Marc Hirsh, MD, FACR, a rheumatologist with The Hirsh Center for Arthritis and Sports Medicine, Delray Beach, Fla., has spent his career treating patients and fighting for the future of medicine. As vice president of the Florida Medical Association’s political action committee, and a past president and an active member of the Board of Directors of the Palm Beach County Medical Society, Dr. Hirsh is a powerful advocate for both physicians and rheumatology patients.
He’s volunteered at both the national and state levels, and has been working with the ACR on a unified approach to physician payment reform, a top legislative priority for the ACR.
“Hospital payments, durable medical equipment, surgery centers, nursing homes—almost every service paid for by Medicare has been adjusted for inflation over the past 20 years,” Dr. Hirsh explains. “The only exception is the Physician Fee Schedule. Even without the repeated cuts, we’ve seen year after year [that] inflation alone has effectively slashed physician payments by 40% over the past two decades.”
In past years, Dr. Hirsh says there’s been retroactive temporary legislation known as a “doc fix” that prevents provider reimbursement cuts from being implemented. This year, there was another 2.8% cut, and Dr. Hirsh says that although advocates weren’t able to get a doc fix passed, they hope Congress will address this issue via reconciliation later this year.
Advocating for Private Practices
Dr. Marc Hirsh
Dr. Hirsh warns that rising inflation, combined with persistently low Medicare reimbursement rates, is putting access to care at risk. He emphasizes that if the issue isn’t addressed, private medical practices may not survive.
“Over the past decade, major insurance, along with large hospital systems and private corporations, have been steadily taking over by employing more physicians,” Dr. Hirsh says. “If Medicare continues to cut payments to doctors in private practice, the remaining few will be pushed into joining these large healthcare systems.”
Dr. Hirsh believes physicians should have the freedom to work in any setting, whether it’s a large healthcare system or a local private practice.
“Independent, physician-owned practices play a vital role in healthcare,” he says. “That’s how medicine began in this country, and if we push these practices out, I think the quality of care is really going to suffer.”
After serving on the ACR’s Insurance Subcommittee for the past three years, Dr. Hirsh recently began serving on the ACR’s Government Affairs Committee. He’s also active with the Coalition of State Rheumatology Organizations.
“At the state level, we’ve worked hard to push for increased funding to expand residency training programs in Florida,” Dr. Hirsh says. “Fortunately, during the last legislative session, Florida passed major legislation that significantly boosts funding for in-state residency slots.”
Ensuring Safe Patient Care
A nationally recognized musculoskeletal ultrasound instructor, Dr. Hirsh is also vocal about what the American Medical Association (AMA) refers to as scope creep—that is, the growing trend of nonphysician providers, such as nurse practitioners and physician associates, to diagnose and treat patients without physician oversight. “Nurse practitioners and physician associates play a vital role in healthcare, especially in rheumatology,” Dr. Hirsh says. “We believe that role should be part of a physician-led team, which is usually the case in rheumatology patient care.”
This year, he and his colleagues are pushing back against proposed legislation in Florida that would allow nurse practitioners to practice independently as psychiatrists or anesthesiologists without physician supervision.
“A patient could undergo a procedure and never know their anesthesia was being administered by someone without the highest level of training and physician backup,” he says. “That’s not acceptable when patient lives are on the line.”
A Legacy of Advocacy
Dr. Hirsh earned his Bachelor of Science and his medical degree from the University of Florida. After an internship at Northwestern University, Chicago, he completed his residency in internal medicine at Jackson Memorial Hospital, University of Miami. He served on the faculty for one year as chief resident before completing his subspecialty in rheumatology at the University of Miami.
Dr. Hirsh says his focus has always been on providing patient-centered care, advancing medical education and demonstrating professional leadership.
“I realized there was a lot we had to do in terms of advocacy, and very few physicians were lawmakers,” he says. “I knew it was critical for physicians to have a voice at both the state and federal levels, but I couldn’t ask anybody else to advocate on my behalf and advocate on behalf of the house of medicine if I [weren’t] willing to spend the time and energy myself.”
Dr. Hirsh says he’s inspired to volunteer by watching his peers lead by example. Their dedication to advocacy motivates him to contribute his time and energy to be part of the solution.
He encourages fellow rheumatologists to get involved by donating to specialty organizations, joining their state medical and rheumatology associations, and being involved with the ACR.
“My proudest accomplishment is seeing people I’ve recruited thrive and carve out their own roles in advocacy,” Dr. Hirsh says. “It’s so important that we get the next generation of doctors involved in this work.”
Linda Childers is a health writer located in the San Francisco Bay Area.
