COMMENTARY
Sandy Johnson , MD
My dad has and continues to have a very big influence in my life . He has many sayings that replay themselves in my mind . Some of these include “ When the blind lead the blind , they both fall in the ditch ,” “ Knowing is doing ,” “ The only way to do great work is to do what you love ,” “ Your life is God ’ s gift to you and what you do with your life is your gift to God ,” “ Judge and you will be judged ” and “ Make sure the door does not kick you in the $$ on your way out .” He likes to work hard and play hard . He also has overcome a lot in life including being injured in battle in Vietnam . He wants me to make sure to live every moment to the fullest because you never know if this moment may be your last moment . I know he repeatedly says these things to remind me to make good choices , give my best , treasure every moment , and to love everyone in my life .
While my dad takes life by the horns and lives every minute to the fullest , my mom believes more in moderation . She believes in “ quality over quantity .” I have been blessed to have two wonderful parents who teach me various great values , love each other , and love me .
I have been thinking about their sayings recently when it comes to the practice of medicine . Our clinic , Johnson Dermatology , has a saying also : “ We strive to provide the most effective , efficient , empathic , and empowering medical care .” We have opted to participate in all of the quality improvement programs that we can . We participate in MOC , MIPS , MACRA , PQRS , Choosing Wisely , MORE , etc . We have our own internal reviews and quality assurance programs . We have recently learned that BCBS is now rolling out its Value Based Compensation Initiative as a way to “ reward value over volume .” At first glance , this sounds skintastic . I believe quality always wins . Quality definitely wins in a free market society . However , as some people say ,
Quality Versus Quantity
the devil is in the details . I am interested to know how many physicians were involved with creating this program . One of my concerns is who is excluded from the program . If I understand it correctly , non-physician providers , NPPs ( nurse practioners and physician assistants ), are not included . At Johnson Dermatology , I work very closely with two NPPs . They went through a rigorous training program with my husband and myself after their schooling . We work under the same roof . We follow the guidelines of working with NPPs closely . I think NPPs are an important part of the medical team . I am concerned why they would be excluded from this program . I think our NPPs provide high quality care .
That being said , I think we all know of NPPs who choose to work independently . There is even legislation and movements to allow NPPs to work without the collaboration or supervision of a physician . I have – and I am sure many of you have – seen patients who have not received high value or high quality care from some of these independent NPPs . My concern is that if BCBS and other organizations are going to be judging physicians on quality , shouldn ’ t they also be judging NPPs ? If NPPs are wanting to be treated the same as physicians , shouldn ’ t they be held to the same standards as physicians ? I think we all would agree that the training of a NPP is much different than medical school , residency , and board certification . I think we all would agree that we all want to provide the latest and greatest care ; that is why we participate in MOC , read journals , do CME , attend conferences , chat with our peers , participate in medical societies , etc . I think we all would agree we strive to provide high quality care . I am excited to participate in these programs . Like my mom , I believe in quality over quantity . Like my dad , I believe that the only way to do good work is to do what you love . I also believe ; however , that when the blind lead the blind , they both fall in the ditch .
Stay skintastic .
David Wroten Executive Vice President
Penny Henderson Executive Assistant Journal Advertising
Nicole Richards Managing Editor
Jeremy Henderson Art Director
EDITORIAL BOARD
Appathurai Balamurugan , MD , DrPH , MPH Family Medicine / Public Health
Robert Hopkins , MD Pediatrics / Internal Medicine
Sandra Johnson , MD Dermatology
Issam Makhoul , MD Oncology
Naveen Patil , MD , MHSA , MA , FIDSA Internal Medicine / Infectious Disease
Benjamin Tharian , MD , MRCP , FACP , FRACP Gastroenterologist / Hepatologist
EDITOR EMERITUS Alfred Kahn Jr ., MD ( 1916-2013 )
ARKANSAS MEDICAL SOCIETY 2017-2018 OFFICERS
Amy Cahill , MD , Pine Bluff President
Scott Cooper , MD , Rogers Immediate Past President
Lee Archer , MD , Little Rock President Elect
William Dedman , MD , Camden Vice President
Chad Rodgers , MD , Little Rock Secretary
Bradley Bibb , MD , Jonesboro Treasurer
Michael Saitta , MD , Fayetteville Speaker of the House of Delegates
Eugene Shelby , MD , Hot Springs Vice Speaker of the House of Delegates
Danny Wilkerson , MD , Little Rock Chairman of the Board of Trustees
244 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY VOLUME 114