Standing on the sideline and complaining is taking the easy way out says John Hale, MD. Taking a leadership role means you have no one else to blame but yourself, so after 24 years involvement in the Tennessee Medical Association, Hale knew it was time for him to take the reins as president. Leadership is nothing new to Hale, who started honing his leadership skills in high school when he was president of his class. In college he was active in student government. As president of the Tennessee Medical Association (TMA), Hale is working hard to make a difference while sharing his passion and belief in what the organization can do for physicians and patients across the volunteer state.
Growing up in Halls, Hale’s first job at the age of 13 was picking tomatoes for $1.25 an hour. Since it was a typical summer in the South, the temperature was scorching and the humidity was nearly 100 percent. “I would bring the tomatoes into the sorting shed where my great aunt Myrtle was,” said Hale. “She asked me one day what I wanted to be when I grew up. I told her I thought I wanted to be a lawyer to which she quickly replied that I would go to hell. Given the heat I was working in that was a pretty good indicator of what it may entail. She then said I was smart and encouraged me to be a doctor. I’m a firm believer in the good Lord, faith and callings. I can say God put medicine in my way and everyday has pointed me toward where I am today. Medicine is my calling.”
Hale opted for a cooler environment for medical school, graduating from Quillen College of Medicine at East Tennessee State University in Johnson City in 1988. He completed his residency in family medicine in Jackson at the UT Family Medicine Program in 1991. Hale began his medical career at the clinic where he still practices today, Doctor’s Clinic in Union City, a clinic with quite a legacy with TMA. Kelly Avery, MD, who had retired when Hale joined the clinic, had served as TMA president in 1970 and was instrumental in the development of the State Volunteer Medical Insurance Company. Many of the older physicians had served on the Board of Trustees and some had been chairman.
“I was by far the youngest physician at the clinic at the time and when it came to my joining the TMA, there was really not a choice. The older partners had all been active in it for most of their careers and they made sure my dues were always paid. I attended my first meeting three weeks after starting,” said Hale. “They engrained in me that this organization is the voice for doctors all across the state, all that this organization has done for physicians and their patients as well as the importance of membership.”
When it comes to passing that philosophy on, Hale has done his part. “I try to do the same thing with any new physician we bring on staff, taking them to meetings and getting them involved. I think their eyes are opening up to what we are all about. I also encourage new members to attend our Leadership College, which is a great way to get an understanding of the TMA,” he said. “24 years ago, this organization was pale and stale, but we have worked hard to overcome that. We don’t want to look to the past but rather build on it as we look to the future. We know as an organization it is important for us to connect with young physicians and female physicians. In fact, the Chairman of our Trustees is a female as well as we have our first female Speaker of the House.”
Hale, who started attending annual meetings in 1992, has followed in the footsteps of some of his mentors and has held various positions with TMA. “I started out being a judicial counselor, which hears complaints and governs the medical society on legal-type issues. I have served as Chair of the Young Physicians Delegates to the American Medical Association,” said Hale. “Additionally I have served on the Impact Board, both the Communications and Memberships committees as well as on the Board of Trustees. Before I ran for president, I was the vice speaker and then the Speaker of the House of Delegates.”
One has to wonder how a rural family medicine physician in a busy practice has time to not just be a member of TMA but to be president. Hale acknowledges that his level of involvement will take time from his busy practice and that not all his patients are thrilled at that. “Some of my patients are a little concerned about me taking this spot. They will congratulate me but ask if I am going to be out of the office,” he said. “I will be out one day a week except during our peak months. I have four wonderful partners who are willing to take up the slack and a very supportive wife and family. Without them, I could not do this.”
TMA was founded in 1831 by the state legislature and is committed to the health of Tennesseans. Hale says there are many things the TMA has championed that have gone unpublished. “TMA works on a legislative basis on Capitol Hill. Often, it is due to our efforts that keep things we know are not good for medicine from getting out of committee. Legislators come to us seeking our opinions and asking our position on legislation. Sometimes they take our advice, sometimes they don’t. But if we don’t have someone speaking for us things would be a lot worse. Just think of the impact we could have if every physician belonged to organized medicine,” he said. “We’ve been a voice on tort reform, led a coalition to get caps on malpractice rates. We have a physician present at every meeting on the Health Initiative and are working with the Governor on what quality medicine is that is not based on economics. There are lots of issues we have been a catalyst in that many do not know our level of involvement on.”
One area Hale knows organized medicine could have had a bigger impact is the adoption of electronic medical records. “We started using them about a year and a half ago. It puts up a barrier to the patient. When I walk in a room I have a laptop with me and apologize to the patient that I have to login before we start,” said Hale. “I try to make sure they understand the good aspects of it but the bad thing is it does take some of my attention away from the patient. Communication is vital. Patients today are better educated and want to be informed. You have to embrace them in the decision making process so they understand their options.”
Many doctors are frustrated with how tough the practice of medicine has become; so much so that many are selling their practices to large organizations to avoid having to deal with the business side of medicine. “I know there are doctors reading this that can identify with this,” said Hale. “We have lost a lot of independent doctors because of the pressures that providing efficient quality medicine causes. The practice of medicine is so tough that you need group mentality to survive it seems. Our practice sold to Baptist. That arrangement has allowed us to have a new building and implement EMRs, which we could not have afforded otherwise. We have a great relationship with them and it has been a good thing.”
While preparing to take over as president, Hale participated in a transition meeting where he was asked what he wanted to do over the course of his presidency. “At first I thought ‘oh my goodness what have I gotten myself into,’ then realized the awesome responsibility I had placed upon me to serve as president of the voice for patients and doctors in this state,” said Hale. “Fortunately I have a lot of folks who will help me maintain this organization and deal with the many issues we have ahead of us such as payment reform, scope of practice, the health initiative and telemedicine. I think my biggest goals are to be a voice for physicians and our patients, keep the organization moving forward and to educate physicians on the value of membership in the TMA.”
In keeping with the changing landscape of healthcare, Hale plans to speak to large groups that are buying up practices and large practice groups across the state to see what they can achieve as a group. “Large groups are where a lot of medicine is heading and TMA needs to address the needs of these entities without sacrificing those of individual physicians and independent group practices,” he said. “The basis is quality medicine. With health initiatives we have to talk economics and quality in the same sentence. We cannot continue to put as much in healthcare as we do but we cannot afford to sacrifice quality.”
TMA is also working to be more accessible to doctors, especially those in rural areas. “We are trying to go where the doctors are rather than have them come to us,” said Hale. “We are taking our ICD-10 seminars as well as our prescribing lectures on the road so that rural areas have easier access to them. We are also trying to capitalize more on the eight regions across the state and go with a more regional model that include the metro areas and then combine the rural areas outside those to make them not only more effective for the TMA but physicians as well.”
With a goal a making TMA a value based membership that is tangible to all, Hale wants doctors across the state to be proud of their organization and encourages members to wear their membership pins everyday. “So often patients believe the stereo typical idea that all doctors have fancy cars, a big house, belong to country clubs but when you ask them about their doctor, they will say he is caring, listens and is such a blessing to my family,” said Hale. “The same is true about the TMA, physicians may not really think there is benefit to membership but when you wear your pin it can start a conversation about what the organization can do for not only doctors but patients as well. Wearing your membership pin signifies that you are committed to quality healthcare and want the best for patients.”
To physicians who are not active and wonder why they should join, Hale says give him five minutes. “I can tell them what TMA has done for them in the past five years alone. What we have done in regard to tort reform alone saves them each year three times the cost of membership,” he said. “You may think that all it takes to practice medicine in Tennessee is to go to med school, get licensed and be board eligible but it actually only takes so many votes in the legislature. We fight everyday to make sure that folks who have not gone to medical school cannot get in on the practice of medicine. Without the TMA there would be so many more barriers between the patient and the physician than there already are. There is a lot more interference in medicine today, which frustrates many doctors but the only way we can move forward and continue to advocate for patients is through membership in TMA.”
When asked why he is so active and involved, Hale says simply someone has to do it. “The TMA is so important to me and I am not being cliché when I say it is such an honor for me to serve and it is something I really wanted to do,” he said. “So often doctors believe they need to just keep their CME’s up, do good work and go home but there are a lot of outside influences affecting patient care. TMA helps control those outside influences. It is a calling and we have to advocate for our patients and fellow physicians.”
