Medical Turf Wars

Many years ago, when otolaryngologists (ear, nose and throat surgeons) were fighting to be recognized as experts in facial plastic surgery, I was involved in suing the Colorado State Board of Medical Examiners to defend my right to be listing as a "facial plastic surgeon" in the Yellow Pages. For those of you who don't remember, that is that big, thick yellow book that most people just recycle or use as a door stop these days.

With the support of several specialty societies funded by a political action war chest, we won the case and , it, among others, established a precedent and the eventual growth and development of the American Board of Facial Plastic and Reconstructive Surgery. Facial plastic and reconstructive surgery is now a recognized, significant part of the practice of otolaryngology-head and neck surgery and testing concepts in facial plastic surgery represents a significant part of the board examination process.

As long as there is ego, fear and greed, there will be medical turf wars. The latest are MDs battling with non-MD providers. Interventionalists are trying to carve out the turf previously reserved for other specialists. Dentists and oral-maxillofacial surgeons want to claim that part of your craniofacial real estate from MDs too. I was a bystander to the birth of the emergency medicine specialty.

In the meantime, patients are wondering who is representing their interests and are increasingly confused by the branding and marketing messages flooding the internet and online sites.

Turf wars are another part of the ugly underbelly of medical practice and will continue to be in the foreseeable future as long as disparate medical interests lay claim to dwindling resources and profits. Some would argue that the turf wars are simply the free market at work. Others, in the name of protecting patients and quality of care , claim they are applying higher standards to protect the public interest or, by creating innovative care models delivered by non-MD provider substitutes, that they are simply serving a market need without sacrificing quality of care. Others see it as a cartel just trying to protect their pocketbooks and those of their members.

Recent turf wars have flared in the world of telemedicine and medical travel. In both instances, doctors in one place don't like it when another doctor outside of their network or location takes care of "their" patients.

The resolution of these conflicts depend on many social, political, regulatory, legal and economic factors. However they play out, they are a part and parcel of medical practice and participants should expect to engage instead of just wishing they would go away.

Remember, there is nothing more ugly or dangerous than a doctor with a wounded wallet.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs and Chief Medical Officer at Bridge Health and Cliexa