There Are Things That We Can Do*

There are many reasons for us to be concerned about the changes in the health-care system and how they are affecting us. At the federal level, we have the impending reforms of the Medicare and Medicaid pro-grams, the proposed cuts in funding for research and graduate medical education, and the continuing regula-tory constraints from the Federal Trade Commission, the Food and Drug Administration, and the Health Care Finance Administration. State and local concerns center on the continuing growth and evolution of managed care and the local consequences of Medicare and Med-icaid reforms. These changes are having a significant impact on our ability to deliver quality care because of the overriding focus on the bottom line, the loss of phy-sician control of clinical decision-making, the limitations in the access of patients to our care, and indeed the viability of our practices and our specialty. These concerns are becoming so overwhelming that there seems to be a growing sense of despair that there is little, if anything, that we as individuals or as an Acad-emy can do about them. The changes are being cost-driven by forces of immense power- the federal and state governments and big business. Individual ortho-paedists are vulnerable if they directly attempt to ad-dress problems associated with managed care. We have concerns that too many orthopaedists are being pro-duced, but antitrust laws and the Federal Trade Com-mission limit our ability to act as groups of individuals or as an organization. Finally, federal and state legisla-tors have little or no interest in what we think because they see us as being self-serving and as merely trying to preserve our incomes. Certainly there are reasons for concern, but I do not believe that there is reason for despair. There are things that can be done that can make a difference. Before turning to those initiatives, I want to emphasize a few *First Vice-President's Address. Read at the Annual Meeting o