TMA President Susan Rudd Bailey, MD: Installation Address

May 1, 2010

I cannot thank enough my best friend and partner for life, my wonderful husband Doug. As many of you know, he's an attorney - not a plaintiff's attorney, put your weapons down, but a corporate finance specialist. As he told me early on, if he ever ends up in a courtroom, something has gone terribly, terribly wrong. We will celebrate our 6th anniversary next month, and we started dating just after tort reform was passed in 2003. On our second date I thought - well, if this relationship is going to blow up, I might as well do it now and save myself the heartache - so I asked him if he supported Prop 12. He said yes. I asked him why. He said if it's good for doctors, it's going to be good for everybody. So I said good - I'll go out with you again!

Doug has become the biggest supporter of organized medicine around, and within months it seemed of getting married he was on the TMA Foundation Board and the Council on Health Promotions. Thank you, sweetheart, for embarking on this amazing journey with me. I love you.

Standing here today, wearing this president's pin, with my family here in my hometown, well, it just doesn't get much better than this. This is truly a dream come true.

But I confess. I cheated.

I know, the Aggie Code of Honor says an Aggie does not lie, cheat, or steal, or tolerate those that do, but I confess I cheated today.

When Doug and I got married, with it being the second marriage for both of us, we decided to have a very small ceremony with just family. Well, it almost killed me to not invite some of my best friends to the wedding. So I cheated - and I decided to have some music at the ceremony.

This incredible choir, the Chancel Choir from University Christian Church, sang at our wedding. There were more people in the choir loft than there were in the pews. It was a pretty sneaky way to get all my buddies into the sanctuary, but having that incredible sound surround us as we took our vows was an experience I will never forget.

Well, it worked so well that I did it again today.

I couldn't imagine being installed today as President of the Texas Medical Association without some of my best friends here, so I asked the choir to sing again. And, frankly, I thought we needed a little inspiration today and what better to inspire us than great music? Please join me again in another round of applause for the choir, our conductor Randy Jordan, and our music director and accompanist Kyla Rosenberger.

You know, this may not have been such a good idea. They're a helluvan act to follow. I never felt sorry for our preacher having to come up with a good sermon after the choir sings every Sunday, but now I understand!

It's also wonderful to have members of my Texas Aggie family here with me - my dorm mates from undergraduate, my Charter Classmates from medical school, and Association of Former Students friends. I am so incredibly blessed to have so many wonderful circles of friends, and today they're all intersecting in one big Venn diagram. I am such a geek.

Family and friends have always been very important to me. When I was finishing up medical school, I interviewed all around the country, like many of us did, and by the time I had to submit my rank list for the Match, I realized I really wanted to stay close to my family.

My first niece was now an adorable toddler. I had only one living grandparent left. My parents were traveling back and forth to London on business and time with them was precious. And I had fallen in love.

So I ranked a Texas program - that shall remain nameless - first. In my arrogance mixed with naiveté of COURSE I would get my first choice, right? But on that fateful Match Day in March 1981 I opened that envelope … and read that I was going … to the Mayo Clinic. In Minnesota. Where it snows. A lot. And it's REALLY cold. And REALLY, REALLY far away from my family.

I was stunned. The Mayo Clinic? You've got to be kidding me. It took awhile to get over my pride being hurt at not getting my first choice, but when that passed I decided to take advantage of this change. After all, the Mayo Clinic does have a pretty decent reputation, right? It could just be MY little secret that it wasn't known for pediatrics, which was what I started in.

And of course it was an amazing and life changing experience. I took advantage of it. I embraced it. I bought wool clothes and a down coat, and I loved the Mayo way - placing the patient foremost in everything you do.

And when it was over I got back to Texas as fast as my little legs would carry me. You can buy RoTel tomatoes and flour tortillas at Barlows' grocery store in Rochester, Minnesota, now, but you sure couldn't then.

And after being involved in TMA as a student, being the amazing organization it is, I was welcomed back into organized medicine here with open arms. Besides, all four members of the newly formed TMA Young Physicians section had already been the Chair, so they needed a new one. That was me. So for a few years, I juggled. I was convinced I could have it all. My sons Michael and Stephen were young, and many of you saw them as little boys coming to meetings with me. My wonderful nurse Joyce would travel with me, and we'd share a room and the boys would share an adjoining room and we had a great time.

I remember Stephen, right before he started kindergarten, coming to Houston with me for TexMed. I gave him some colors to keep him occupied, and he started making himself ribbons for his name badge. He worked REALLY hard on the ribbon that was red, white, and blue - even a five year old realized that the really cool people were in TEXPAC with those neat ribbons. Well, Stephen, I wish everybody in TMA had a red, white, and blue ribbon just like that one you colored when you were a little boy.

It never ceases to amaze me that only 15 percent of TMA members belong to TEXPAC.

We moan and groan about what Austin and Washington DC are doing to the profession of medicine, and only 15 percent of us belong to TEXPAC. At an entry membership fee of $125. PLEASE, if you're not a member of TEXPAC, join before you leave today.

If you are a member, like me, then I challenge YOU to leverage your investment. Before you depart this weekend - recruit, persuade, cajole, or convince at least one physician member to match your 2010 contribution. Remember, there are strength and opportunities in numbers.

I don't remember if Stephen colored a badge for TMA Foundation members, too. But if he didn't, he should have. Our foundation is such a big factor in how we improve the health of all Texans. Like they say on public radio, it's men and women like you who allow us to do what we do … who pay for immunization clinics and bicycle helmets and tobacco cessation programs … who bolster our Trusted Leader image. Please make a donation to the foundation in honor of someone you admire … or love … or respect. Remember, there are strength and opportunities in numbers.

Back to my boys, I remember that we'd go to Chicago to AMA meetings together. I remember once at a Texas Delegation party. I couldn't find Michael. Gone. Vanished. Finally we found him in the receiving line at the Georgia party handing out stickers. THEIR stickers.

Of all the people in my life who have contributed to and sacrificed for my ability to be involved in organized medicine, my sons Michael and Stephen surely are at the top of the list. You have grown into wonderful young men who are smart and handsome, but the thing I'm really proudest of is that you have good hearts. Thank you. I love you.

When they were small, my marriage to their father unfortunately fell apart. And my world fell apart. But after I pulled myself back together, I found myself desperately in need of a support network, and so I did something I'd wanted to do for a long time but hadn't done because it would have taken too much time away from my family - I joined the church choir.

As you have had the privilege of hearing today, this was no ordinary choir singing "Bringing in the Sheaves" from the church at 24th and Plowed Ground, as our dear departed choirmaster Ron Shirey used to chide us - this was a world class group with an invitation to sing with the New York Pops and Skitch Henderson at Carnegie Hall later that year.

So I plunged into the alto section and when my ex and I made out our custody schedule, I said "The boys are with you on Thursday night so I can go to choir practice." THAT's taking advantage of change. Little did I know that the choir would become not only a spiritual lifeline and a creative outlet but also a support group, the people I travel with and party with, and a great source of patients! Joyce, some of them might need some medication refills this weekend. I'm not on call, so you might want to go check on them after we're done.

I have decided that the theme … the agenda … the challenge of my presidency is "Taking Advantage of Change." I knew that somehow I was going to have to deal with health system reform - either a good bill, a bad bill, or no bill at all. Some of us think the Patient Protection and Affordable Care Act is a HORRIBLE bill and needs to be repealed. Some of us think it will save primary care from oblivion. But the reality of the situation is that it's here. I do not believe the TMA can afford to sit and wait around to see if it gets repealed after the November elections or is chopped up in a court of law. We don't have that luxury.

We have to get to work now - and as Bill Fleming reminds us, the TMA slogan for health system reform "Keep What's Good - Fix What's Broken" is still our rallying cry.

I don't see this as a "if life gives you lemons, make lemonade" situation. Yuck! I hate that expression! Maybe it's because I hate lemonade.

Taking advantage of change is NOT making lemonade out of lemons. It's NOT making the most of a bad situation. It's NOT digging through a pile of manure because you're convinced there's a pony in there somewhere. It's NOT putting lipstick on a pig.

But it is human nature to be more willing to change when there's a crisis. People - and organizations - and societies - will be more likely to change when the pain of change is less than the pain of staying the same.

I don't think anyone in this room is happy with the pain of staying the same -interference in our relationships with our patients -rationing health care by hassle -choking a practice's viability through declining reimbursements.

We know the status quo is not acceptable. We know Medicare is going broke in a few years. We know Medicaid has the potential to bankrupt the state.

TMA is not afraid of change - our House of Delegates has been working on health system reform policies for years. And if any medical society is prepared to help its members through these seismic changes through advocacy, education, and engagement, it's our Texas Medical Association. This is not an organization that just drifts along with change - this is not an organization that is in denial about change - this is an organization that listens to its members and responds to their needs. This is an organization that focuses on its vision - physicians caring for Texans.

Together this year we will take advantage of change. We will use the health system reform bill as a catalyst to help us identify what needs to be done on Capitol Hill, in Austin, and in our own offices to make sure our patients have access to excellent care. We will use the health system reform bill as a catalyst to make sure that our practices stay viable. We will use the health system reform bill as a catalyst to make sure physicians have the autonomy to make decisions that are in our patients' best interests.

Our first step is to analyze what is and is not in the bill. TMA has already been hard at work on this, and I'd like to take this opportunity to thank Dan McCoy and the Council on Legislation for the work they've already done and will continue to do.

The next challenge is EDUCATION - of ourselves, our members, our patients, our legislators, and policy makers. No one can understand how a practice works and how medical care is delivered like a doctor can.

We're developing a multipronged communications plan to reach out to the many different constituents involved. From written materials to seminars to social media - TMA is there.

I will be starting a regular WebCast from my office - which means I have to clean it up - that won't just go out to TMA members - we'll broadcast it through Me and My and YouTube. We'll continue and expand CME offerings like the one we had yesterday afternoon.

Then it will be time for ADVOCACY. We have already started developing a comprehensive state legislative package in anticipation of the 2011 Texas Legislature, which is only 8 months away. We have the tremendous opportunity to make sure that Texans decide what health reform will look like in Texas. We will be able to take advantage of change by focusing on issues we can best deal with at the state level - some of which we identified in the House Calls that we made around the state last summer.

People are paying attention to health care right now - this is a teachable moment, as it were.

Although I am quite aware that budgets and redistricting will preoccupy our legislators next spring, I think we should take advantage of this opportunity and strike while the iron is hot.

We'll continue and expand our House Calls around the state - we will need your help because these are truly local events and they work best when the local physicians are involved and get their patients involved. So when I come to your community … I sure hope to see you there.

Every two years TMA develops a state legislative agenda, but I think it's time TMA developed a formal national legislative agenda. TMA is the largest state society in the country. We pack a powerful punch, and I hope to see us become more active in Washington.

I want more Texas physicians visiting their Congresspeople and Senators. In fact, I think we should have a summit - in Washington DC - somewhat similar in format to the very successful Border Health summits held every summer. I want dozens if not hundreds of Texas physicians and alliance members to swarm Capitol Hill and visit every single Texas legislator in a couple of days. We'll have seminars attended by legislators and their staffs. It will become a "must event" on everyone's calendar. Stay tuned for more details.

An area where physicians must take the lead … indeed ONLY physicians can take the lead … is in measuring the quality of care we provide.

There's no question that there is a huge effort to pay physicians for quality, not quantity. There's not a physician in this room or in this great state of ours who doesn't want to deliver the highest quality of medical care possible. Not one.

But how do you measure that quality - fairly and accurately? I'm sorry, but we are just beginning to learn how to do it. And you DON'T do it by looking at claims data. Cheap medical care does not define quality medical care.

In my specialty, allergy-immunology, we have struggled for years on how to measure quality - or even WHAT to measure. It's axiomatic in our field that a hospitalization for asthma represents a failure of outpatient management. Right? And asthma hospitalizations are expensive. If I keep patients out of the hospital, not only does that save money, it's excellent outpatient care.

But do I get rewarded for that? Are any of the payors even THINKING of that? The quality measures currently proposed for my specialty - all 2 of them - are coding whether we put chronic asthmatics on preventive medicine - and how often we prescribe antibiotics. Wow. That's not quality measurement - that's bean counting - and it's missing a whole lot of very important beans.

Physicians must be the drivers in quality measurement, and this room is full of pioneers and experts in this. Past president Josie Williams told us two years ago in her installation address that she who holds the data rules the world. And right now, folks, that's not us.

As I thought about this coming year, looking at council and committee appointments, I looked at our current organizational structure and realized that quality measurement really didn't have a place to lay its head. It falls some in Socioeconomics, it falls some in Public Health, it falls some in Health Service Organizations - and it's far too important to the practice of future practice of medicine to just let it fall somewhere.

So I have begun the process of creating a new TMA Council on Health Quality. It will bring together the talent and great ideas from around the state to focus our efforts and help physicians and our practices show the world how good our medical care is and get rewarded appropriately.

I was hoping I'd be able to get through this speech without mentioning the SGR, but sadly it is still not fixed. Fixing the SGR permanently will not fix all of Medicare's ills - but we know that health system reform will not work without it.

The patches that keep happening at unpredictable intervals have made an already chaotic system even worse - and have made Medicare completely unreliable as a source of physician payment.

And the two week holds on filing claims that have happened twice now in four months have created terrible cash flow problems for many of our offices.

Surely everyone in this room has signed our petition to Stop the Medicare Meltdown, and we WILL get one million signatures. Every state society and 30-plus state and national specialty societies have signed on with us. Download some paper petitions and share them with your neighbors - take them to the hairdresser … take them to church.

How many of you are on Facebook? Well, organizations can create groups of "fans" - TMA and our Stop the Medicare Meltdown have Facebook Fans. I have had fun watching a group called "I Bet Texas Can Get One Million Fans Before Any Other State" and it started with 20 thousand, 50 thousand, and kept going and going until they're over 900,000 fans now. They will make it! If something like this can get a million signatures, WE CAN TOO!

Wouldn't it be nice to have our Texas Summit in Washington DC and present Congress with a million signatures to fix the SGR?

In addition to advocacy and education, we must have ENGAGEMENT. I plan to reach out to other groups such as AARP, employer groups, even other states - and work hard to make sure that all physicians in all of their varying situations - new in practice, academic, large groups, small and solo practices, rural - and to our amazing alliance.

I am a proud alliance member, and I have been for many years. Our alliance is a treasure and will be the key to our success. I look forward to working with Doris and utilizing the alliances' talents and energy this year. If your spouse or you are not alliance members, please join today. Let's make the strongest state alliance in the country even stronger. 

As long as we're talking about change, I changed a couple of months ago - I became a grandmother for the first time! I have had the wonderful privilege of having 3 bonus grandchildren through my and my son's marriages - Mason, Bailey, and Emily are the light of our lives and we are so proud of you - but Jackson is MY first grandchild. Yeah, yeah, I know I'm far too young to be a grandmother, blah blah blah, but he IS the cutest little boy the world has ever seen. Really. I'm being totally objective here.

When Jackson was just 19 days old, my son and his wife got a phone call that changed all of our lives forever. My grandson's newborn screening - screening tests we advocated for in the last legislative session - came back positive for cystic fibrosis. Within hours we were in the CF clinic at Cook Children's here in Fort Worth - numb and dazed. As we sat in the examining room staring at the floor, my daughter-in-law looked at me and said "I can't believe the health reform bill we fought against has something in it we actually like."

You see, Jackson now won't be discriminated against because he has a preexisting condition. My son won't be locked into a job because he needs insurance for his son's monumental health needs.

But as we fight to find a cure for this devastating disease, we must also continue to fight to make sure that adding millions of new Medicaid patients to the rolls doesn't bankrupt the state or destroy this important safety net.

We must fight to ensure that clinical research isn't brought to a standstill for lack of funding.

We must fight to maintain and grow our medical schools and GME programs and have plenty of good primary care physicians and specialists.

We must make sure that physicians have the autonomy to practice medicine the way we see fit without interference in our decision making or our sacred relationships with our patients.

My sleeves are rolled up and I'm ready to get to work. I need you with me. We need your wisdom and courage and dedication, now more than ever. With your help, TMA will continue to be the largest and strongest state medical society in the country.

And I am honored and awed by this amazing opportunity and privilege to be your president this year.

Thank you Thank you all very much. I promise I will do my best to represent you and our patients as we take advantage of this time of change.

God bless you all, God bless Texas, and God bless the Texas Medical Association. 

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