Results of the Governor's survey of San Diego Area Surgeons and the Governor's Report to all San Diego ACS members. I received responses from 30 surgeons. Here's how they ranked the issues (in order, and with a scale of 1-10, 10 being most important, and 1 being least important): They are listed in order with the level of importance number in parentheses, and comments following:
1. Physician reimbursement: (10) - On nearly every surgeon's list, this
is by far the most important issue of concern to San Diego Surgeons today.
2. Changes in Medicare/Medicaid (9) - Those that listed Medicare and
Medicaid changes (53%), listed it first or second in importance.
3. Health Care reform and its Impact on Practice (8) - Health care
reform was also listed by nearly half of respondents as very important.
4. Relationships with Managed Care (8) - Nearly half (47%) of respondents
listed Managed Care issues, and ranked them above all but reimbursement.
5. Professional Liability and and Malpractice (8) - Liability, Malpractice,
Tort Reform and Public Reporting of Awards, Settlements, Claims were all
listed
6. Tort Reform (8)
7. Assistants at Surgery (7)
8 (t). Graduate Medical Education Issues (7)
8 (t) Workforce Issues (6) - Mentioned frequently, but ranked
about the middle in importance. Of note was the issue of "recruitment"
of new surgeons.
10. Funding for Education Activities (6) - One-third of respondents
(overlap, but not the same third as for GME issues) thought this to be
important.
11. Competency Measurement for the Practicing Surgeon (5) - Only 27%
of respondents listed this as an issue, but those that did, listed it as
very important.
12. Trauma Care and Reimbursement (4) - Listed as an issue by 40% of
respondents, but, typically, well down the list.
13. Hospital Privileging Issues (3) - Those that listed this issue
(only 20%) ranked it highly.
14. Medical Education and Research (3)
15. Peer Review Issues (2) - Also listed by 20% of respondents, but
ranked near the bottom.
16.(t) Recruitment of New Surgeons into the Community (2) - Not on
the original list, but listed by one respondent as the most important issue.
17.(t) Public Notification of Malpractice Awards, Settlements, Claims
(2) - Not on the original list, but listed by one respondent as the most
important issue.
19. Medical School Issues (1)
>From the Chief of Surgery at one of our large institutions: "...Trends
in the 'big picture' concern me greatly...Everyone is looking for a gimmick
to make more money, reduce liability, and improve lifestyle. Almost
no interest is shown in improving the concern for patient satisfaction....The
excitement of talking about interesting and difficult cases with colleagues
is replaced by mundane discussions more appropriate to the sordid world
of business....We must demonstrate that we really care about our patients
and the quality of our care....Doctors will lose the battle wrangling with
reimbursement agents and lawyers...We've got to 'take the high road,' get
ourselves out of the business gutter and reestablish ourselves as special
people who really care about others." A concern mentioned frequently
in San Diego is the Aging of the Surgical Community, and the difficulty
being encountered bringing new, young surgeons, particularly general surgeons,
to the area -- partly because of the cost of living in San Diego, but also
because of the dominance of managed care and the low rates of reimbursement
for services. There is also concern re: will there be enough general
surgeons in the workforce in the future...trends amongst those going into
surgery are toward the subspecialties. These were generally ranked
by respondents as "workforce issues."
Clearly, it will be very important for the College to maintain an emphasis on Quality of Care through its many educational programs and opportunities and activities which actually track outcomes, like the National Cancer and National Trauma Databases and related Committees. We need to be seen as an organization and individuals that care for people. Our membership is appealing to us to be at the forefront in defending surgeons' interests at the National and State level in issues of reimbursement, managed care and hospital relationships, tort reform, surgical education and training. These are difficult times, and the call to the College is for unity and leadership, so that we, as surgeons, can do what we do best, which is provide the highest level of care and compassion to our patients.
Respectfully submitted,.
Jon M. Greif, D.O., FACS
Governor, American College of Surgeons
California State Chair, Commission on Cancer
Attending Surgeon
Kaiser Permanente Medical Center
4647 Zion Avenue
San Diego, CA 92120
