Willie Underwood: Thank you very much. I had a great time at the SUO, and it's usually meeting physicians and stuff. And Sam, you and I have been friends for over 20 years now, man. This is awesome. Look, the main point is this, is that we have to get involved, and this is an opportune time for us to truly transform this healthcare system. And then they say, "Willie, why are you transforming the healthcare system?" Because we all know it's broken, right? I don't think there's any one of us, any physician, that would disagree with these simple things, one, that the hospital administrator's clipboard has greater power, greater weight than the physician's stethoscope used to detect a murmur. We know that. The computer or the pen that we use to write a prescription, and the scaffolding robot we use to save a life, they have more power. The insurance company has more power. They're able to inflict pain when they see fit. And what we're doing is grinding, trying to figure out how to sustain our practice, but most of all, improve the quality of life and the healthcare of our patients. There's chaos right now, total chaos. We try to enhance. The AMA works extremely hard.
So with the AUA and other groups in medicine, we've got 50 states, over 130 specialties working together, and we tried to get Medicare reform. Because why? Because 33% decline since 2001. That's including the cost of inflation. We all know that, and we all feel that. We know the current cuts in Medicaid are going to have a significant impact on our ability to provide care in every aspect of society, be it rural hospitals, urban hospitals closing, labor and delivery shutting down, millions of people being left off the rolls, not having healthcare. We know that that's going to be a major impact. With those things afoot, right around the corner, coming in January, now is the time for us to get involved. And how should we get involved? Join, join, join. Participate. And we could talk about that later, but I got an idea on how we should, and should participate, but I want to hear some more questions, but that's the key message. Get involved. Get off the couch. Let's come together. Let's create a system that works for us.
Sam Chang: So Willie, as you are leading this big national organization, just as you said, we've got the 50 states, we have these different subspecialties. Kind of tell how an individual, say an individual urologist in, let's say, Cookeville, Tennessee, or in Fayetteville, Arkansas, or in Santa Monica, California, how can they get involved locally, regionally, nationally? Give me some ideas.
Willie Underwood: Okay, so number one, join, because membership has its benefits. And the more physicians we have that are members of the American Medical Association, that are members of the American Urological Association, American Association of Clinical Urologists, that's key. That's number one. Number two, get involved in your county society and your state societies. Now, being a member allows them to count you, so when people say, "Well, who do you represent?" If there's 50,000 physicians in your state, you want to be listed as one of the 50,000 physicians that say you care. If you're not a member, you're basically saying, "I don't care, so if you want to kick me, kick me. I'll take it and I'll continue to take it." But being a member says, "No, no, no. Enough is enough and too much stinks." That's number one. Some of us, like myself and like you, may decide that we want to be actively involved. That's a greater commitment, which the more the merrier, the more people that we have who are involved, but we're saying, "If you get involved, please understand and study the issues so that you can be a valued participant in the conversation as we begin to evolve this system to a greater place."
So we think about it. So then that's secondly. If you're a member of your state society, you're a member of the AMA nationally, you're a member of the AUA or the AACU or both, I'm a member of both, then your number's counted, your financial support gives us power. The second aspect of it, or the third even, is the PACs, so our political action committee, and making sure that we're financially committed to the PACs. What do I mean by that? So let's say our 14,000 urologists all gave $250 to the urology PACs. We would have a $3.5 million PAC. That allows us to, whether we use that at the state levels to deal with scope-of-practice issues or insurance issues that are all state levels, or we use that collectively at the federal levels, that gives us not a seat at the table, that gives us a seat in the driver's seat. We're now driving the bus, so to speak. If you give another $250 to the state PAC, then the states become tens of millions of dollar PACs. So if you think about it, $250 times 50,000, let's say, now you got, what, $13, $14 million PACs. Then you give another $1,000 to MPAC. That makes it a $300 to a billion-dollar PAC. It all depends on ... We got 300,000 physicians who are members of the AMA, and that doesn't include the majority of urologists. So let's say we all become members and we all give that money, then our PAC is a billion-dollar PAC. Every problem that we face in healthcare goes away overnight, overnight, because we're now saying, "This is what this system would look like." So that's at the bottom level, the resources. At the top level, we have to have a plan.
We just can't say, "We don't like this. We don't like that." We got to sit down and say, "How do we deliver healthcare in the regions in which we live?" So I do locums and I practice in Pennsylvania ... not Pennsylvania, Princeton, West Virginia. Doctors in Princeton, West Virginia should be sitting down saying, "How do we provide care in this part of West Virginia? And how do we provide care throughout the State of West Virginia? How do we provide care throughout the State of Tennessee, in each county?" We have to drive that conversation, because there are people sitting down saying they believe that they can manipulate us to get us to do what they want us to do to solve a problem that they're trying to solve, but that problem may not be the real problem that needs to be solved. So example, insurance companies say, "Hey, our bottom line is not ... We want to increase our margin." That's the problem they're trying to solve, while we're trying to figure out how to provide care to the individuals walking in our door. So, we have to have a delivery system and a financial system that actually works.
Sam Chang: I mean, Willie, you've taken a very difficult concept and you can clearly see how just if each of us do just a small amount, in terms of support, and then at higher levels, we're able to actually then formulate policies for local areas, for state areas, for our subspecialties, et cetera, then that ability to have so much more weight really will help, just as you said, actually provide the framework of what we need to do, as opposed to being told what we need to do. I think the frustrations that you state regarding what we feel that many practicing physicians and many patients regarding the insurance companies dictating what we do, the administrators dictating what we do, as opposed to the physician and the patient and their journey together, I think is an incredibly powerful one. And obviously everybody needs to really work together, but there is a real sense, and I think you've really kind of made that quite clear that the physicians feel a bit left out, for sure. And to be able to help direct policy, just as you said, with you in your leadership role, I have no doubt we're going to make some significant inroads to improve patient quality of care everywhere. And so, I want to offer, first of all, my support, and I think, but most importantly, my thanks for all of your efforts and all the efforts that the AMA and all of our organizations have made on our behalf, and I look forward to more future involvement from all of us.
Willie Underwood: Me too, and thank you very much. Your support and the support of others is what brings us to a reality.
Sam Chang: Willie, you're the best. Thank you so much, man. I appreciate it.
Willie Underwood: I appreciate it. Thank you.
Sam Chang: All right.
Willie Underwood: Looking forward to working with you.