EB: John, why have you devoted so much time and effort to advocacy for better payment of GIM physicians?
JG: Even 30 years ago, the sustainability of primary care GIM was uncertain. There were many practitioners, but workforce projections were worrisome. In the 2000s, I was offered the opportunity to represent SGIM in a multi-specialty committee of the American College of Physicians. I learned that there is a federally managed process for establishing the prices for every individual physician service. After reading the history behind the development of federal price fixing, I discovered that the processes had been corrupted and mismanaged from the beginning. When I personally witnessed a small, self-selected group convened by the American Medical Association and dominated by procedurally oriented specialties with a 90% acceptance by the Centers for Medicare & Medicaid Services, I realized that the premise of fairness within physician service pricing based on the relative intensity of each service had been unduly influenced by those professionals who had no concept of complex care management and continuity. I felt like an investigative reporter getting to the bottom of this story.
EB: What are the keys to your success in being an effective advocate for changes in physician payment?
JG: Finding your people. My passion for advocacy stems from a commitment to service that we all share. I knew that the nation needed a robust primary care internal medicine workforce. Within SGIM, I was exposed to social activists who thought big. They became my people. They provided extraordinary examples of collaboration and relationship building among colleagues and the legislative and executive branches of government.
Effective advocacy has four elements: First, develop an independent understanding of the issue. Second, develop a succinct message. Third, crosscheck to be sure you have the passion to sustain yourself. Fourth, be prepared to present your material at any time and at any place. Opportunities present unexpectedly. Focus on issues of powerful personal importance. Become a trusted source. Know that if you are right now, you will likely be right in 10 years unless things change. Advocacy is a socializing experience and building ongoing relationships is part of the fun.
EB: What do you recommend as top priorities for SGIM’s continuing advocacy for the clinical practice of GIM?
JG: SGIM is an emerging professional society with distinguishing characteristics. We all need to celebrate our unique identity. We are a community of practitioners, educators, and health services researchers within academic medical centers. There is no other organization that has our capabilities. Others are starting to recognize that SGIM is a forward moving professional society. Our policy recommendations are based on evidence. Activism has become part of our organizational identity. We need to be skeptical and questioning at all times. For example, the fundamental flaw with many proposed changes in healthcare reimbursement goes back to the legacy distortions of physician service pricing. Unless we change the pricing mechanism to more accurately capture the complexity of our work, we will never be appropriately valued, and the future of primary care GIM will look even worse. Although the Primary Care Collaborative is advocating for a hybrid payment model that should help to provide more support for the services that primary care clinicians provide outside of face-to-face encounters with patients, any model that retains the current federal service pricing within the Medicare fee schedule will fail to properly value the evaluation and management (E/M) services by primary care clinicians.1 Thus, SGIM must persist in calling attention to the inadequacies of any payment model based on the fee for service rates.
In its advocacy work, SGIM must also call attention to the distinctions between GIM physicians and other primary care clinicians. We must find ways to collaborate with other primary care oriented professional societies in demanding increased investment in primary care, while helping policy makers understand the unique role that GIM physicians have in providing comprehensive care to patients with multiple chronic conditions or serious complex conditions.
To be effective, SGIM will need a strong network of members committed to sustained advocacy for an accurate, evidence-based, publicly accountable mechanism for the pricing of all physician services. The individual relationships that each of us develop and maintain will assure our ability to influence health policy.
EB: Mark, what should SGIM do to facilitate further advocacy for the clinical practice of GIM?
MS: To carry on John’s extraordinary advocacy efforts, we need to recruit and nurture a new generation of SGIM members that have deep understanding of the history and complexities of physician payment policy, strong skills in health policy advocacy, and a passion for effecting change. Since 2017, the year-long LEAHP career development program has graduated 82 Scholars, with another 19 in the current cohort. SGIM is committed to using the LEAHP Program to train more members in health policy advocacy. The Program is fulfilling its commitments to develop members who are effective health policy advocates and local health policy experts, leaders, and teachers; offer health policy career development resources and opportunities to all members; and develop a national cadre of HPC members and broaden engagement in the Society’s health policy efforts.2
We want to strengthen the LEAHP Program by launching a new fund-raising initiative that will enable us to offer more support to LEAHP Scholars who are doing projects that will enhance our advocacy for better support of the clinical practice of GIM. In recognition of John’s decades of relentless advocacy and inspiring leadership, we propose to establish the John Goodson LEAHP Scholarship Program in time to solicit applications from the cohort of LEAHP Scholars that will start in May 2024. Members may donate to the initiative by contacting SGIM’s Development Officer, Liz Davey, at email@example.com.
- Goodson JD. Unintended consequences of resource-based relative value scale reimbursement. JAMA. 2007; 298 (19): 2308-10. doi:10.1001/jama.298.19.2308.
- SGIM Leadership in Health Policy. https://www.sgim.org/leahp. Accessed June 15, 2023.
Health Policy & Advocacy, SGIM
Dr. Bass (firstname.lastname@example.org) is the CEO of SGIM. Dr. Schwartz (Mark.Schwartz@nyulangone.org) is the Director of SGIM’s Leadership in Health Policy (LEAHP) Program. Dr. Goodson (JGOODSON1@mgh.harvard.edu) is a mentor in the LEAHP Program and a longstanding member of SGIM’s Health Policy Committee (HPC) and Clinical Practice Committee (CPC).
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