Steve Stack, MD, Chair of the AMA Board of Trustees, sits down with EPM executive editor Mark Plaster to discuss physician discouragement, AMA leadership and strategies for handling runaway medical expenses.
ACEP 2012: Steve Stack Part 1 – Physician Discouragement from EPMonthly on Vimeo.
ACEP 2012: Steve Stack Part 2 – AMA Leadership from EPMonthly on Vimeo.
ACEP 2012: Steve Stack Part 3 – Physician Satisfaction from EPMonthly on Vimeo.
ACEP 2012: Steve Stack Part 4 – Steps to Improve Physician Satisfaction from EPMonthly on Vimeo.
ACEP 2012: Steve Stack Part 5 – Issues of Healthcare Expenses from EPMonthly on Vimeo.
Boy, I am ready to get raked over the coals for this one!
17 years ago, increasingly disSATISFIED with the deterioration of the quality of my professional life, working harder and longer, spending less time in patient care, increasingly stressed by bureaucratic, administrative, and legal oversight, and making more money than I could possibly spend, I left US medicine for an employed position in a universal national health service. Now, 17 years later and semi-retired I can reflect and compare.
My income dropped by 50%(+). The offset was 44hrs/week with limited and low risk call for peak overflow, a comprehensive and generous benefit package including more than ample Leave time, 70-90% actual patient care with limited administrative duties in peer review, education, credentialing, and such, all in a stratified physician designed, physician dominated system with Consultants like me supervising layers of junior doctors, residents, students, and ancillary staff. Definitely bureaucratic administrators to deal with, cranky Consultants to cajole for referrals, and patient complaints requiring response, but no litigation or professional liability concerns, and almost absolute professional security in what I have always strived for – evidence based, cost effective medicine.
You might guess which life has been better, professionally and personally, which life better suited my family. For my second country and its people, less money for the same service. Paid me half, and got twice as much patient care from a rested, relaxed, minimally stressed pit doc whose primary concern was optimal patient outcomes.
From the other side of the political spectrum, the far left, maybe the backside of a closed loop in which right converges, almost unseen, with the left.
The Conventions and especially, the “debates”, are naught but the scripted blue smoke and mirrors of a cabal of rich, old miscreants who increasingly have a duopoly on everything of value and power.
“Debate”? I say Debacle, wrested away from the League of Women Voters by the “Commission on Presidential Debates”, an 80’s creation of the mavens of the DNC and RNC, specifically interjected so they could control every speck of content and exclude any threat of third party interference.
Foisted off on us plebes are two sides of the same coin, the Republocrats, Rombama, tweedle dee and tweedle dum. Which of them sits in the Oval Office makes not a whit of difference. Those we will likely never know, but whose affiliations are increasingly obvious, will continue to pull the strings, and their preselected puppet will dance their dance, sing their song.
We have been near terminally weakened by the continuous onslaught of disinformation from a contrived controlled media. The silent majority have been drugged with their nostrums.
Our dwindling options, other than working the rigged game of the ballot box, are mostly those of the Arab Spring; non-violent revolution fueled by social media, or (shudder) blood in the streets.
On November 6, we have an outside chance to send up a message. There is little or no hope that we can seat someone representing us in the White House, but if enough of us vote our conscience rather than our convenience, we can use their weapon of choice, and strike some fear into them, fear of the rest of us.
There are third party candidates, some of whom may represent solutions aligned with those of us from the thoughtful opposition to the existing duopoly. A third party vote, far from a wasted vote, can amplify our voice, register our displeasure. The wasted vote is a vote for one of the two sides of the same corporate coin.
For me, probably not for you, it will be Rocky Anderson and the Justice Party.
Interesting piece. I will first admit to being on the liberal side. Sounds like I am as far left as you are right, and yet much of what you write squares perfectly with my views. I think the problem here is that both of our cynicism is based on the public rhetoric fed to the masses, us included. Most Americans don’t dig any deeper and can only process soundbites in their busy lives…so that is what they feed us. I suspect that the actual daily process of governing is, or at least was, much more practical and at times even based on some real numbers. The problem now is the growing influence of money. You need money to win. You can only attract that money at the cost of compromising the agenda from numbers and honest facts (that you ask for) to dollars, and once the dollars flow in, the public is inundated with BS exacerbating the problem by creating an ill-informed public pushing ever increasing partisanship based on flawed and simplistic understandings of complex issues. The plan all along was to cut us, the public, out of the equation. Politicians say whatever it takes, pissing off their opposition (at them), their supporters (at the opposition) and those on both sides who thoughtfully consider issues (for all the reasons you mentioned). The system thrives on people being pissed off and that is what gets people to write checks. When the election is over, they go back to the practical issues of trying to run government. Unfortunately, in this age of media, and bought media, they have turned up the partisanship so high, nothing can get done, and the need for dough means they are only short cycles between elections and fund raising.
As to the implications of a serious view of the facts as applied to healthcare, I supported the ACA because it, for the first time, established in law and society the concept of universal coverage. It has many features which fall short and some provisions that move the ball forward. Bottom line is that real reform from a “numbers” and logic standpoint clearly favor a single payer, Medicare-for-all, system. Estimates are 40,000 people a year die due to lack of insurance. Considering what we spent to avenge 3000 lives on 9/11, and the ongoing bill to prevent a recurrence, seems like it would be a bargain at whatever price (though it would actually be a savings in the long run). True some savings would accrue because many people would make less money, us included. So the next question becomes how objective and fact based do people want the discussion to be when the conclusions will affect their bottom line in a negative way.
Great piece of good, logical thinking. Dr Henry, as always, speaks to the point. We live in a declining democracy, just as de Tocqueville predicted 150 years ago! Lying (half-truths are half-lies after all, while whole lies are acceptable in this society) is the modus operandi of our post-modern society.
Our politicians simply reflect the simpletons who want to replace logic with feelings, and cold hard facts with wishful thoughts.
The movie ‘Idiocracy’ is coming true by the moment. Although Seneca was talking about another problem, the expression remains valid–‘O tempora! O mores!’