The "House" Doctor

Those doctors sure do get around. I recently learned that the person responsible for the design of the United States Capitol building in Washington, DC was a physician, William Thornton, MD (1759-1828).

“You can’t take your eye off the US Congress … it must be a constant vigil on the doctor’s part.”

—Rep. Michael Burgess, MD

Those doctors sure do get around. I recently learned that the person responsible for the design of the United States Capitol building in Washington, DC was a physician, William Thornton, MD (1759-1828).

His plans, widely praised by both George Washington and Thomas Jefferson, were approved in 1793 and construction was finally completed in 1811. Dr. Thornton also served as the first architect of the Capitol.

I also learned that the medical profession has someone looking out for them in that historic building. He’s Dr. Michael C. Burgess, a US representative from Texas and an OB/GYN doctor. One of seven physicians in the US House of Representatives (nearly one-third are lawyers), Dr. Burgess says that part of his challenge is to better educate members of Congress about healthcare matters (their eyes usually gloss over, he says) while also working to put the brakes on bad health policy ideas (of which there are plenty, he explains).

Despite the difficulties, he remains very positive about the nation’s medical profession and the future of healthcare. America’s doctors should be most grateful for his intelligence, advocacy, and eagerness. A third generation physician, Dr. Burgess recently talked with me via phone from his home in North Texas. Here are some of his thoughts:

Doc Buy In“When it comes to any reform or transformation in healthcare, if you don’t have the physicians on your side, it’s not going to work. I have seen that over and over again. I can't understand why that's such a hard lesson to learn? If you don’t have physician champions out there, I don’t care what it is—EMRs, e-prescribing, pay-for-performance—it’s just not gonna fly.”

Departing Docs

“About half of all healthcare spending is publicly financed. We in Congress do a very poor job of maintaining a physician workforce for the future. How we determine Medicare pay for doctors, through the SGR (Sustainable Growth Rate) formula, is fundamentally flawed—and it’s really just a bookkeeping error. The problem is most members of Congress, regardless of party, don’t understand it. When you seek to talk about it—you quickly lose them. How do you think the doctors feel? We’re at risk of losing many doctors who are at the peak of their skills—and you want to keep them working. They’re very discouraged right now and a rational approach to how we pay them in Medicare would be a step in the right direction.”

Out of Touch

“So many in Congress maintain the fantasy that with new technology will come quick solutions. I was a practicing physician, I know the challenges and hear from doctors all the time. Sure, these things are helpful, but there’s a learning cure involved and you’re asking doctors to invest a lot of uncompensated time. And today’s doctors don’t have a lot of time. For example, if you’re an OB/GYN and you’re not seeing 30 patients a day, you’re not even covering your overhead.”

Act on Solutions“One way to improve the system would be through an electronic health record that’s owned by the patient and follows them around. The problem is that the Stark laws say hospitals can’t help the doctor do it, the CMS is too Byzantine in its practices, and no one else wants to pay for it. We don’t act like this is something we want, meantime we say if we had it look at all the money we could save.”

Stand Down“When it comes to creating and delivering real value in healthcare, in a lot of ways Congress should get out of the way. They should just provide the correct environment, along with the oversight, for new things to be tried. Congress is too clumsy—the Founding Fathers wanted it that way because they wanted limited government.”

Bright Future“When it comes to the future of medicine I am very optimistic—probably more so than when I was in practice. The changes taking place on a scientific level are nothing short of astounding. Thanks to genetic research, doctors in the future will be able to intervene at a point far earlier then anyone thought possible. For the youngsters considering a medical career, it’s phenomenal to think about the tools they’ll have at their disposal. We’re on the cusp of a transformational time in medicine—which will no doubt bring societal change.”

Ugly Body“Congress is not a transformational body, we’re transactional body. We take things from one set of people and give it to another. It’s my job to see that Congress does not impede the development of the transformation that’s going on in medicine.”

Bad Deal

“The trade laws must be changed to ensure a more even playing field. For example, it makes no sense for us to develop the next generation statin drug and then have Canada be able to, through coercion and unequal application of the trade laws, say they want this medicine but only at this price. We must go to bat for the preservation of intellectual capital in this country.”

Up at Night

“The liability issue for doctors is what keeps me awake at night. We’re greatly damaging our physician workforce even while the first of the baby boomers are now retiring.”

Center Stage“A lot of the energy that should have gone into dealing with Medicare reimbursement for doctors was taken up by the SCHIP negotiation. We’ve put that aside for 18 months so perhaps there will be more energy dealing with Medicare this year. Unfortunately, the problem with Congress is that not much happens unless you’re up on a deadline. Things are glacially slow here. A departing congressman told me that you need to be ready for show time, because when it starts it goes quickly. I’m not going to let up—we’ve got to be ready for show time on this issue.”

Partnership Play“Practicing physicians recognize that they need to get up to speed on technology. But they should be allowed to partner with others—like with hospitals or a major insurance player. That would go a long way toward getting the technology in the hands of people who could make a difference and who would champion it. Sadly, Congress is far away from that model—we just want to control everything.”

Get Involved

“The big reason I ran for a seat in Congress was because of 9/11. I had this deep sense of irrelevance for weeks and months afterwards. I told myself that if there ever was the opportunity to step up and do the right thing I would. When a congressional seat in my district opened up for the first time in 18 years, I thought that’s the door I need to walk through.”

Fine Father

“My dad had a profound impact on me. He was a physician who was a calming influence—in his practice and his community. He was never one who was out for personal gain. It was always the furtherance of the medical profession and taking care of patients that mattered to him. To some degree, I hope I’ve captured that.”

Be Ready“With all the problems, I still believe that physicians are fortunate to be practicing in this day and time. Their ability to do good for the patient is unparalleled in human history. At the same time they have to pay attention to what the policy makers are doing. You can’t take your eye off the US Congress or your state legislature. It must be a constant vigil on the doctor’s part. Do it in a civil way and provide the education we need—let’s not make it a pitched battle. The reality is that doctors need to be engaged because they know what works in the healthcare business.”

Ready for Answers“Doctors are reasonable people. They’re goal directed and if you show them that you have a better idea or direction—whether it is from the CEO of Aetna, a presidential candidate, or a leader in Congress—they’re apt to listen and embrace the change.”

For more information, visit the doctor’s congressional web site.