Running an
Office While
Running for
Office
Michael T. Macfarlane, MD
T
wo of the most common questions I
get when my colleagues find out I’m
running for Congress are, “Why?”
and, “Are you still practicing?” Both are excellent questions.
Why am I running for Congress? There is
really no single reason for my decision. At 60
years of age, I believe I have acquired some
wisdom, and my goals have become increasingly less about myself
and more about others. Most of us have our political views, but
they rarely rise to a level that would cause us to give up the profession we love. Just yesterday, after visiting a post-op patient, I was
reminded just how much I would miss it. Yet when the very reason I
love medicine is in jeopardy, I find my inhibitions fade away. It was
the sweeping changes in medicine we have all witnessed in recent
years that ultimately pushed me to run for office, to preserve the
profession I love.
My father was a physician. He practiced family medicine, and
later psychiatry, from our home while I was growing up. When I
was young the entire first floor of our house was his office, including
his consultation, examining, and waiting rooms. I remember my
mother sending the patient bills out from our kitchen table after
she served as nurse. These were some of the experiences that led
me to follow my father into the medical profession.
I trained at Columbia University P&S, Harvard Medical School,
and UCLA. I stayed on as a full-time academic faculty surgeon at
UCLA and was made Chief of the Urology Service at one of the VA
medical centers in LA. After moving to Louisville in 1992, I practiced
in a group for 14 years, and I now operate as a solo practitioner.
I believe the medical profession is the most honorable and rewarding career one can pursue, and it is worth fighting to preserve. Most
of us gave up some of the best years of our young lives to become
physicians. And after all of the years we spent in training, we are
now being told how to practice medicine by bureaucrats.
While our problems began years ago, it sure seems like we just
stepped into a sinkhole. There is no end to the regulators at every
level who believe they know better than us how to treat patients
they have never seen or examined.
CMS and insurance companies have been hampering patient
care for years by coding and reimbursement disincentives. Now we
have entered the world of full-time regulopathy with the so-called
Affordable Care Act. The Secretary of Health and Human services
has been given enormous powers to control clinical practice with
the help of 150 new agencies, boards, and committees who have
already written over 20,000 pages of new rules and regulations we
must follow.
The private practice of medicine in a typical small group is essentially dead. Even large groups and hospitals are finding it increasingly
difficult to meet their financial and regulatory burdens.
I have experienced most every kind of medical practice arrangement from full-time academic to VA and county hospitals, and
most recently private practice in both group and solo settings. I
understand the long hours, frustrations, and stress physicians are
under from various sources. Physicians have one of the highest
burnout rates of any profession and it is only going to get worse
as we lose more control of our practices and lives with 70,000 new
ICD-10 codes, excessive computer documentation requirements,
and ever-growing pressure from employers to increase productivity.
Surveys show that the two most common reasons cited by doctors
for leaving practice are the costs and headaches of government and
insurance regulations and the high cost of new IT requirements.
Keeping a viable practice amid falling reimbursements and rising
overhead is both overwhelming and unsustainable, yet we remain
the target of bureaucrats in Washington.
Physicians are easy targets because we have rightly committed
ourselves to the care of our patients first. It is not from callousness
or selfishness that we oppose the health care takeover. Rather,
we understand that an independent medical profession—not one
subject to the dictates of the government, insurance companies,
or hospitals—provides the best patient care. Theirs is a different
agenda. They have never taken the Hippocratic Oath, but we did.
Physicians are patients’ true advocates.
Physicians are also easy targets because we have very little