In many respects, this is the beginning of the golden age of rheumatology. Diagnostic and therapeutic approaches are now available that have radically altered for the better the lives of people with diseases that were considered virtually untreatable just a few years ago. The rheumatologist’s approach to patients with rheumatoid arthritis, the spondyloarthropathies, osteoporosis and vasculitis has changed in almost miraculous fashion for those of us who are fortunate enough to be Founding Fellows of the ACR and still taking care of our patients.
So with miracles occurring daily in our offices, why the frequent appearance of such long faces among my colleagues? In brief, it is because many of us have experienced a loss of control to insurance companies, hospital administrators, pharmacy benefit managers, attorneys and politicians—all of whom see healthcare from a very different perspective than do we rheumatologists and our patients.
The Element of Business
Some time ago, while we were busy seeing our patients, we lost sight of the element of business in the practice of medicine. For us, medicine was a special and almost sacred calling. The “business end” of medical practice was something for which we had neither time nor inclination. Into that vacuum, we now know, rushed a collection of businesspeople (a few of whom were also doctors) who saw a tremendous opportunity to turn medical care into a profitable business. In many instances, these medical enterprises used their influence (read: dollars) with our legislators to control reimbursement, protect markets, collect data and otherwise slant the system to the disadvantage of rheumatologists and the patients for whom we toil.
RheumPAC Steps In
Rheumatologists are late to the notion of “pay to play” as it applies to the legislative process. Ten years ago, the ACR created RheumPAC with the idea of establishing our specialty’s voice in the halls of Congress. Legislative issues of concern to our specialty and our patients could be highlighted for our elected representatives, and we could provide financial support to those who supported our aims while educating those legislators who might not understand our concerns.
The rheumatologists of the Illinois Bone and Joint Institute (IBJI)—along with just 4.5% of total ACR/ARHP membership—have recognized the importance of getting our collective voice heard on Capitol Hill. The IBJI, the largest completely physician-owned and directed group practice in Illinois, has a strong culture and history of looking at things from the physician’s point of view. We have supported RheumPAC from the beginning and are proud of our 100% participation. We frankly don’t understand how 95% of ACR/ARHP members don’t agree with the need to personally support RheumPAC. Is it naiveté? Resignation? Inertia? You can be sure that trial lawyers, pharmaceutical companies, insurance companies and hospital associations all understand with crystal clarity that it takes money to get their voices heard in Washington. Rheumatologists can be no less pragmatic and proactive.