In My Opinion

“A CALL TO ARMS”

Jack L. Gluckman, MD
University of Cincinnati
Cincinnati, Ohio, USA

I am, by nature, an unabashed optimist. I am proud of what we do as head and neck oncologists and what the American Head and Neck Society accomplishes as an organization. I am sure that you will agree that the field of head and neck oncology has always been interesting and exciting, fueled by dramatic developments in the basic sciences and the clinical applications that have resulted. Our patients receive superior care with improved quality of life and survival. As such, it has kept us all enthusiastically involved and has attracted the brightest and best of our residency graduates to our field. Add to this the pleasure of being part of a community of like-thinking individuals who comprise the membership of the American Head and Neck Society and we have created a wonderful milieu in which to ply our trade and tend to our patients.

Unfortunately, today even the most optimistic amongst us are becoming frustrated and disillusioned as dwindling reimbursement is taking a terrible toll on our ability to deliver high-quality care. Many of our colleagues - highly trained, experienced surgeons, both in community practice and at academic centers - are becoming physically and emotionally exhausted and are opting out of the field, citing “burn out”. While in some cases this is true, we all know that for most the reason is simply economic. “I just cannot afford to take any of these patients any longer” is a common refrain heard today.

While this trend has been occurring for some time, the sequelae are only now becoming apparent. The tertiary referral centers, usually academic centers, are being swamped by the deluge of referrals, straining their already limited resources and negatively impacting on the morale of these physicians. At many of these centers, the wait list for surgery for these cases is becoming unacceptably long. I am not sure how long this situation can continue before patient care is gravely impacted.

Even more disturbing however, is my impression that many patients are now being offered “the wrong treatment for the wrong reasons”. Treatment dictated by cost and time constraints by well-meaning, but overwhelmed physicians. The number of recurrent and persistent cancers following failed inadequate and ill-advised initial therapy has increased dramatically and this impression is confirmed by colleagues throughout the land. Yes, the unthinkable has finally happened and I, like you, am appalled for in the end it is our patients who are drastically impacted.

And yet, who can blame them? The system is collapsing, and if we don’t do something to pull ourselves out of this downward spiral, I fear for our patients and our subspecialty. Our trainees have noted these developments and are no longer attracted to our field. Note the declining number of applicants for fellowship positions if you need proof of my words.

So, this editorial is a “call to arms” to members of our society. As a matter of urgency, we need to embark on an aggressive campaign to educate the public and our own colleagues as to the complexity of our work and the importance of providing superior care to assure quality of life and improved survival. Secondly, we need to work with governmental agencies and third party payors to improve reimbursement. Organizations such as the American College of Surgeons and the American Academy of Otolaryngology – Head and Neck Surgery can help, but in the final analysis, we, as the greatest stake-holders, will have to take the lead in organizing and coordinating the efforts.

So let us take the initiative now. If we don’t, we may end up with a derelict specialty and will have failed our patients in the worst way.