DO Day on the Hill

Posted 5/11/08 ( by Travis)

This was my third time in Washington DC for 'DO Day on the Hill', where osteopathic medical students 'lobby for changes affecting their profession and their patients'. That's what they call it, but what we really do is go ask government for taxpayer money, one way or the other, just like any other special interest. There have been exceptions, such as a national malpractice bill from three years ago. But even that bill I received somewhat lukewarmly due to my natural federalist tendencies.

So, this year we again lobbied for perpetuating the failed and failing Medicare program by increasing payments to doctors. This was done to 'increase patients care and access', because doctors may increasingly opt out of Medicare if the fees are not raised; as if this would be a bad thing. If more docs absconded Medicare then perhaps we would in due time be liberated from the socialism of healthcare, which particularly plagues this industry. 'Wither on the vine', as Newt Gingrich so eloquently plotted Social Security, is actually an apt policy position. My opinion on Medicare can be summed up in the following brief, yet succinct, article:

Fix Medicare - Not Prices (Required Reading)

10/10/06 Cato

The other subject, given as a lobbying concept more than an actual bill, was 'obesity', which provides excellent segway into two topics which I've been mulling over of late: prevention and the role of the family practice physician in the healthcare system.

Prevention is quite a fadish term in medicine these days and you can look up any number of studies purporting to save money and lives from 'prevention'. Yet, how do we 'prevent' disease? Are we talking about advanced treatment options or the fascinating genetic investigations? No, when people use the term 'prevention' they are invariably talking about lifestyle changes (diet, exercise etc..) to combat diabetes, hypertension, heart attacks, strokes, some cancers, and a wide range of other chronic type conditions/diseases. However, with this approach the doctors role has changed, from someone the patient consults because of his/her expert medical knowledge, to a nanny, to an encourager, to a motivator, to a cheerleader. In the same vein we engage in 'prevention' by badgering the patients not to drink, abstain from risky sexual contacts, and now risk being sued if we don't follow the appropriate guidelines in advising patients not to smoke.

A common theme heard during this weekend in DC was the idea that doctors aren't paid to spend time with patients, that the government and private insurance pays out much much more to 'do things' to patients, procedures etc... and that this should change, with some emphasis on prevention.

Obviously, I'm in favor of letting the market set the price for procedures and office visits, something the government is surely mucking up and distorting merely by being involved. Yet, if my opinion or input was warranted, I'd disagree with both sides. Most procedures don't really require expert knowledge; anyone with enough experience can become an 'expert' at most procedures. And expert knowledge is not required to sit down and be 'friendly' with a patient and chat up about their social lives, enforce screening guidelines, or encourage patients to do things they already know they should be doing but aren't.

However, expert knowledge is required in making a diagnosis, in assessing symptoms, illness management, in determining when and if a patient should undergo a procedure, a surgery for instance, in explaining cost/benefit analysis, manipulation, and to some extent in medication management.

Physicians today, mostly in the subspecialties, sometimes end up doing things to patients (procedures) that don't require expert knowledge, but pay quite well because of legal monopolies, monopoly coverage which extends even into the specific subspecialty. On the other hand, family physicians may undertake tasks which don't pay well and don't require expert knowledge, but which they are legally obligated to perform. One might say family physicians are bitten by the hand which feeds their kin. :)

The family practice doc is increasingly under siege from the upcoming PA and nursing professions, and rightly so, some of what he or she does can be performed by others more than adequately, especially issues dealing with 'prevention'. Thus, even if the emphasis in the Osteopathic profession on 'Family Practice' is understandable, from a historical point of view, as is our friends on the left's preoccupations with 'prevention', I don't believe either fits the objective template for optimal medical practice and resource allocation (as a free market might see fit), nor do I believe they represent current medical trends.

Needless to say, I wasn't looking forward towards talking about obesity (there is nothing the government can do to influence social trends), nor Medicare, and luckily those in our group didn't seem overly enthused about either either :), so we talked mostly about our school, its rapid growth, and positive financial and medical contribution to the state of NV (plus not costing NV taxpayers over $500,00 per non licensed MD as the state school in Reno does). We also discussed graduate medical education and residency programs in NV, where government rules and regulations have mucked things up. Of course, practice conditions in a state must be the central plank for any strategy to increase physician supply or address physician shortages in a state.

Some other highlights:

Defeating an anti pharmaceutical company resolution in SOMA.

We were again wowed by Michelle Spence, the health policy aide to Senator Ensign, whose encyclopedic knowledge of healthcare issues is always impressive to behold.

And we ran into this guy in the halls of Congress:

I also stepped down from my position as National SOMA director of Political Affairs; it was a great ride and I was privileged to have met some great folks in SOMA, the AOA, and elsewhere.

See also 'DO Day on the Hill round 2' (2007)