved a work plan for the next year that is bold, innovative, and exceptionally ambitious. Amongst other things, it directs CMS to continue the excellent work of our legislative team in defense of Colorado’s stable liability climate, as well as multiple other legislative issues; to examine our work in defending scope of practice, and look at new and innovative ways to conduct that work; to modernize our governance and policymaking processes in an effort to remain nimble in defense of the profession; to explore new means of communicating with our membership and the public; to further support our medical students; and to more directly integrate the health of the public into the regular priorities and operations of the organization. The leadership of CMS is excited about this work, and looks forward to bringing all of these projects to fruition, continuing to serve as the convener for physicians on the issues that matter to us most.

Of course, even with such a substantial agenda, CMS will not be able to solve every problem that the physicians of Colorado face. Some challenges will take years of work to solve; other new challenges will arise even as we are addressing those I’ve listed. But, together, we can continue to meet whatever we face … and to ensure that the future remains bright for the physicians, and the patients, of Colorado.

This is exciting work, at an exciting time. And I am happy, and honored, that you will be joining me for it.

Let’s move, friends.

Forward.