Compared with almost any other career, the path to becoming a physician requires a substantial up-front commitment of time, effort, and, of course, cost. For oncology specifically, an additional ten years of training after college are required before seeing your first patient independently. In a sense, the day you finish your fellowship, you are already fully “committed.”
After this substantial investment, the oncologist immediately begins practicing in the split-screen world of medical practice. On one side of the screen are the positive aspects of medical care that make up our driving motivation: the ability to help patients in need, to form close personal relationships, and to be challenged intellectually. It is hard work but we enjoy it. On the other side of the screen are the more onerous aspects: complex and changing regulation, highly uncertain futures, insurance pre-authorization, potential legal jeopardy, continually declining reimbursement, and true financial risk. For many physicians, the ballooning of these latter obstacles is overshadowing what we enjoy about oncology.
This reality begs the question: with such a huge upfront investment in our careers and the ascendancy of so many problematic issues, why do so many physicians choose not to engage in the political and regulatory processes that determine their future? Some may think that policy makers may have some natural inclination to be supportive given the investment physicians have made in their training. Unfortunately, it may be the opposite. I have had a congressman tell me twice that policy makers understand that physicians in their thirties and forties cannot just quit. They know that we have to make a living, and he described us as “on the hook.” From the perspective of some policy makers, our investment in training can be used against us.
When speaking with physicians about engaging more in political advocacy, I hear two common explanations for why they choose not to. First, they are simply too busy. Second, policy makers should be willing and able to solve our problems without requiring our input. Additionally, physicians can feel uncomfortable in an environment in which they are not the expert; our nation’s opaque political process certainly does not lend itself to easy understanding. And physicians tend to value autonomy; organized group efforts are not our strength. These two traits may have made a medical career appealing to our personalities, but they work against us in the current environment of health reform.
Others express dissatisfaction or even outright contempt with the political process itself. While this may be understandable, engaging the political process is not the same as condoning the political process or its participants. It is simply an acknowledgement of the reality that many of our professional obstacles begin on Capitol Hill and, thus, misguided policies can only be corrected by engaging with the policy makers themselves, understanding and dispelling their misconceptions, and offering better solutions to the problems that they perceive. That said, the engagement of these policy makers motivates the medical community to participate in policy solutions that are viable in the real world.
The Affordable Care Act has hundreds of provisions which CMS is tasked to define and implement. I feel strongly that now is a critical time for all physicians to engage at some level in policy formation. Political advocacy should not be about blatant self-interest. Rather, it should be about the providers who actually touch patients on a daily basis giving input into how to positively evolve our nation’s health care. Instead of reacting to poorly crafted policy initiatives, it is our responsibility to innovate and address the central problems in our health care system: high cost, uneven access, inefficient care delivery, and insufficient ability to measure quality and outcomes.
I encourage you to find the professional organizations that you feel most reflect your views and get active. Most organizations are eager to have greater engagement and can provide guidance.
Our organization, the Community Oncology Alliance, has a website www.communityoncology.org designed to make this as easy as possible. It is updated daily with the latest health policy news.
The site includes a section titled “action needed” which makes it seamless to participate. Of course, there is limited time available to many physicians. However, medicine has entered a phase of fateful transformation. Many of the policies implemented in the near future will endure for the remainder of our careers and simply working harder will not provide a true solution. Your voice needs to be heard now.