June 2011

Remember My Name

By Michael J. Katin, MD

Eventually circumstances may allow this column to again address scientific issues. Unfortunately, there continues to be a daily struggle to maintain the status of the specialty of Radiation Oncology against the constant onslaught of legitimate alternatives , questionable new competitors, questionable old competitors, and, most importantly and most threateningly, the best intentions of the United States Government.

It has now been well over a year since on March 23, 2010, the Patient Protection and Affordable Care Act was signed into law. The main accomplishment so far has been the generation of thousands of consultants to prepare medical care institutions and practitioners to adapt to the new system. The term "shovel-ready project" comes to mind to deal with the mountain of regulations looming over our future. It will be a very short time before medical practice becomes almost impossibly cumbersome. This is not only from the Affordable Care Act. Many of us know that the American Recovery and Reinvestment Act of 2009 established a timetable for conversion to electronic medical records but how many know that is also expanded restrictions under HIPAA?

The only hope we have to salvage a workable system out of this is to realize that many of the specifics have not yet been fully detailed. We can have hope that legions of bureaucrats are not expecting to diligently work 40 hours every week ( excluding holidays and vacations ) to set these up and would much prefer to copy them from other sources. The goal, then, is to make sure our national organizations establish credibility and, more importantly, get the attention of these persons before it's too late.

What organizations would these be? The AMA has lost credibility by supporting the Affordable Care Act in exchange for the promise to eliminate the SGR, which never happened. The ACR and RSNA will want to protect their diagnostic radiology members, as ASCO will also always be inclined to defend medical oncologists at our detriment, intentional or not. That leaves ASTRO, ACRO, and AFROC. Starting a new organization to represent our interests would probably take too long and have substantial startup costs.

But how do we get attention for any of these groups? ASTRO sounds as if it could be involved in lobbying for space exploration, the only field for which support is even more controversial than medical care. Regardless, the name is somewhat passive, giving images of cerebral contemplation rather than the hard-core realities of today's problems. ACRO is better with its hard consonant, but it's still unclear what it means. The name AFROC is even more problematic.

The name is more important than the substance. History shows us that a name that is memorable and evokes an emotional response is always preferable. Why was the U. S. presidency elusive for Bob Taft, Bob Dole, Bob Kerrey, Bob Barr , and Bob Graham? It's been said that the American public would have the vision of someone with a blue workshirt with the name "Bob" on the pocket. Whether true or not, Joseph Robert Kerrey, with incredible credentials, may have doomed his candidacy by using his middle name. Bobby Kennedy, who would have been president, never used the short version. There will probably also never be a president with the name "Newt," although for a different reason.

When Randy Poffo was starting out in professional wrestling, he did not seem to be getting the attention he deserved. This changed after he took the name of Randy "Macho Man" Savage. He was known as an intimidating force, with a memorable personality that, unfortunately, came to an end several weeks ago. Would Randy Poffo have had the same impact? It would seem improbable.

I think the message to take from the Macho Man is that you can't make much of an impression unless you first get attention. The time has come, before it's too late, for our representative organizations to come together with a new name that will allow inroads into the hidden chambers of Washington and allow us to have input into definition of quality measures, practice patterns, and, not the least important, construction of Affordable Care Organizations, a name that will be taken very, very seriously. We need to be represented by the Society for the Promotion of the Extraordinary Contributions of Therapeutic Radiology Enterprises: SPECTRE