“Change is the law of life. And those who look only to the past or present are certain to miss the future.” ~ John F. Kennedy

No one really likes change. Some may claim they want or welcome change, but there is something within them that wants to cling to the present, or the past. How many times have you thought to yourself, “But we’ve always done it this way!” Don’t worry; it’s natural to resist change. But understand this: change IS the law of life. Everything changes; hopefully it is in small, easily-digestible bite-size pieces, because we accommodate more change when it is slow and barely noticeable.

Think of the (usually) slow transition of the seasons, or the budding and then flowering of fruit trees. Eventually that bump at the base of the flower becomes a pear, or an apple. If one day there were bare branches and the next day full ripened fruit, how magical it would appear to us, though the same end is accomplished through the gradual process of growth.

I sense we are on the cusp of some big changes—in our neighborhoods, our state, our country, and in our world. I’ve told more than one of you “It’s going to be a long, hot summer,” and I mean more than just the weather. When so many different things are teetering on the edge, change is inevitable. Whether for better or for worse is anyone’s guess, and subject to their own perspective.

The Affordable Care Act started a wave of change in the medical world that continues to have an impact on patients and physicians and medical care workers daily. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2013 will change how physicians are paid, especially with the recently disclosed 952-page rules on payment. The very physician organizations that heralded that bill as the “Doc Fix” are now complaining that this will bankrupt the vast majority of independent physicians and are “demanding” the rules be changed. That will not happen any more than will Congress repeal or replace the ACA. These changes will impact American medicine for years, if not generations, to come. Locally, here at the Lake of the Ozarks, a major hospital chain has pulled out and left their clinic (and its patients) stranded. Sure, patients can travel 30 minutes or more to go to one of their other clinics, but they will NOT be able to “keep their doctor” as the hospital system has stranded him as well. He will now be an independent physician, but if he intends to bill Medicare, the rules of MACRA will actually punish him for being independent! How long can one tread water?

Meanwhile, we soldier along here at Direct Primary Care Clinics, serving our members regardless of their insurance coverage, or lack thereof. I anticipate a day that Medicare will not cover the medications I write for Medicare patients, and when that day comes I am sure we will find a way around that roadblock too. Because that is what change does—it forces one to either conform or to find creative alternatives.

Here’s to creative alternatives!