It is impossible to not be moved by the profoundly important concerns that these letters express[1] as well as by physicians' general frustration at their perceived inability to affect the problems. As many authors point out, doctors lack the professional unity to drive meaningful change, and are only one of many influential groups that shape American health policy and markets.

 

The problems are formidable. Some, such as healthcare's high fragmentation, the power exerted by corporate interests, and growing uninsurance, are outside physicians' making. However, several authors note that the medical community's lack of cohesion and common purposefulness about issues that should be easy to affirm, eg, universal coverage and the value of evidence-based best-practice guidelines, has contributed to its loss of influence. Also, others observe that physicians' sometimes unbridled pursuit of individual and collective self-interest has amounted to complicity in the health system's larger problems.

 

Even so, there is no good reason why the larger community of physicians could not convene to dissect and develop a unified response to the deeper dynamics of our health system's pathologies. The crisis is serious and intensifying. The handwriting is clearly on the wall that the cost explosion is pricing increasing percentages of Americans out of the markets for insurance. Most Americans are frightened that they' won't be able to get care or that it will bankrupt them when they need it, and the business community is now frantic over unrelenting cost growth that threatens not only the health coverage of their employees, but the stability of the larger US economy.

 

Until now, the responses of the specialty, state, and national medical societies -- the American Academy of Family Physicians is a notable exception -- have been primarily focused on issues that would accrue specifically to the benefit of physicians (or a subset of physicians) rather than to the system at large.

 

Although advocating for one's own interest is standard practice, at some point -- now is a good time -- it makes more sense to advocate instead for the common interest. Rank and file physicians can lead by mobilizing behind solutions that can work to the system's interest, bringing pressure to bear on your medical societies to offer fresh and progressive solutions. This must be done with the full awareness that it is not enough to simply ask for more money, or to ask others to compromise. The necessary changes have to do with system structure, and can almost certainly be best achieved by relying on longstanding business principles -- standards, pricing/performance transparency, payment tied to results -- that are now taken for granted in every other industry sector.

 

Only vested self-interests are resistant to the meaningful change that we need so desperately. Rise to the occasion and your leadership will be welcomed by everyone else. Develop a clear, rational, believable plan to reestablish national healthcare stability and sustainability for the common interest, and the overwhelming support of the American people, business, and government will be with you.