Since 1994 I had the privilege to serve in several leadership positions within organized medicine including Chair of the American and Florida Medical Association International Medical Graduates Section, Chair of the FMA Medical Education Committee and President of the Dade County Medical Association. During my fifteen year service commitment I reached the conclusion that organized medicine has to be more than a trade organization but a professional association for physicians.

In that context we not only have to strive to represent the interests of physicians but most importantly the interest of our patients.

The trend towards health care corporatization and commercialization challenges and threatens our traditional ethical commitments towards patients. In an AMA policy statement published in 1997 Dr. Arnold Relman, former Editor-in-Chief of the New England Journal of Medicine, pointed out that “if doctors do not preserve their identity as ethical professionals they will be swallowed up by the health care corporations, Without an ethical compass, physicians will end up simply as part of the labor force employed by, or under contract with, these corporations, or they will become profit driven entrepreneurs themselves, competing with the corporations.”

That does not mean that the practice and business of medicine are mutually exclusive. But as physicians we have to be especially aware of the potential conflict between both concepts.

The author further states that ” a medical profession lacking ethical standards that set it apart from business will inevitably lose the public trust and the ability to influence public policy.”

That implies a commitment to advocate on our patients behalf and to insert ourselves in the political debate regarding health care reform issues. In those efforts we should not primarily be motivated by financial self-interest but guided by our responsibility to protect our patients’ rights to access affordable health care delivered by the physicians of their choice.

Our behavior, and not simply our rhetoric, must reflect our values as they pertain to physicians and patients alike.

As such we must address current and future problems from the perspective and view as a physician and patient.

Our response to recent events may illustrate how such abstract principles can be translated into real action.

The rampant and out-of-control abuse of the Medicare and Medicaid in South Florida results in billions of dollars annual loses. This jeopardizes the financial viability of the entire system and reduces the resources available for fair reimbursement of legitimate physician’s services. Furthermore, it limits the capacity to add and expand needed health care services for our patients. As a physicians organization we addressed the failure of the regional Medicare administrator to identify the payment and reimbursement deficiencies, to allow physicians to practice medicine and to provide appropriate medical services for their patients.

The current debate about health care reform is primarily focused on payment reform and cost containment. The passionate discussion about the perceived increased government involvement in the health care delivery process has pitched physicians against each other. Both sides argue passionately about the validity of a single-payer payer system versus market based solutions, or if the introduction of a public health plan will lead to “socialized” health care.

Unfortunately, we may loose one important perspective: what is beneficial for our patients! Shall we idly stand by when millions of Americans loose their health insurance benefits? Can we accept the fact that the average Miami family has $20,000 year in health care costs — and pays 41 percent of that out of its own pocket?

Shouldn’t our business interests be aligned with the need of our patient to have access to affordable health care? I think they should!

Our organization is an association of physicians and NOT a trade organization.

Our actions should reflect the ethical implications of that crucial distinction.

Therefore we must align our interest with those of our patients and act responsibly towards the creation of a fair and just universal health care system.

We cannot afford to squander this opportunity!