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On the edge of the abyss.

We live in tumultuous times. President Obama has signed into the law the Health Care Reform Bill, which will bring changes none of us can anticipate fully. As I write this, significant Tort reform has not been included in the new Health Care Bill, and, the Sustainable Growth Rate (SGR) for Medicare has not been addressed. In addition, holding off a disastrous decline in Medicare reimbursement has become an on-going challenge. Physician incomes have gone down while the cost of maintaining a practice have increased. Many of us are facing unfunded mandates that will increase our costs further. Health-care providers around the country are suffering financially; some are no longer able to care adequately for their patients, and others even face going out of business. Our patients are struggling financially, and many admit to self-rationing their medical care and medication to make ends meet.

The Pain Medicine community has seen its share of tumult. Struggles continue, as the various stakeholder organizations work to establish the rules for pain medicine practitioners. The relationships among the various societies are, if nothing else, complex. Meanwhile, time marches on and much less gets done than needs to get done. Many feel as though we sit on the edge of abyss. Who will rescue us?

The answer is no one. We will have to do it ourselves. We physicians simply need to look at the reality of things, quit talking about what is wrong and pitch in to help ourselves. Look at the reality. Healthcare expenses are now close to 18% of gross domestic product, AND RISING! Physicians are among the top income-earning group in the United States. In these tough economic times, physician practice expenses are unlikely to find a sympathetic ear with the average American.

What is our best response to these unsettling …