Change is Here!

By Donald Gordon, MD, PhD

As this issue of San Antonio Medicine reaches you, we will no doubt be made more aware of the contents of the federal reform legislation.

Change is never comfortable. Unknown and uncertain change is even more unsettling. I am forced to remember that the political climate that generated this apparent rush to improve was spurred by public dissatisfaction. What caused this unhappiness? Why change what was touted to be “the best medical care” in the world? What were the reasons?

Why can’t our fellow physicians make ends meet in their practices? Why do they have to “moonlight” to subsidize their lives? Why are our business models failing? Is it the weak economy?

Business Plans

Economists tell us that weak economies expose weak business plans. As I understand it, a business plan is basically what was taught to me as a “budget” for a projected set of scenarios. It can have three general perspectives. The “pessimistic” outlook takes into account the “worst case” scenario. The “optimistic” outlook is a bullish projection that paints a rosy desired result. The mean position is, thus, the “expected” outcome. It appears to me that very few physicians enjoy the second perspective and those that do should be congratulated and they should share their models.

My discussions with my colleagues tell me that you know you have a weak plan when you are “out of cash” and when your consumers are “dissatisfied”! Well, this past year, many of our citizens found themselves “out of cash”. Jobs were lost. Homes were lost. Businesses were lost. Investments plummeted. Good resources were thrown into questionable endeavors far from our shores. And the hard-nosed tactics of previous years did not bolster, encourage or sustain our economy.

I think that we will all agree that many of our patients are “dissatisfied”! We have obviously had a “bad business plan”. The majority of the voters in this country expressed their desires for a change and we got the current administration. Our political leaders seem to agree only that we need to change (some things); although many of the same politicians believe that if they can¹t have it their way, then it will be “No way!”

Now, my business friends advise me that you need to take several actions if you wish to be headed in the direction of improvement. They say that for a successful future, you need to reduce costs and invest in a trusted and honest team that will implement a “strong” business plan. It is my belief that in the case of our medical economy, this would translate into reducing administrative costs, reducing bad habits, and increasing productivity, along with increasing access to care.

Many successful industrial leaders have stated that a healthy workforce is more productive, uses less sick time, experiences fewer accidents, participates in preventive care and wellness, and therefore spends less money on medical care. Now it is said that in our current system, 60 percent of corporate pre-tax profits are expended on healthcare benefits, while 30 years ago, only 7 percent were so expended. Our current expenditures reflect the trends of our society.

Our population is more sedentary and physically inactive. Obesity has become epidemic; Bariatric Medicine did not exist three decades ago. It is said that 10 percent of our healthcare costs are now expended on obesity-related diseases. Is there a primary care physician CPT code for obesity treatments other than surgery? Is obesity a disease? Addressing Obesity is only one example of an area where costs can be reduced if we have the national will to improve the wellness of our citizens. Every day, I tell patients, “You really need to lose some weight”! They usually smile sheepishly and say, “I know”. Then they leave.

Much of our future could be painted by our past successes. We need to study these successes, learn from them, then update and reapply them. I believe that Bexar County physicians must be concerned for all of our brothers and sisters starting in Bexar County and especially our colleagues. They also say, “I know”. But they do not leave...

This month, your San Antonio Medicine is featuring items focusing on topics in Black History in Medicine. The recent success of the Martin Luther King March in San Antonio highlights the leadership that our community demonstrates in its support of diversity on an annual basis. We are all proud of this status because it affirms our dedication to respecting people from diverse groups and origins. It symbolizes the reason many of us settle here and call Bexar County our home.

It emblemizes our highest ideals. I hope that you all enjoy this issue.