Opportunities for Change

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Opportunities for Change => Autumn 2006

James W. Orr, MD, FACOG, FACS

It is likely that each of us completed the grueling rigors of Medical School, Residency (and Fellowship) because we were motivated to improve the quality of life and ameliorate the suffering of women during the reproductive and menopausal years. Despite all of the associated stress, it was just fun fulfilling our dreams in a most respected profession. Similar to most medical professionals, I have the opportunity to direct the care of hundreds of women on a yearly basis. The spectra between health and illness witnessed in our offices on any given day is immense and unpredictable. The rampaging evolution of knowledge for many-if not all-of the diseases we treat constantly challenges each of us to march faster into incorporating the continually changing "standards" of care. The unending introduction of new diagnostic and therapeutic technologies contributes another layer of "weight" that we carry in our efforts to offer the safest, most efficient care possible. Sadly, the "fun" of the practice of Medicine has been dulled by the continued hum of decreasing reimbursement, the increasing cost of doing business and the ever present liability risks. In fact, 90% of Obstetricians-Gynecologists have had at least one liability claim and we face the prospects of having 2.62 liability claims with average pay outs in excess of $500,000 during our professional careers (2006 ACOG Survey on Professional Liability). It is little wonder that the attitudes of physicians have changed!

Regardless, we are faced with all of these current issues and will undoubtedly have additional challenges. Every physician will continue to search for an answer. Unfortunately, there is no easy one-size-fits-all solution for physicians; however it is apparent that change requires an organized approach and efforts to effect change are proportional to the number of individuals involved. I believe that FOGS represents an excellent answer and opportunity to effect such change. FOGS offers comprehensive educational opportunities, constant surveillance and effective response to important related issues in the State legislature, insurance and liability programs and, perhaps most important, collegiality.

To that point, FOGS leadership recently appointed a NICA Task Force to comprehensively review the program's operation in an attempt to determine the adequacy and "acceptability" of all aspects of NICA services. The mission of this Task Force, chaired by Dr. Bob Yelverton, was to examine the current status, review NICA funding, assess the functionality and applicability of their actuarial process, intake methodology and reserves, and to evaluate the possibility of programmatic expansion to allow coverage of additional birth-related injuries. This exhaustive effort involved numerous meetings with NICA staff, NICA physicians, and input from others in addition to the review of other like programs. The Task Force final report/opinion found the NICA administration to be sound and the staff professional and efficient. It is felt that there are significant efforts are being made to include all potential NICA recipients; however the report did include several suggestions to lessen any existing conflict of interest related to the evaluation and intake process. The report found the current level of funding sufficient for existing operations and that reserves were adequate; NICA staff was asked to consider the possibility of expanding to include coverage for brachial plexus injuries, suggesting that the broadened coverage might encourage additional physician participation. The report also noted that several sources have independently determined that NICA's reserve process and the life expectancy evaluation are appropriate and sound.

The Task Force also recommended that hospital benefit from NICA should be tied to individual assessments and elimination of any hospital exemptions be abolished.

The Task Force presented this "formal second opinion" process and NICA has agreed that the FOGS Task Force would continue to be involved with NICA through the advisory council, board activity and the finance committee and should seek legislative action to expand the NICA program.

Additionally, FOGS representatives attended the annual FMA meeting (August 31–September 3, 2006) in Orlando and strongly supported FMA Resolution 06-46: Opposition to Deletion of Prenatal Genetic Testing by Florida Medicaid in an effort to ensure that genetic testing remains a service and choice for all families.

In an attempt to broaden membership and representation, the FOGS Board recently voted to proceed with a President's appointment of a senior-level resident to serve a voluntary, one year non-voting FOGS Board term. The position will be filled shortly.

I treasure my 20-year FOGS membership and I am honored to have been granted the opportunity to serve as your 57th President. This year's efforts will focus on inclusiveness and growth, remembering that medicine remains a most respected profession. I urge you to mark your calendars for the 2007 Florida Obstetric and Gynecologic Society Annual Meeting, jointly sponsored by Florida Section ACOG at the Naples Grande Resort and Club in Naples, Florida. Bring a colleague or two. I can assure you that you will not regret it!