A weekend with political docs

I just spent the last 3 days attending the American Academy of Family Physician's (National) State Legislative Conference, where a hundred or so docs and staff members representing the leadership of nearly 30 State Academies (and a few crashers of committee meetings and self-appointed policy-watchers like me) listened to political pundits, consultants, and each other as we contemplated last week's election and next year's legislation outlook.

It was interesting to listen to the slightly bipolar comments on the Democrat's win on the National front and in many of the States. There were probably a few more Democrats than Republicans present, and just a bit of discussion based on voter's expressing their displeasure with the last group of legislators. (BTW, they pretty much got the motivation of the Right wrong.)

However, I'm proud to say that we reflected the purpose of the Conference: how we Family Docs could and should interact with our local, State, and Federal lawmakers to influence policy in order to help our patients and stay in business. Most of the comments were based on whether and how well Medicaid and Medicare funding would be financed, how much farther the "scope of practice" of "practitioners" without medical degrees and with less training would need to be watched and a very rare note that tort reform wouldn't be possible.

It's important to understand, however, that "staying in business" means one thing to the majority of docs and another thing entirely to most academics and State Academy staff members.

I'm sure I've mentioned somewhere that I have noticed that there almost seems to be two populations of doctors at medical meetings: the ones in the Committee meetings and the ones I talk to at lunch who attend for the Continuing Medical Education. The former tend to be from the big city medical centers, left-leaning, "prochoice," and to work for the State and/or in a Medical School, Residency Program setting or very large, multi-specialty group and the latter tend to be from smaller towns or rural areas, right-leaning, pro-life and work in private practice clinics, quite often solo or very small groups.

This observation is a generalization that tends to break down as often as most cliche's, and is not nearly as consistant in Texas Academy of Family Physician meetings as it is in the Texas Medical Association meetings, but it's a good working model.

I'm impressed that we manage to find common ground in funding for medical schools, residency programs, and health care for the indigent and those locked in to Medicare and other Government-paid medical care. We all agree that we need tax funds that our States send to Washington to be returned to our States from Washington, that our States need to manage those funds with our input, that medicine should be practiced by physicians rather than corporations, bean-counters and lesser-trained "practitioners," and we'd like to keep ourselves out of malpractice suits.

One of the "discussions in the House of Medicine" (a polite way of saying there's disagreement between doctors) is whether medicine should be "single payer" or "socialized medicine." Those who use the first term either believe that government-run medical care paid for by taxes is a good thing. Or they've learned to speak in Politically Correct terms to keep those who use the second term (not coincidentally members of the second group, above) happy, while slipping in the occasional "Universal coverage," "Health care for all," and "medical care, while not necessarily a right, is a common good that society should fund."

The fact that our AAFP literature is very good at hiding this "discussion" (and the dichotomy between the Committee members and the general membership) was proven in one of the workshop sessions.

Our presenter gave an informative and instructive step-by-step workshop on "Framing the question," or offering perspective to influence the opinion of others. He just didn't know that we docs don't agree on the issue of government-financed health care and that we've agreed to disagree, in order to take care of our patients and stay in business. I could feel the stillness around me as my fellow Conferees realized his mistake.

(We're too practiced in our bedside manner to actually gasp.)