On March 30, 1842, Crawford W. Long performed the first surgical operation using ether for general anesthesia. The patient, James Venable, felt no pain when he regained consciousness. Long’s fee for the groundbreaking surgery was $2.
Dr. Jack Chapman reflects on how different the practice of medicine is from the days of the trail-blazing Long.
"We don’t know if Mr. Venable paid the two dollars that day, made a partial co-payment or if a third-party payer covered the expense," said Chapman, a Gainesville ophthalmologist who was inducted Saturday night as the new president of the Medical Association of Georgia.
Chapman used the story of Long to point out how both the practice and regulation of medicine has changed in 165 years.
"It’s a great time to be in medicine," Chapman said. "But at the same time, the interference between the doctor-patient relationships is at an all-time high. Many physicians are retiring at a younger age, in their late 50s, because the hassle factor is up there for them."
That "hassle factor" stems from various managed care insurance programs administered by third-party payers. The type and extent of treatment is often predicated on what the insurer will authorize.
"Those of us who came in as this was beginning are adapting," Chapman said.
The new president said the association has made great strides in recent years to benefit doctors, including its efforts in passage of state tort reform legislation, which limits the amount of liability in malpractice cases.
On the federal level, the association is seeking passage of a bill that would reverse a decision to cut payments for physicians in residency.
"We are concerned about the doctor shortage in the future. We need medical schools to train physicians, but the key issue is residencies," Chapman said. "A lot of times, where doctors do their (residencies) are where they will practice. But the problem comes in Medicare’s unwillingness to reimburse for residency physicians, which was cut back in the 1990s. A bill is pending in Congress to change that."
The association is closely watching attempts in other states to establish universal health care coverage, which could prove costly to physicians.
Also on the horizon is a second attempt to change Georgia’s Certificate of Need law. The current statute, which has been in effect for more than three decades, requires government approval for expanded service lines.
"It used to be that surgeries could only be done in hospitals," Chapman said. "Now procedures and surgeries can be done in the physician’s office. We need, for example, to place general surgeons as a single specialty under Georgia’s Certificate of Need law."
That proposal has placed the association at odds with the equally powerful hospital lobby in the state.
Another concern is providing some coverage for the state’s uninsured residents.
"You have people who are working to provide for their families and the cost of insurance is out of reach for them," Chapman said, adding that 68 percent of the uninsured are working. "Our Health Access Initiative in Hall County is (becoming) a model for the state."
Both Gov. Sonny Perdue and Lt. Gov. Casey Cagle, of Chestnut Mountain, have floated programs to address the medically uninsured. The programs will be taken up during the next session of the legislature in January.
Chapman is preparing to preside over what he hopes will be an eventful year for the group.
"It’s very exciting. I sit and reflect on the fact that I will be the 153rd president of the Medical Association and the first president since 1845 from Hall County," he said.