In order to spur the widest possible member involvement, LACMA has re-established a number of dormant committees and created a variety of new ones. A few officers and board members cannot do this alone, and I encourage you to participate either through a committee or in your local LACMA district.

Due to the antitrust restrictions on the freedom with which physicians can negotiate with insurance companies and the discussions that we can have with each other, LACMA cannot and will not urge physicians to take any concerted action as a group with respect to the latest Blue Cross fee schedule alterations. However, every physician must be cognizant of his practice overhead and margin to ensure practice survival while making a reasonable income given the long years of training, steep education loans, and return on investment of time and energy.

Where does the patient's personal responsibility end and physician babysitting begin? When do patients and families take responsibility and when do we stop blaming physicians for everything that goes awry in healthcare?

Physicians are under constant pressure to alter their prescribing habits--and new developments are adding to the force.

In October, KCET Channel 28 interviewed me about medical tourism. While many physicians who hear the term medical tourism may think of continuing medical education programs held in vacation locales, that is not the type of medical tourism I was asked to discuss. Rather, there is a growing trend of patients seeking medical care overseas to avoid the higher cost of healthcare in the United States.

The Los Angeles County Medical Association delegation to the California Medical Association House of Delegates had an amazingly successful and productive meeting this year. LACMA's advocacy on behalf of our members resulted in the passage of a number of policy statements by the CMA.

The Los Angeles County Medical Association is getting set for a dynamic 2008 by bringing in new executive leadership and organizing vital political advocacy programs.

Although Governor Schwarzenegger's healthcare proposal failed to pass the state legislature, both the CMA and LACMA are on record in support of some form of healthcare reform. As physicians, we are painfully aware of the control that insurance companies exercise over the care we provide for our patients. We find ourselves frequently at odds over requirements for prior authorization for medications, procedures, imaging studies and even necessary laboratory tests with insurance company medical directors who may not be aware of the latest advances in a given specialty.

When we ask Los Angeles County Medical Association members and non-
members what they consider to be the most important activities that LACMA should engage in, we are consistently told that economic and legislative advocacy are the two highest priorities.

I believe it's appropriate to reflect on Dominick's accomplishments during his first 100 days in office, as well as LACMA's accomplishments over the year of my presidency.