Shelton G. Hopkins, MD
President's Page

Whither the TMA

I believe that the way things are is the way they always will be. This is not the result of a rational evaluation, of course, only a mindset. If I can just get the machine running smoothly, everything will fall into place forever.

All of our intellect and our experience, however, tell us that that is absolutely wrong. The one thing we know for sure is that change is inevitable. But it is not inexorable. Change can be channeled and guided. Therefore, because we are responsible members of our medical community, we must accept that change is upon us so we can nudge it in the best direction. We always are aware of this at our DCMS and our TMA.

Our TMA is in the midst of a thorough effort to evaluate the current and future practices of its members, their attitudes and desires, and the external forces impinging on those practices and attitudes. This is a huge undertaking.

This is possible because the membership of our TMA (i.e., you and I) has been generous with time and money. This has created a staff nonpareil in Austin (nonpareil in other state capitols, that is; DCMS is at the same level), and a sense among the medical leadership that problems can be solved with thought and effort. Because of that optimism, tinged with urgency (and our older members know just what a strong driver urgency can be), our TMA recently convened a meeting of its committee chairs, board members, AMA delegates, and presidents of the larger county medical societies. At issue were underlying questions we have to face if we want TMA to forcefully represent us in the legal field and state legislative level.

Those questions included, “What will our position be on the independent practice of nurse practitioners (NPs) and physicians assistants (PAs)? The long-time answer has been (and, in my opinion, still should be) that there is a clear, bright “line in the sand,” and on one side are those with a medical degree and on the other are those without one.

“All right, Dr. High and Mighty,” a West Texas legislator could say, “perhaps in a better world where Texans did not have the 42nd poorest doctor/patient ratio in the country (including the ratios in Dallas and Houston, where you can’t throw a rock without hitting a doctor), you might be right. But what do I tell my constituents in Rotan, Texas, when they get sick or have an injury? ‘Be tough! You’re the one who chose to live out here.’ It’s not like we’re stupid; we recognize that we take a step down in medical knowledge and sophistication when we use a PA or NP, but they are a lot better than Aunt Edna at the corner of the town square.” (My apologies if there really is an Edna at a corner of the Rotan town square.) One participant in the meeting described being on the receiving end of a legislator’s forceful “expression of opinion” regarding the above question.

We must each consider, discuss and then reconsider the primary care and specialist physician shortage/maldistribution. Over it all must be the concern for our patients, both ours individually and as a class. (I don’t have any patients in Rotan, but any policy I push for should take them into account.)

If considering the pros and cons of the above doesn’t give you a headache, then what about employment of physicians by nonphysicians? It’s always been a no-no in Texas. Only a few other states have our (previously) strict prohibitions, but they have not fallen into Bhutan medicine or UK medicine. Many of the same arguments given in the above paragraph can be used to justify allowing rural counties or hospitals to hire physicians. In fact, those arguments were used to good effect in the last legislative session. Plus, just how “free” are the physicians and groups whose practices have been purchased by hospitals? (I know it’s not exactly “purchased” or “by hospitals.”) Is it much different than being hired outright by a hospital? Do the young physicians care? Should we spend political capital and money on that issue every legislative year?

Other questions are just as difficult and contentious: will we still be demanding a $250,000 cap on pain and suffering when a Big Mac costs $250? What should the TMA position be on government-directed interactions with patients (the pre-abortion sonogram and graphic counseling)? Should physician couples get a break on membership dues? Yes, they probably could afford the dues better than most, but one of them can get many of the bennies with $0 outlay if he/she relies on the spouse. Would it not be better to offer double membership at 1.5x regular dues?

These questions are being pondered as I write, and after many queries of the membership and much gnashing of teeth, we should have answers in about a year. These are important and difficult issues, and they deserve the discussion and dissection they are receiving.

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