06/21/2009 11:48 am ET | Updated May 25, 2011

Which Side Are Docs On?

Politicians and physicians share a professional perspective that the painless optimal solution is often out of reach and that they'll have to settle for an imperfect answer than will impose some discomfort.

This quest for the least painful option defines the ongoing dance between doctors and the White House. The Obama administration basically argues that change is inevitable and the only question for physicians is whether they'll help drive or risk becoming road kill.

But doctors are harder to cow than insurance companies, who have no friends, or pharmaceutical firms, who are simultaneously loved for their product and hated for their pricing. Doctors have a lot of friends - the patients who rely on them. As Ceci Connolly points out in the Washington Post they outpoll even a popular president.

On the other hand, they do not speak with a single voice and are very aware that reforms may advantage some physicians - especially those providing primary care - at the expense of others like highly-paid surgeons. That gives doctors reason to try to get on the winning side rather than defending a status quo that seems increasingly untenable.

The quest for evidence-based medicine, embedded in already-enacted economic stimulus legislation, gives reformers a tool to recruit doctors. New research would define optimal care, which often is different - and less expensive - than what doctors are doing today. How to turn these findings into practice is a key question.

Doctors can reject it, attempt to stick to their old habits, resist efforts to impose it on them and rally their patients against rules imposed by faceless bean-counting bureaucrats. That worked when they successfully resisted and rejected managed care a decade ago.

Things have changed since then. The cost problem is seen as more acute. There's a growing realization that there's substantial overconsumption. And opposing protocols set by reputable scientists would be much tougher than pushing back on insurance companies that had meager public support.

Or physicians can get with the program, embrace such research and argue that it will allow them to provide the best possible care that has always been their goal.

The choice isn't easy for many physicians who still have years of practice ahead because they don't know how onerous the standards, which won't exist for at least a decade, will be.

Doctors are being asked to gamble about the future, something they often do in making treatment decisions. The Administration is betting that they'll ultimately conclude that joining the process and trying to influence it, both now and later, is the best of the imperfect options they face.

Right now, it looks like that's a pretty good bet.