Mark T. Edney, MD, FACS
Increasingly, urologists are migrating from private practice to hospital employment. Employed models are also appearing more and more attractive to graduating residents. A leading driver of this trend is the suffocation of private practice by increasingly expensive, time-consuming federal regulatory requirements.
In order to influence these regulatory changes, we need to be at both the state and federal tables. Complicating organized urology's efforts to present a unified and powerful front in both the state house and on Capitol Hill is the fact that a large number of urologists, once hospital employed, "check out" of advocacy efforts and don't contribute to urological political action activities. It has never been more important for urologists to stick together through this storm of payment and delivery system reform. I will herein make a case for why the employed urologist needs to remain engaged if not in person, then through at least the financial support of the urology advocacy organizations which continue to fight the fight on their behalf.
The fundamental question is why do we fight for our seat at the table? Why do we go the Urology Joint Advocacy Conference? Why do we go to the AACU State Society Network meeting? Why call, write, and meet with our state and federal House and Senate members?
Quite simply, we do it for our patients.
Whether you are grinding it out in large or small group private practice, multi-specialty group, academics, or hospital employed, we all want to preserve access to quality urological care for our communities, our friends, neighbors and family members.
To sign a hospital contract and then begin deleting the emails and tossing aside the mailings from the AUA Government Relations shop, the AACU, LUGPA, and UROPAC is essentially to say, "the hospital can now deal with this." The hospital, however, has a very different organizational mission. Most of us work at least some of the time in hospitals. Many of us hold leadership positions on medical staffs and indeed on hospital boards. Hospitals' missions include improving the health of communities, developing and expanding service lines, doing research and training residents among others. Their focus is broader than ours in the house of urology.
We in organized urology are the only group battling for the urology patient. The integrated, efficient, cost-effective care of the prostate cancer patient, the bladder cancer patient, the stone patient. It's us. And that's it. None of us fought through 36-hour stretches in residency longing for the day we could become cogs in the hospital machine. We yearned to be vested with the trust of a patient who would come to us because we care and have the knowledge and skill set to help her. The system in which we're able to provide that care will continue to rapidly evolve and that evolution will be shaped by others, many with competing interests, if we're not adequately man-powered, funded, and organized. We need every foot soldier from the private world (large and small group), HMO, multi-specialty clinic, academic, and yes, hospital employed to stay engaged, stay current on the issues, and come to an advocacy meeting once in a while. Contribute to UROPAC and make it an annual habit. Call and write to your state and federal elected officials, contribute to their campaigns, and go to their fundraisers. You will become a trusted source of information and advice. It's easy to forget that medicine is a black box to most elected officials- they are hungry for a trusted advisor. Be that advisor and tell the story of the urology patient.
To my hospital employed colleagues: you are still critical players on this team. Please don't disengage. We need you. The urology patient community needs you.
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