General surgeons in the world of gatekeepers

Abstract

Iam extremely honored to be speaking before my friends about some issues that are of critical interest to each of us, issues that we must tackle both individually and together if the role of the general surgeon in today’s society is to retain its significance. Since our meeting in Tucson last year, a great change has taken place in this country’s medical profession. Twelve months ago, doctors in the United States were carefully preparing themselves for the interface with government and the proposed health care reform. But that reform never happened. Since President Clinton’s so-called managed competition disappeared, it has been replaced with unbelievable speed by the appearance of new managed-care entities all over the country. Sometimes we are probably tempted to think that the difficulties our profession faces today are unique, the result of a government that has changed. But history tells us otherwise. The government has long been involved in our work, and only in the more recent generations has that relationship become more adversarial. Thirty-six years ago, in 1958, my father, Ken Sawyer, stood before this very organization and delivered his presidential address.’ The fact that he did that is another reason why I’m honored to be here before you all today. But more important, the core of his message was not all that different from what you will hear from me over the next few minutes. The title of his 1958 address was “Eternal Vigilance,” and it centered on the need to be organized and work together in the face of governmental changes affecting our calling as surgeons. For him, it was the threat of socialized medicine. For us, it is the threat of managed competition and managed care. Before I get into those topics and where we should consider taking ourselves in the future in light of them, however, I think it is appropriate to touch on a couple of historical footnotes about the Southwestern Surgical Congress, and its important role in organized medicine in this country. Nearly half a century ago, in 1948, three surgeons-Dr. B.T. Beasley of Atlanta, Dr. R.L. Saunders of Memphis, and Dr. Walter Stuck from here in San Antoni-attended the meeting of the Southeastern Surgical Congress in Hollywood, Florida. There, they acknowledged that the Southwest was