Physicians have been absent without leave when it comes to their participation in the processes that are shaping our profession whether it be locally in the hospital setting or in our state capitals or in Washington DC.  Just think about all of those hospital committee meetings you did not have time to attend and lend your voice or all of those elections that we have not supported financially candidates who were medicine friendly or modify the views of those who are not so friendly.  We all know in politics that money talks.  This power vacuum has now been filled by physician unfriendly administrators and bureaucrats. What we do well is whine after the fact. How much money have you given to a physician friendly congressional campaign? How many times have you gone with the ACC to meet your congressional representatives in D.C.? Was the potential loss of two days of practice revenue and cost of an airline ticket and two nights in a hotel worth the 30% cut we in revenue we took in January and the pending 21% cut we may see in less then two weeks? I bet that is going to cost you six figures plus every single year that you have left in practice. And worse it will have a detrimental effect on how we can take care of our patients, something we have dedicated our lives to. Have you been waiting for someone else to do the heavy lifting so you can see one more patient in the office, do one more procedure in the cath lab or get home a little early for that shot shot of Scotch after a tough day?

This has been the result of a failure of both physician leadership and the individual physicians. Why did it take the ACC leadership so long to integrate the political process into their annual scientific sessions? Even now, it is a marginal part of the meetings. Didn't they know that how we practice in the future was going to be impacted more by what goes on in Washington DC then all of the late breaking clinical trial presentations combined. Why does the AHA not even participate at all in the political process that is bringing medicine to its knees? Does tradition win over necessity? Where is the passion in our leadership?  Are we supposed to be proud of the fact that we did all we could by sending some silly emails to our congressional representatives? Worse yet, I bet most of us have not even hit the keys on our computers to even do that.  And this is what our adversaries are counting on and so far that is one expectation we have been able to live up to.  And whether we work in an academic center, staff physician or in private practice the implications are the same. We will not be in control of our destiny.