Mid-summer brings in a new executive team for Los Angeles, Orange and San Bernardino counties. In July, three major medical associations--the Los Angeles County Medical Association, the Orange County Medical Association and the San Bernardino County Medical Society--rang in new presidents and other executive members. While all three support many of the same policies and actions as their predecessors, they all bring in their own special interests, causes and fresh ideas. Here's where--and how--you can expect them to lead their members in the coming year.

Howard Krauss, MD
President, Los Angeles County Medical Association

Remember "Network"? Peter Finch won a posthumous Oscar for the 1976 movie in large part for an stunning, unforgettable scene in which he exhorts his viewers to rise up and say--all together now--"I'm as mad as hell and I'm not going to take this anymore." That's exactly what Howard R. Krauss, MD, the ophthalmologist who just became the 137th president of the Los Angeles County Medical Association, wants physicians to do.

Listen to this: "I'll admit that surviving an upbringing in a city housing project in the Bronx has contributed to a significant reservoir of paranoia and cynicism that's easy for me to tap into, and I hope I'm wrong, but I know that it's time for physicians to come together to take back the practice of medicine from the politicians, the press, the regulators, the administrators, the reviewers and, worst of all in the lineup, from the for-profit health plans. It's not about our income. I haven't taken a raise in ten years. It's about our ability to be respected as the best authority for evaluating and directing the management of our patients' care."

Specifically, says Dr. Krauss, a 25-year veteran of LACMA, organized medicine must drive a return to the primacy of the physician-patient relationship. "A physician shouldn't have to employ someone to obtain authorizations for treatment or spend 15 minutes on the telephone tracking down a health plan nurse to obtain authorization for a MRI for a patient with headaches and papilledema," he says. "Our system abuses patients and doctors."

One especially damaging result of the bizarre economic pressures in the healthcare system is a medical profession that has circled its wagons--rifles aimed inward. "We've allowed ourselves to be divided against ourselves," he says. "While the for-profit health plans and their CEOs have enjoyed ever-more-sumptuous meals, we physicians have been set to fighting under the table, at their feet, over which one of us is entitled to the biggest crumb!"

The situation is dire, he adds. Solo and small-group practice doctors fight with group docs. "Cognitive doctors" demand an ever-increasing share of an ever-shrinking pie. Radiologists continue to support changes in law and regulation to inhibit ownership or utilization of imaging devices by non-radiologists. And plastic surgeons continue to advocate that only those certified by the American Board of Plastic Surgery are the best-qualified to perform any procedure construed to be cosmetic or plastic.

And things are going to get waaaaaay worse before they get better if physicians don't get, well, as mad as hell. "If we physicians don't claim the high ground, to which we are inherently entitled, of individually and collectively being the prime authority in the care of our patients; if we don't work together to fight for the best interests of our patients, we will become extinct," he says. The American healthcare system is close, he warns, to "a monolithic, universal takeover by for-profit health plans that will be more concerned about executive compensation and 'shareholder value' than about facilitating the provision of high-quality, necessary medical care."