Installation Address given January 27, 2001   Carolyn Evans, MD 118th President, Dallas County Medical Society

There are many reasons I love being a doctor. One of the reasons is my patients and the impact I have on their lives. Another is the company I get to keep. I get to hang out with the brightest, the most caring, the most compassionate, most dedicated people on the planet. For that I'm very grateful. I am honored and humbled to be your first president of the new millennium. I am your second African-American president, your second female, and your youngest president ever. I know I am the youngest because I am only 21. That's my story and I'm sticking to it.

I was fascinated several years ago when I was introduced to the idea of paradigms and paradigm shifts. To change your paradigm, you have to figure out where you are, where you want to be, and then set a course on how to get there. In medicine, I don't have to tell you where we are. We deliver the highest quality of medical care in the world, but the delivery system is in crisis. The cost of the medical care delivery system is increasing in this country, despite managed care. This is an opportunity for a paradigm shift. I am not going to figure out how to get there tonight, but I'm going to tell you where I want us to be.

In my new healthcare delivery system paradigm, all patients are covered. The rising number of uninsured surely will sink the system if we don't do something. This is the quickest route to a single-payer system. And if that single payer is the government, we will have all the efficiency of the post office and all the sympathy of the IRS.

In my paradigm, doctors will be paid, fairly, for results. They will be paid for getting patients well and keeping them well, with a built-in modifier for severity case mix. This will encourage the most efficient means possible. The current system rewards us for the patient being unwell.

Monitoring all doctors has proven costly and mostly unrewarding because the majority of us practice good medicine. So my system will have highly trained medical SWAT teams that monitor trends in claims. These teams will be equipped with the ability to tell honest mistakes from outdated practices from fraudulent behavior. Then the rest of us will be left alone to practice medicine.

We will have continuing medical education on best practices and updates in technology. This then will eliminate the need for malpractice insurance and trial lawyers. This is, after all, my paradigm.

We also will need to address personal responsibility. People need to have healthy life-styles that includes exercise, good nutrition, and staying away from drugs, alcohol, cigarettes, and anything unhealthy. This also involves reducing violence. Personal responsibility often is overlooked in the healthcare cost puzzle, but it is a significant piece.

In my paradigm, we all will be members of the American Medical Association. We need some organization that is national and represents all geographical areas and all specialties. We will work out all our differences internally so that when we approach outside agencies, we do not shoot each other in the foot or counteract the work that has been done by another group. We need to start working on this part of my paradigm right away. And I will be talking with many of you over the next year about this.
We need to ensure that funding to our medical schools remains strong and that we continue to attract the smartest and brightest to a medical education.

We will continue to deliver the highest quality of medical care in the world, but technology and efficiencies will allow us to deliver it with less paperwork and less cost. Who knows? We even might be paperless, with a universal digital medical record and electronic billing. This will mean that some of you will have to learn how to use a computer.

We will use physician extenders to make ourselves even more efficient. We will blend all aspects of our profession--all colors and nations of origin, academic as well as nonacademic. We will be happy and probably rich (this is my paradigm, anyway). And, most importantly, our patients will get the best medical care in the world.

I welcome any help as I start into the next phase of the implementation of my paradigm shift. And as your fearless leader, I will never forget that my job is to serve you. And I'm proud to have this opportunity.

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