How's this for breaking news? Here's a sneak phone-camera shot of Dr. Lander presenting a well deserving Dr. Francis with the Buzzy award.

Quite a day.

• We all heard the great news (though overdue) about United and the -25 modifier from Dr. Lander. I'll get the official announcement shortly and post it. Great work.

• The presentation and acceptance from Dr. Francis was wonderful. We are very proud and honored to sponsor the award.

• Wow, the SOAPM room was full of friends and family. I had a chance to say hello to Drs. Lessin, Lander*, Sutter, Stoller*, Simon, Cain*, Bienstock, Craig*, Schaffer, Katz, Oken*, Bradley, Shenkin, Pillsbury*, Diasio*, Khort, and many more - I can't forget Lynn Cramer* and JR Vaught*. (* = PCC client).

It has been interesting to me, as an outsider, to witness the maturation of SOAPM over the last few years. They are clearly on the verge of something great, but they are also struggling with some social management issues that any organization of its size and energy has. They have to do decide what they want to be, where they want to go. It will be interesting.

During some of the conversations (with the AAP board, the medical directors), a number of folks kept referring to medicine as a "market based system." The implication is that the "market" decides what pediatricians are paid. Adam Smith would turn over in his grave - pediatrics is may be a market, but it's not a free market. In a free market, there are not protected monopolies. Information moves freely. Consumers have choices. Consumers understand the value of their decisions. That's not true when it comes to medicine, especially caring for kids.

Drs. Oken and Shenkin both made very good, insightful comments that weren't given enough attention, imo. The former was, essentially, pushing hard on the market conditions pediatricians face (I've heard him ask the same questions every year and beg that he not stop until they are answered). He's the one who, like me, keeps pushing for a standard for payment levels for pediatricians - and I thank him for it. Dr. Shenkin mentioned the concept of Facebook/MySpace for SOAPM and a lot of people chuckled...but couldn't be more correct in his thoughts about where the group should be looking in the future. Sure, it would seem silly - at first - for the AAP or SOAPM to have a Facebook entry, but the more you think about it, the more sense it makes. Especially if you actually try to navigate the AAP site.

Finally, the line of the day came from one of the managed care executives. I don't mean to speak out of school here, and who actually said it doesn't matter, but can you beat this message come from the payers themselves?

"If you don't like what someone is paying you, don't sign the contract."

He was right.