Nearly 10,000 Los Angeles area physicians, and anyone else, for that matter, can vote--the doctors because they are supposed to and the others because there is nothing to stop them--on a proposal to assess each physician in the county $1,000 a year for an advertising campaign extolling the virtues of organized medicine.
The balloting has been planned by the L.A. County Medical Assn., whose leadership says it expects the strictly advisory, telephone referendum to fail. It will almost certainly not be a valid result, because anyone--doctors, patients or others--can vote, as many times as he or she wants.
To vote in favor of assessing doctors $1,000 each, or $8.4 million a year, to mount the slick radio, television, newspaper and magazine ad campaign, one need only dial (900) 720-1076. To vote against such an assessment and the campaign, the number to call is (900) 720-3076. Each call will result in a 50-cent charge to the caller.
It wasn't intended to be this public, but the medical association published both phone numbers on the cover of its magazine--a publication often available to patients, doctors' family members, employees and friends. The voting period began May 21 and ends Monday. Phone lines are open 24 hours a day.
By the end of last week, however, only 193 votes had been recorded--60 in favor of the campaign and 163 against it. At least two of those votes were not from doctors--a Times reporter cast them (one yes and one no). But officials of the medical association noted that copies of the new issue of LACMA Physician, a biweekly magazine published by the society in which the voting was announced, had only started to arrive in doctors' offices by week's end.
"No one intends, at least as far as I'm concerned, to use these phone-in results in any meaningful decision to do anything," Frank Clark, the association's executive vice president, said. "It doesn't mean a darned thing to me, except it is serving the purpose of creating a discussion."
But if the idea of the poll seems unlikely, the fact that this unusual step is being taken at all appears to lend emphasis to a growing controversy in medicine.
At issue is what many doctors and health workers see as a change in the fundamental way doctors are perceived in U.S. society--with the traditional image of the altruistic, almost god-like healer replaced by that of a mercenary businessman trying to make money and avoid malpractice litigation.
The controversy over medicine's image has split doctors across the country and there are vast disagreements over what--if anything--doctors can do to shore up what many of them perceive as their badly sagging image. On one side of the issue are practitioners like Dr. William G. Plested III, a Santa Monica heart surgeon who is president of the county association.
"Most people do feel that the doctor's image has slipped lately," said Plested, "But what the physician needs to do is behave as he would be expected to behave. The best advertising is through patients who are treated promptly and courteously and at a very reasonable fee."
A Vocal Minority
But on the other side is a vocal minority of doctors, typified and led in California by Dr. Robert Saltzman, a La Canada-Flintridge orthopedic surgeon who was instrumental in persuading the California Medical Assn. earlier this year to authorize a statewide referendum among physicians on the question. The balloting, which is waiting to be organized, will help decide if the CMA should mount a huge, costly advertising program.
Saltzman believes, he said in a telephone interview, that only by advertising aggressively enough to take the public relations initiative away from politicians, news media and opponents of organized medicine can doctors hope to halt the gradual erosion of their authority and image among their patients. Saltzman said he believes patients at large do not understand the extent to which insurance companies and government regulators have compromised the ability of doctors to decide what is best for their patients and get paid reasonable fees for treatments they and their patients agree are needed.
Saltzman charged that the medical association's leadership is unwilling to face such a sensitive issue head-on and he contended the poll amounted to a stacked deck. Saltzman said he knows that the leaders of the medical society are correct when they predict the county's physicians will never approve an assessment of $1,000 each--more than triple their current dues in the society.
"There is a vocal minority in medicine that is causing them (leaders of organized medicine) an embarrassment by bringing this issue to the fore," Saltzman said. "Rather than saying they won't deal with it, they deal with it in a way that kills it or tables it for a while. The image of the physician and his perception by the public as the principal advocate of patients' rights has been lost. Medicine is now being perceived as a business."
The proposal described for the county's physicians--the local association, with 9,555 members, is the largest in the state, where total CMA membership is 29,253--was drawn up by staff members who estimated costs of a multimedia campaign. The estimates assumed ads would be fully paid and appear in virtually every mass media outlet in the county--including regional advertising in national publications as Time and Newsweek.
The $8.4-million cost estimate yielded a $1,000-per-doctor assessment figure, the association said, because only about 8,200 to 8,400 of the members here are active. The rest are in training, retired or not fully participating in association affairs. There is a total of about 20,000 physicians in the county, including those who do not belong to the association.
Saltzman contended the $8.4-million total cost was inflated because it did not take into account services of ad agencies that would probably be donated to the association and space in publications and time on broadcast outlets that might be made available free or at reduced rates.
He said the sum would probably pay for a statewide ad campaign of the type he has in mind. The ads Saltzman wants to run would make the point that many health insurance policies don't pay adequate benefits; that doctors have been supplanted by government regulators and insurance company agents, and that major changes are needed to restore to the patient and doctor the right to decide on the best care.
The California Medical Assn. said it has not arrived at any estimate for such a statewide program.
Saltzman said the poll results here won't change his position, but he plans to continue pressing, statewide, for more assertive and aggressive steps by doctors to tell their story to the public--in whatever media forum is available.
He added, in a conversation last Friday, that he had already voted--yes, and only once. But, he said, there is a clear temptation to take advantage of a good thing.
"I am thinking," he joked, "of plugging the number (for a yes vote) into my auto-dialer and turning it on."