Mack
Hall, HSG
Mhall46184@aol.com
Patient, Heal
Thyself?
Dr.
Candice Chen, assistant research professor at the George Washington University
School of Public Health and Health Services (how does she fit all that on her
business card?) has made a study concluding that there aren’t enough physicians
in primary care, especially in rural areas.
Who
would have known?
Maybe
Doctor Chen could give up research and move to a rural area and see patients. That would help.
The
headline of the UPI story reads “U.S. producing ‘abysmally low’ number of
primary care doctors.” The primary
carelessness here is the false concept that primary care doctors are produced
by the U.S. They are not. Primary care doctors produce themselves. Young men and women choose – they are not
assigned by the state - the noble calling of serving mankind as a physician
(okay, it’s not as noble as being an RN, but it’s still pretty cool), and after
university, medical school, and the layers of internships, residencies, and
exams, are finally permitted to practice their art and science at about the
time they develop grey hair and creaky joints.
Long
before the middle-aged physician sees her first patient, she is burdened by
enough debt to make even the most blasé Swiss banker take notice and dust off
his amortization schedules.
Given
that a physician might qualify for Medicare before she pays off her debts, why
would she become a physician in the first place? And if she does, should some GS-2 clerk be
empowered to tell her where she is to practice?
We
have all read narratives about how a surgeon bills $X cubed and squared for
each hour of an operation, and have done the Gee! doctors-sure-do-get-paid-a-lot-thing.
But
physicians aren’t paid a lot, especially general practitioners and
double-especially general practitioners in rural areas. The doctor saving your life made nothing for
eight years of undergraduate school and medical school, and very little as an
intern and as a resident. Her need for food,
clothing, and shelter did not take a hiatus for a decade, nor did the cancerous
growth of debt. The alternative to an
accomplished surgeon would be having your appendectomy performed, as in the
misbegotten Soviet Union, by a retired Red Army medic with a dirty scalpel in
one hand and a bottle of vodka in the other, assisted by Comrade Fyodor with
ether through an old lend-lease rubber mask.
Beyond
the years of preparation, the surgeon must pay her debts, her office nurses,
her office staff (who spend their days quarrying through slurry pits of bizarre
insurance and government forms), her loot-and-pillage malpractice insurance
notes, and her taxes based on this year’s billable hours and not on the
previous twelve or so years of accumulating nothing financially except
encumbrances.
Our
hypothetical physician is constantly monitored, supervised, judged, and faulted
by insurance companies and by state and federal entities.
An
insurance clerk, private or government, sitting behind a computer screen in Mumbai
or Newark, is no more qualified to second-guess a physician than the physician
is qualified to critique the welder joining a critical seam along the pressure
hull of a nuclear submarine.
And
yet it is so. When you receive the
heart-stopping bill for heart surgery, most of that bill disappears to pay
critics and overseers, private and public.
This
nation suffers a shortage of physicians because no one wishes to spend years in
education and training while amassing debt in order to begin work in early middle
age and to be faulted and bullied for being good at what she does.
Healing
is a wonderful vocation, from the physician to the RN to the LVN to the NA to
the imaging folks and surgical techs and EMTs and the strange people in the
laboratory and pharmacists and the nice fellow who cleans up the bloody
emergency room at 0-dark-hundred in the morning. None of these health-care professionals is a
product. Each one bases her (or his)
life on getting you well and back to your house.
To
discuss physicians as products, as units to be plugged into place here and
there as some ideologue demands, is a bizarre detachment from reality. To punish physicians for being physicians is
national suicide.
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