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“I am thrice blessed. I am blessed to be a physician, a practitioner of the healing arts. I am blessed to practice in the State of North Carolina where physicians are still held in high regard. I am blessed to have been nominated by my peers and appointed by the Governor to serve on the North Carolina Medical Board—a Board which is among the finest in the country and which protects its citizens yet treats physicians humanely and fairly.”

I meant the words that appear above when I spoke them to physician colleagues at a Medical Board dinner in 2007. Today, I feel even more strongly that I am blessed, in part because of my experiences at a recent professional meeting.

In October 2008 I represented the North Carolina Medical Board at an international conference on medical regulation. The theme of the conference was professionalism, a term that had many meanings in the context of the conference and indeed in the practice of medicine. The purpose of the trip was for a member of the Board to see if we could learn from other countries that are at similar and dissimilar places in the regulation of physicians.

Having attended a number of Federation of State Medical Board meetings during my tenure, I knew that North Carolina is a national leader both in the protection it affords its citizens and for the fair manner in which it regulates physicians. I always come away from these meetings with new ways of thinking about the job we do. I felt confident the international conference also would prove useful.

I was struck by the undercurrent of loss that permeated the meeting. Doctors in many other countries felt that they had lost the regulation and control of medicine. While your medical board is comprised mainly of physicians, lay people hold a majority of Board seats in many other Anglophone countries. The lay Board members present were forthright, even strident, in their positions. Some of these positions were well intentioned, but misinformed. A number of formal presentations, and the informal conversations that occurred between sessions, confirmed my unease with government-run medical regulatory systems.

On returning to North Carolina, I was grateful to be home. I felt grateful – truly blessed -- to practice medicine in the United States. Listening to my brother and sister physicians from abroad, I realized that physicians in the U.S. are fortunate. For the most part our voices are not only heard but heeded, especially in this great state of North Carolina. Physicians, for the most part, are trusted to uphold the best interests of their patients.

In other countries, where medicine is regulated by lay people, physicians do not enjoy this type of public trust. Often, there have been high-profile cases where physician-led regulatory bodies did not adequately protect the public and patients suffered or died. The price of those lapses was the loss of self-regulation.

How close are we to losing self regulation in North Carolina? In my opinion, we are closer than some might think. A few years ago, after some very public lapses here, the Board faced both a lawsuit and proposed legislation that would have, in my opinion, gutted the Board. We could have ended up with a Board dominated by political appointees or physicians handpicked by special interest groups. . Instead, the Board stepped up and proposed alternative changes and legislation that gave greater public protection while preserving physician regulation of medicine. Even with all these changes —changes that benefitted the citizens of North Carolina — we can still lose the authority to self-regulate.

The best way to ensure that we retain the privilege of policing ourselves is to do such a good job that no one else could do better.

Many physicians are offended by the new world order that demands that duly licensed medical professionals submit to intense public scrutiny and greater disclosure. We gnash our teeth and talk about the “good old days” when physicians were honored and respected, almost without question.

But step back for just a moment. Are we any different from our patients? Are we not suspicious of the car mechanic who says that our vehicle needs a major repair? Don’t we want a second opinion on the cost of the new addition to our house? Why shouldn’t our patients want more choices, more information? How many of us would allow a relative stranger to perform surgery on us without making a few phone calls first?

At a dinner not very long ago where I believe that I and fellow medical Board members were on the menu as the main course (I say this only half-jokingly), I stated that we are fighting over the choice of wallpaper when our house is burning down.

As physicians, we can argue till we are blue in the face about the value of malpractice information. We can squander political capital and good will fighting over changes that will not affect 95 percent of physicians and will have a negligible effect on the other 5 percent. Or, we can work to change the things that really matter, such as, reforming a payment system that values procedures and sickness over prevention and health and reversing the ongoing loss of primary care practices (the back bone of all medical care) that are daily declaring bankruptcy and threatening to implode the entire health care system.

As our health care system is continues to fail, continues to leave our patients without adequate care, we need to consider our every action and every lobbying effort carefully.
Medicine will be regulated. The only question is, by who?