Today's News

Friday, February 23, 1996

New fellows urged to keep standards high

Excerpts from Thursday's Annual Meeting Address to Incoming Class, by 1993 Academy President Augusto Sarmiento, MD.

Who has not heard words to the effect that we, as physicians, are going through one of the most serious crises in our history? That because of changes we are witnessing today, the practice of medicine, as we have known it, is experiencing the pangs of a slow death?

Almost daily we hear older physicians remark that 'I would not recommend a medical career to my children because medicine has become a constant hassle; that we have lost our autonomy and cannot make any money practicing medicine.'

Some of these complaints are justified. However, I disagree with the conclusions.

The so-called crisis of today will be nothing more than a footnote in the annals of history and medicine will continue to be one of the most gratifying and exciting professions.

I am not overly concerned, and you should not be either, about the rapidly unfolding events or the magnitude of the dilemma we are confronting in regards to health care reform. We are not witnessing a crisis in medicine, but a sociopolitical upheaval.

The American people will not tolerate second class medical care and will demand the quality of care to which they have grown accustomed and are entitled to receive.

It is necessary, however that we, as members of the medical profession, recognize the role we played in the genesis of the problem.

We need to admit that organized medicine failed to respond unselfishly and objectively when the problem first loomed on the horizon. It elected to ignore the gathering clouds and posited that the thundering was inconsequential.

There are those who believe that with financial restructuring, the Academy will be capable of doing much to solve the problems facing medicine today. I submit to you that the power of the Academy is limited. No matter how much money we allocate toward that end, the effect that the Academy has in the final sociopolitical decisions will be very small.

The Academy's ability to provide advice to those who are in control of the situation would be preserved. However, this should not be done at the risk of losing the strength of our commitment to education, for it is in education where the Academy should continue to excel. Because it is in the area of education where our greatest needs lie.

Any action that might move the Academy in the direction of a trade union would be a gross mistake. The Academy would then suffer the same fate that the AMA and other medical groups suffered and which made their educational roles almost irrelevant.

You have come to the Academy at a time when orthopaedics is fragmented, but not critically so.

The current fragmentation of orthopaedics is, to a great extent, the result of the rapid expansion of technology and the logical desire of people to assemble with others holding similar interests.

The growth of subspecialization has increased the cost of training its practitioners and has resulted in the appropriate as well as the inappropriate utilization of expensive technology and the performance of unnecessary surgery.

Those in control of financing health care are stating in an unequivocal terms that they are not going to cater to subspecialists as they perceive them to be the real culprits in the escalating cost of health care. We must continue our efforts to develop viable and logical approaches to this dilemma.

In no area has the orthopaedic-industrial complex been able to extend its powerful tentacles into the practice of medicine more than in the education of the orthopaedist. There is no doubt in my mind that today the continuing education of the orthopaedist is structured to satisfy the marketing needs of industry. This is happening in our residency programs, and in the activities of a myriad of orthopaedic societies and even in our own Academy where its economic dependency on industry continues to grow at a rapid pace. You must remain vigilant and weigh the consequences of such an increased dependency.

Several of the developments and problems that I have addressed today are largely the result of a decay in our professional and societal values. The real crises in medicine are the declining professionalism of its practitioners; the lowering and anesthetizing of ethical standards and the belief that everything is okay, which eliminates the possibility of being morally wrong.

You come onto the scene, not in bad times, but in challenging times. It is your mandate to be active and committed participants in the renaissance of high values and professionalism in our ranks. It is also a great challenge and opportunity.

I would suggest that you, the future leaders of orthopaedics, adopt the following lines from Hensley's poem as your motto:

It matter not how strait the gate,
How charged with punishments the scroll,
I am the Master of my fate,
I am the Captain of my soul.

On behalf of the Academy fellowship, I wish you well and welcome your will to action as you venture into the unchartered waters of the next millennium.

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Last modified 27/September/1996