When Madelyn Butler, MD, takes office next month as president of the Florida Medical Association (FMA), the OB-GYN from Tampa will take over as the association's second female, second of Cuban descent, and youngest leader during arguably the most tumultuous time in organized medicine in the United States.

 

Medical News spoke to Butler, president of the FMA PAC, past president of the Hillsborough County Medical Association, and a member of the Florida Medical Association Board of Governors, about priorities during her 1-year term, industry challenges, legislative wish list, and controversies brewing in organized medicine.

 

I've always been very civic-minded. At the University of Florida, I was involved in Greek life and campus leadership. During the first year of medical school at UF, I joined the medical student section of the AMA. Shortly after, I joined the FMA. I've never known medicine without a very deep involvement in organized medicine, and the organizations that make up physician representation.

 

No, when you look at it, I have the experience. There are very few leaders of the FMA who have gone through the medical school section, the resident section, the young physicians section, and the PAC. With the overlap, for about five months, I'll be president of the PAC and FMA at the same time. Knowledge brings respect. And FMA members know I have the knowledge because I've been around a long time and have a lot of institutional memory.

 

Helping Florida physicians navigate the constantly changing, very dynamic landscape so they can continue—and choose to continue—to practice medicine. 

 

We do that through building partnerships with counties, specialties, and medical schools, and strengthening those grass roots connections. We also do that through the education of constituent members and political advocacy. We have to advocate in Tallahassee for our physicians, because so much of what we do in our exam rooms is decided in Tallahassee and Washington. Advocacy is one of the most important things we can do.

 

With the changing landscape, gone are the days of 2- and 3-physician practices. Practices are getting larger; physicians are becoming employed. So we really have to forge new partnerships with medical schools and large multi-specialty practice groups to help doctors see where things are going and adjust their sub point to deal with changing times. You can advocate for doctors, and in the end, help them practice, which is why we exist.

 

In the last legislative cycle, managed care companies wanted to expand the managed care component of Medicaid and we know that hasn't worked in the past. The Medicaid HMO concept has not served patients or physicians well.

 

The FMA would like to try something new centered on patient care: the patient-centered medical home. The way it works: a family doctor or primary care physician will form partnerships with people who help deliver care to patients such as hospitals, physical therapists, and other specialists, and act as the patient's healthcare coordinator. That physician becomes the medical home for the patient, and has a staff of nurses that will make sure to follow up, for example, if a patient's diabetic, that they're coming in for maintenance testing. It's a more intensive level of coordination. Before, money for the healthcare coordinator was going to the managed care companies in the form of profits. Now we're hoping this money can be put back into patient care.

 

One reason: Medicaid is reimbursed at 56 percent of Medicare. Practice costs continue to escalate. Electronic medical record systems, on average, cost about $30,000 per physician. We have increasing overhead every year, and we don't get any kind of uptick, even with the cost of inflation. Most physicians can't afford to see Medicaid patients and pay their overhead.

 

With Medicaid reform, hopefully we'll get Medicaid reimbursement at least up to the level of Medicare. That's a challenge because we have a significant shortfall in the state budget. But we have to continue to look for ways to accomplish that, if not immediately, at least through the patient-centered medical home. As we achieve savings, those savings should legislatively be put back into healthcare delivery so those patients can have access to healthcare.

 

We're about to see three to four million Medicaid patients in Florida through healthcare reform. Initially, the federal government will pay the bill, but after 2015, they're going to pull out and we have to be able to fund those patients. If you continue to reimburse physicians at 56 percent of Medicare, it's simply impossible for them to care for Medicaid patients when they can't even meet their overhead.

 

This year, we were at an impasse with state lawmakers during the legislative session. I believe it was taken up at the end, but then dropped. I think what's going on is, we'll refine the fine points of the patient-centered medical home and it'll probably be introduced during the next legislative cycle.

 

Again, we understand, and we're sensitive to the fact that the state has a budget shortfall, but we're telling legislators: let's implement this patient-centered medical home. If you write the bill so that once we start realizing savings, and that money is put back into patient care, more doctors will see Medicaid patients. Once we know that reimbursement will come up to Medicare levels, at least, we'll be willing to make a little bit of a sacrifice in the beginning. We understand these are tough times.

 

We hope to see a cap on non-eco damages and an expert witness bill pass. We understand and acknowledge that malpractice happens. When it does, we acknowledge the patient needs to be made whole. We understand lost wages need to be recovered, and damage done to them that can be quantified.

 

What society can't afford is money for nebulous pain and suffering, which could reach into multiple millions of dollars. Society cannot afford it. It causes doctors to leave the state, medical malpractice rates to go out of sight, and something needs to be done.

 

We understand that Florida is a state with a lot of elderly. And I'll be an elder in this state one day, and I want the very best doctors to take care of me. But if we don't make this state a good environment for physicians to practice, they're not going to come. They'll go somewhere else.

 

We understand these are big goals, and that you have to have the right leadership in government to achieve these goals. But we're willing to be patient.

 

People ask me that, and I have no interest running for public office. I like the medical politics through organized medicine, where things are not quite as ruthless. It's very respectful running for office in the FMA or the AMA. We're professional people. There are no personal attacks. So we're strictly on the issues. Those are the politics I like.

 

That said, I've learned to never say never. You never know what the future will hold. I would never have predicted many things in my life, but certainly that's not an intention of mine going forward right now. I love being a doctor. I can't imagine anything that I would let take me away from me being in the office with patients long-term. Maybe in retirement I'd reconsider.