BCMA’s Presidential Inauguration Speech
– Francisco A. Ward, D.O.
I want to welcome everyone including my wife Nadia, children Javier, Maxi and Luis, while giving a call out to my eldest daughter Leila and her also expecting younger sister Sofia. A special thanks to her adopted husband Thomas Evans 1st Lt Field Artillery Corps and 2nd year law student at Baylor for his continued service to our Nation.
I’d like to thank our Medchi President Dr. Benjamin Stallings, Dr. Thomas Edmondson (President of Baltimore City Medical Society, and our Medchi president elect, Dr. Michele Manahan). A special thanks to our Medchi CEO Gene M. Ransom III. Shelly Brouse (CEO of MedChi Insurance) and Cheryl Matricciani Exec VP, COO from MedMutual, for their ongoing support of the BCMA.
As I ponder how my fate blessed me so to bring me here to stand before you today to celebrate a long Baltimore County Medical Association tradition, I immediately think of the kindness of so many people.
I’d like to thank those who played a memorable role in guiding me by starting with my family – my beloved parents Joseph and Carmen Ward; my siblings; my extended Spanish family; my very large established but dispersed American Negro family;
I’d like to thank St. William of York Parrish and educators like Sr. Tess Horvath, Sr. Una, and Sr. Margaret McCabe for taking such an interest in me. I’d like to thank the welcoming and caring Hunting Ridge families: the Langmead’s (kindness and parties), Queeney’s (tree platform rope experience, Christmas cookies, board and card games), Gioia’s (Roy taught me my first horticulture tricks to collect beautiful azaleas), Dr. Horvath (countless hellos), B&L Cantori (greeting and laughter), Gary’s (wolf wolf, pond, tree tag), McPhillips (friendship and my first medical school books to brouse, and why you should try to provide care out of the hospital), and Mackey’s (who welcomed us to play both in and outside, whose tennis racket first caught my eye) and who provided me an enriched community.
I’d like to thank the Cardinal Gibbon’s community and their committed mentoring educators, such as Mr. Victor Corbin who had a profound influence on my high school experience. I’d like to thank Dr. Gian F. Poggio for giving me the opportunity of a lifetime to work with him at the Bard Laboratories of Neurophysiology (PCTB) and for becoming my first post high school mentor. Dr. Poggio’s legendary perfectionism with un-achievable expectations polished my very rough diamond (he would later say). I’d like to thank Dr. Vernon Mountcastle for recognizing my efforts and being so kind as to write my first medical school recommendation (the other being from Dr. Poggio after I explained to him that Osteopathic Medicine was for real). For without their encouragement and kind words & recommendations, I surely would not have been accepted by the only medical college to which I applied.
I’d like to thank the doctors who most impacted my medical education. Drs. Anthony Dekker and Bruce Peters at CCOM (who mentored me and introduced me to the people in the homeless shelters, to the “inner city”, to adolescents suffering with AIDS), Dr. John Rogers, who (taught me how to critically read the medical literature) and Tom Wilson (whose resident clinic developed my outpatient skills) of Good Samaritan Hospital, Dr. Mary Betty Stevens (who taught me how to recognize the rarest of connective tissue diseases), Dr. Edward McFarland (who taught me how to care for sport / msk injuries in an evidenced based outcome focused fashion), Dr. Peter Holt (who taught me that I didn’t want to round between 9 & 2 am and that no lead is too small to chase down to optimize the care you are providing a patient), & Dr. Barbara DeLateur (who taught me clinical muscular physiology and physical medicine). Most importantly, I’d like to thank the countless patients, greater than 25 thousand, who put their trust in me to improve their state of wellness, their functioning, or to ease their suffering.
Lastly, I’d like to offer a deep appreciation to my professional colleagues and friends who have entrusted me with their patients, who have welcomed me into their professional society and who have provided me their friendship.
It is an honor to be standing here now and I offer a debt of gratitude & appreciation to all prior & current officers and active members of our Baltimore County Medical Association for without them and you the Association would not have persevered to continue to advocate for the patients of Baltimore County and the physicians who care for them.
After returning from Chicago in 1992, I moved to Owings Mills, New Town. By 1994, I obtained my license to practice medicine and surgery in Maryland and soon after began to see my first patients in Baltimore County’s Commerce Center in Pikesville. The forces of change never slowed but rather seemed to accelerate over my next 25 years. Little did we know how much the profession of medicine was going to come under the influences of Wall Street and of government regulators?
Our status was dropping. Our respect was dropping, In 1994 Americans spent 967 billion dollars a year on healthcare and now we spend over 3.5 trillion dollars a year. Did doctor salaries triple? Did patient access to quality care improve three times? Did our healthcare rank rise to the top? Did we finally alleviate the scourge of healthcare disparities? Did the cost of a medical education drop? Did the percentage of doctors in private practice increase? Did physician wellness improve? Did we give greater reverence to the patient’s wishes? Have we strengthened the doctor – patient relationship? Have we taken greater responsibility for our errors of judgement when a patient is harmed by our hands or do we rely on a weaponized surgical consent and medical record. The answer to these questions points to a very somber state of our profession. What did we get for the increase in healthcare dollars?
A continued seismic shift in the seat of power from the physicians, as well trained shepherds looking over their “family” of patients, to the Wall Street executive architects of the emerging healthcare industrial complex. With this change comes an increasing concentration of wealth and consolidation of power to further shape the playing field. The safety rails continue to be breached as the doctor patient relationship is now under full assault. No longer is it death by a thousand cuts, but rather by directly impeding the doctor patient relationship using technology to prevent patient access via prior authorization or by controlling formularies. We are told what metrics to monitor, what constitutes an appropriate notation for billable levels when we can use a particular medication and when we can perform a procedure. We are told how to monitor compliance. We are told who can be on a panel and who can’t. We are told to provide a service and then petition to collect our professional fees. The collectable fees for a service are determined by the payer. Physicians are not always provided due process before we can be stripped of the ability to practice our profession despite having dedicated our life to our Art. This list goes on and on.
We must regroup and determine for ourselves what does it mean to be a professional, a physician, a healer? Our brand that once provided us with a respected status trusted by our patients has been eroded. By professing the Hippocratic Oath, “to do no harm” we pointed our moral compass towards righteousness and became advocates for our patients, collectively the people. We should not jump on the bandwagon of corporate greed or taxation bonanza and turn a blind eye to the public health and wellbeing. According to a USA Today review of government records and medical databases, tens of thousands of patients undergo unnecessary surgery every year. Pharmaceutical, hospital and other “private equity financed” large medical groups have turned to television advertisements to bypass the primary care doctor patient relationship to guide patients into the clutches of the medical industrial complex.
The employed primary care doctor is often forced to achieve production targets set by financial rather than clinical objectives. The public that once respected the medical profession is now often encouraged by their peers to get a second, third and possibly fourth opinion. Apparently they’ve bought into the narrative that the physician is considering more than what is in the patient’s best interest when making a clinical recommendation.
Just considering one Maryland pain management ASC chain, I counted over 40,000 ASC pain procedures in 2015 alone. The entry of private equity into the pain management space has led to an exponential increase in services (ASC, opioid prescriptions, UDT & DME) and at what benefit or should I say cost to society? Are we easing patient suffering or increasing it? Can our citizens afford medicine when private equity masters the art of loophole exploitation?
Many of our patients now have “access to healthcare” but cannot afford the out of pocket cost that directly limits their ability to receive the services prescribed by their treating physician. As a matter of fact, 39% of bankruptcies (530,000) in the USA are due to the patient’s inability to pay for the healthcare services received. Corporate greed and consolidation often hold the public hostage by predatory price gauging.
The BCMA members have embodied the spirit of public service since its founding. In 1897 the newly formed BCMA society’s resolution was passed calling attention to the fact that the health of Baltimore County residents was jeopardized by the presence of leaking cess-pits. Now our cess – pits are the heroin, fentanyl and prescription opioid overdose epidemic. We’ve added other public health risk such as legalized gambling, reckless cannabis legislation and the proliferation of assault rifles and semi-automatic hand guns.
“Physicians Working Together For a Healthy Community.” Is our motto.
In order to be successful over time, we as a group need define our Brand and the Physician profession and not let it be defined by others. Physician should never be replaced by provider.
Advocating for our patients requires an ongoing legislative presence to derail the misguided efforts to deconstruct our profession with changes to ancillary healthcare providers scope of practice, stripping of funding from patient E&M services, and attacking our profession with frivolous litigation.
We need to maintain a hand in determining who and how we are going to educate tomorrow’s physicians. The rapid growth of physician assistants and nurse practitioners can help and hurt the physician practice of medicine. Remember, the early Medchi community of Physicians (The Medical and Chirurgical Faculty of the State of Maryland) lobbied the Maryland state legislature to pass the Medical College Bill, authorizing the formation of the College of Medicine of Maryland later to become the UM Medical School. We should take back our ability to train medical school graduates who have completed the USMLE exams. Currently a Maryland license to practice medicine is not required for trainees in the performance of postdoctoral training duties in the training program. In Maryland, one year of postgraduate training is required for US graduates and 2 years of postgraduate training is required for FMG but there are 5-8 thousand less residency spots than needed and so each year thousands of medical school graduates each year must disrupt their physician training despite a complete physician shortage. Rather than abandon these young physicians in training to financial ruin when the high debt of medical school training loads them down. One doctor recounted “I am on Medicaid and I qualify for food stamps…mostly because my loans are so high that if my dad didn’t show mercy on me I would be homeless”. Let us regain the ability of seasoned private practice physicians to provide community based outpatient training that meets the States licensure requirements of post graduate training, allowing the physician to obtain a full medical license to practice medicine & surgery.
Policies should not be enshrined into law that gives greater power and advantage to large consolidated Wall Street financed conglomerates to direct patient care into channels designed to extract ever growing healthcare dollar’s while restricting competition. We must fight the systematic erosion of the doctor patient relationship and the private practice of medicine. We must continue to fight for improved patient access to preventive and evidenced based physician care while recognizing the styles and the Art of Medicine. We must continue to protect our patient’s timely access to the healthcare services that we recommend for them, currently blocked by the use of prior authorizations, pharmacy benefit plans and other forms of physician time taxation.
Our public discussion about the need for “medical reform and suppression of quackery began the in the 1790’s but now we need to combat the use of social media and other information platforms that rapidly propagate false clinical information. We see this with the current measles epidemic in NY and the rise of false or unsubstantiated medical claims for nutraceuticals and medical devices. Quackery, often synonymous with health fraud, is the promotion of fraudulent or ignorant medical practices. A quack is a “fraudulent or ignorant pretender to medical skill” or “a person who pretends, professionally or publicly, to have skill, knowledge, qualification or credentials they do not possess; a charlatan or snake oil salesman”. Now consider that we have not taken a position against our patients walking into a dispensary of cannabis products and asking the bud tenderer to advise them on which cannabis flower, elixirs, balms etc. to obtain to treat a wide range of medical ailments. We should take a strong position against providers or physicians practicing quackery by giving each of their cannabis certification seekers 120g of flower / 36 g of concentrate THC for conditions that they are not currently responsible for managing without regard to their scope of knowledge. We must care that 18 year old seniors can simply pay a fee and gain access to a supply of psychoactive THC that can be sold in the halls of our high schools.
We need to grow the percentage of physicians in Maryland that take an active role in Medchi and its component societies, such as our BCMA, willing to embrace the mission of Medchi and serve as Maryland’s foremost advocates and resource for physicians, their patients and the public health.
Thank you Russ Kujan and Patricia Keiser for whose efforts steady and help maintain the BCMA.