What If There Were No SDCMS and CMA
In the classic movie, It’s a Wonderful Life, Jimmy Stewart plays a small town banker who despairs at not having achieved the life he planned for. Just before he hurdles himself over a bridge to his death, he is shown what a difference his life made to the town he lived in. In one of the most graphic turnarounds in moviemaking, he sees the corruption and despair his entire community would have suffered if it were not for his efforts.
Likewise, we could imagine what practicing medicine would be like in the San Diego area if the San Diego County Medical Society (SDCMS) and the California Medical Association (CMA) did not exist. Sure, these organizations have not been able to make the medical environment everything that we might want it to be. But rather than despair, let’s imagine what it would be like without these organizations.
We would be paying medical liability premiums in Southern California similar to the Miami, Florida area. Specialists who perform major procedures, like orthopedic surgeons, neurosurgeons, OB/GYNs, and others would be paying around $200,000 a year. Even primary care physicians would be paying around $70,000 a year. All of us would be paying between two and three times what we pay now because MICRA would not exist.
Our reimbursement would be even lower along with the increased overhead expenses. We would be getting even less from the health insurance industry because there would not have been any RICO settlements, and health insurance plans would have their way with physicians in private practice, impotent in bargaining for fair treatment without being organized.*
Medicare payments would be much lower than they are today. Years ago, Congress put in place the Sustainable Growth Rate (SGR) formula, which helped physicians at the time but set in place cuts in physician reimbursement of 5–10 percent a year. These cuts have been reduced or removed each year by acts of Congress directly because of organized medicine. Had these not taken place, many physicians would have gone on strike like they have in Germany.
Other healthcare providers would be practicing medicine besides physicians. Nurse practitioners, physician assistants, and physical therapists would have independent private practices with all of the privileges we have. Head to toe, psychologists, optometrists, and podiatrists would have much a greater scope of practice, essentially practicing medicine at competitive fees with physicians.
Without powerful organizations representing all physicians, there would be intense competition among specialties with winners and losers and great animosity. Rather than working together for the good of patients and medicine, physicians would easily lapse into competition with each other.
What a bleak world indeed! And I’ve only given the major highlights of our world without SDCMS and CMA. These organizations do not exist automatically or on their own. They exist only with our support. Their existence requires less than half of one per cent of our professional revenues. Sadly, less than half of physicians provide this modest annual support to keep them going, with many physicians getting a free ride. Just sit and imagine for awhile your version of life without SDCMS and CMA. Maybe we should make a movie about it. Then all physicians would realize what a bargain those dues really are.