Our top priority at the VCMA has and continues to be increasing and strengthening physician membership. We are only as strong as our membership.

The Medicare physician reimbursement cut fostered a great debate among physicians. Should we be Medicare-participating provers or nonparticipating providers? Should we opt out of the Medicare system completely?

Medical staff concerns about the board's apathy toward medical staff issues are being addressed. Medical staff officers have been reinstalled to the board, including chief of staff, chief of staff elect and past chief of staff. Two medical staff members appointed by the chief of staff and approved by the board are seated on every board committee.

When the Medicare Part D drug benefit was enacted on Jan. 1, the Medicare system became responsible for the prescriptions of its 41 million recipients. In essence, the federal government became the largest buyer of pharmaceuticals in the U.S. However, the legislation that authorized Medicare's drug benefit forbids the federal government from negotiating directly with the drug manufacturers to obtain lower drug prices for seniors and the Medicare program.

We physicians are making every effort to increase the funds for uncompensated medical care and to prevent further transfer of funds to the county health system. To support our message, we presented the recent Office of Statewide Health Planning and Development data from the first two quarters of 2005. This data showed a breakdown of the total number of uninsured (self-pay) and underinsured (Medi-Cal) seen at each hospital emergency room in Ventura County. Surprisingly, the majority (67 percent) of these patients are treated through private hospital ERs.

In April, the American Medical Association released a study chronicling the concentration of the U.S. health insurance market. Titled "Competition in Health Insurance: A Comprehensive Study of U.S. Markets," the study analyzed 294 metropolitan health insurance markets. Alarmingly, the study found 95 percent of markets had a single insurer with greater than a 30 percent market share.

In May, I attended the Ninth Annual California Healthcare Leadership Academy in Indian Wells. The theme was "Re-engineering Healthcare: Meeting Future Expectations Without Breaking the Bank." The California Medical Association developed an outstanding program. Personally, I found the meeting invigorating, yet sobering.

I have read many passionate e-mails from doctors. And I have had many discussions in hospital hallways with physician colleagues and at my office with my partners about these two issues. We agree the time has come for the physicians of California to stand together.

Physicians everywhere hope to avoid beginning 2007 as we began 2006 with a reimbursement cut implemented and retroactive action required to reverse it. In addition, we hope to avoid the situation where physicians must decide to opt out of Medicare due to poor payment rates, which results in reduced access to care.

On Sept. 19, the Ventura County Medical Association held its quarterly general membership dinner meeting. But the rather generic name of the event doesn't reflect the valuable and meaningful nature of what occurred that evening.

Late fall brought a flurry of activity at the Ventura County Medical Association. Most significantly, leaders of the VCMA attended the California Medical Association House of Delegates during the final few days of October. I was there for the action, along with Drs. Nick Bednarski, Art Inoshita, Lynn Jeffers, Kelvin Loh, Robert Lum, Gerry Murphy and Ronald Thurston.