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The President's Report

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Almost Out of Time =>Summer 2008

Tamberly McCarus, MD FOGS President

I can hardly believe that the year has passed and that this is my last President's Report to the society. I have been deeply honored to serve you in this role and have enjoyed the many aspects of the job. The best part of this office is the chance to meet and interact with so many of you. What a great group of people! I pray that our society continues to grow and expand itself in the future. There is so much that we have accomplished, and yet, so much more remains to be realized.

Keeping with our annual theme of "Collegiality," we have worked diligently to reach out to future colleagues and colleagues-in-training. We have continued to support and fund awards that are presented to graduating medical students who have excelled in the field of Ob/ Gyn. This year, each medical school in Florida bestowed awards to deserving recipients on behalf of our society. The newer medical schools were added to the process, and were thrilled to be able to participate.

Additionally, we touched bases with each medical school in the state and inquired as to whether or not they have an established Ob/Gyn special interest group. We offered to assist these groups with the cost of their meetings and delegated funds accordingly. In this way, the FOGS name can be implanted into their brains at the earliest of stages in their medical careers and hopefully will result in increased membership when their training is completed.

As a final act of collegiality, we sent letters of congratulations, a FOGS lab coat (complete with embroidered names), and membership information to each graduating resident that plans to remain in the state after completion of residency! I think that this will yield an increased awareness of our presence amongst our newest colleagues and will feed new blood into our society on an annual basis.

I would encourage the society to track these doctors to determine whether or not these various endeavors have been successful. We definitely want to attract all of the physicians in the state, but in particular young physicians and those with fresh ideas.

ow I would like to take the liberty of sharing with you some opinions and observations of mine. I began private practice in Miami in 1991. At that time, patient loads were reasonable (in terms of number of visits per day) and reimbursements were very good. We happily saw Medicare patients on a daily basis and occasionally saw Medicaid patients as well. We all felt good about this, as it was the right thing to do for our fellow man. ACOG had supplied us with a grand total of 96 Committee Opinions since their inception, and ABOG had begun awarding time-limited board certification, as opposed to unlimited lifetime certification. The process for recertification had yet to be determined, but we all knew it was in the works.

Shortly after that, a new President of the United States was elected and "health care reform" became a hot topic—one of his and his wife's first 100 days' priorities, if memory serves me correctly. Well, I don't know about you, but all that I saw result from this process was the formation of HMO and PPO organizations, greatly diminished reimbursements, private insurers touting their reimbursement rates as percentages of public assistance programs (like this was a good thing), skyrocketing malpractice insurance rates, skyrocketing health insurance premiums, and so forth. Nothing accomplished benefited the working physician and, in fact, everything seemed to target us as the likely candidates to suffer in the wake of the "new system." Physicians had been left out of the health care reform process. Can you imagine universal legal reform without input from the attorneys? I guarantee that would never happen!

How did we respond? We did the only thing that we could do—we increased the number of patients seen each day in order to keep the business running and income steady. Our expenses had gone up tremendously, so to keep afloat we had to run patients through the office at breakneck speed. This does not create a happy environment for the patient or the doctor. It undermines any doctor-patient relationship that you are trying to create and leads to a system inherently riddled with increased chance of error, oversight, and misdiagnosis. There is no business in the world that gains accuracy and thoroughness by speeding up the process, and this especially applies when your business is the health and well being of mankind. Simultaneously, insurance companies began requiring more paperwork, more thorough documentation, which again resulted in less patient contact time. Medicare and Medicaid patients began to be dropped simply due to financial difficulties—no office could maintain itself with their low reimbursements, especially since the private payers weren't paying much above these once-considered charity payers. Our college/board began cranking out committee opinions (53 since Jan 2007 alone) and instituting greatly expanded recertification processes. The Catch-22 in this is that we must dedicate time to complete reading and perform testing, but in reality this is causing us to have even less time to spend with our patients, which is the culprit of the entire problem to begin with!

Doctors deserve to be paid fairly for the vitally important work that we perform. There would be no health care system at all without us and yet we seem to be the group left out whenever the problems of health care come up for discussion. Private insurers need to step up to the plate and recognize their role in this downward spiral. If we received fair compensation, we could slow down in the office and give each patient the time and attention they deserve. We could easily accommodate more public assistance patients and end their struggle with obtaining specialty care.

As I see it now, if nothing changes, we will be the most highly trained, well-read, overly tested group of Ob/Gynsever to grace the USA, yet we will still be facing all of the challenges that we do today. Without time to spend on our patients, without time to draw on our extensive training, we are back to square one!

My opinions stem from a sincere and deep love of medicine. I am truly passionate about what we do and how we do it, and I always will be.