Every day at lunch in the doctor’s lounge of my hospital, I listen to my colleagues bemoan the state of our present system of medicine. The vast majority of these fine fellows began practice in an entirely different era, what I call the golden age of doctors, when practitioners made virtually unchallenged decisions about how to take care of their patients and checks arrived in the mail soon after charges had been submitted.
Since then, largely due to expensive technology, well organized economic forces have enterered the fray and hospitals, insurance companies, HMO’s, pharmaceutical and governmental entities are now in firm control of the pursestrings and methodology of medical practice. Doctors are mere pawns on the chessboard.
If I told a my colleagues in the 1980’s that a hospital committee headed by a nurse would tell them who could be admitted and how long they could stay, it would be minutes before the laughter died down. But this is indeed exactly the case today.
The economic rewards of a career in medicine were such that doctors spent their time protecting their individual turfs from other doctors and were totally ignorant as the handwriting was being written on the wall. Well my dear friends, the party is over, the horse has long since left the barn and it will never come back.
All this bitching and moaning will soon be a distant memory as the older generation of doctors leave practice. In one way, medical schools have adapted to the present as those who now enter are not left with an expectation more than a reliable and sustaining forty hour a week job.
The same is the case for one of doctors favorite complaints about medical malpractice rates and the higher costs brought about by defensive medicine. Trial lawyers have always been far more politically savvy than physicians but now their fight will be with hospital systems rather than individual physicians.
I am a Democrat, a rarity among my colleagues. A week does not go by where I am not asked “How can you or any physician be a Democrat?” Well folks, lets see what the Republican party has done to improve the plight of the downtrodden physician? Answer: Absolutely nothing. They have been busy kowtowing to big pharma, HMO’s and other insurance entities as long as I can remember. My philosophy is that it is best to work within the system and achieve some modest gains. That’s what the AMA appears to be doing.
If you listen to that great Republican leader Ben Carson, for instance, who is more economically clueless than most of his colleagues (if you don’t believe me, see: http://www.marketplace.org/topics/elections/full-interview-dr-ben-carson-economy), Obamacare is the root of all evil. Obamacare isn’t perfect by any means, but it’s the only hope we have for the future of medicine in America and the virtually total knee-jerk opposition by those within the Grand Old Party continues to hamstring any possibility of improvement. Thank goodness Chief Justice Roberts has his head on straight!
All this being said, the greatest problem for medicine going forward is to train physicians for the specialties needed to take care of the population. There is already an immense gap in practitioners in primary care that continues to widen. It is simply not possible in today’s world for a medical student to aspire to enter a field with limited income potential in the face of crushing debt. Not only Family Practice and Pediatrics are affected. The attrition rate for general surgeons far exceeds the rate they are being turned out. Entering Obstetrics in private practice is a non-starter as malpractice rates eat up any hope of financial viability.
I am yet to hear a plan from either party as to how to correct this poison pill for American medical care. Right now, primary care specialties have been largely ceded to nurse practitioners and physician’s assistants but they are largely incapable of making many of the sophisticated medical decisions that a well trained physician can. A public health disaster is looming unless a solution is found. Everyone entering medical training can’t be a neurosurgeon, an ophthalmologist or an invasive cardiologist. The present system is simply not addressing the future needs of the American public. Perhaps the government (here I go again with Democratic ideas) should step in a subsidize the medical education of high-need specialities. Remember the Berry Plan during the Vietnam era? Uncle Sam needed doctors so he paid to educate them. It can work today. In the long run the costs will be generously justified with a high-quality cost-effective medical system in place.
I am of medicare age. My practice is booming as few others in my specialty, neurology, will accept the insurances that I do. But after I retire there won’t be anyone to replace me either. Now I have to deal with the new and often humorously complicated ICD-10 coding and continue to watch mega-hospital corporations continue to swallow up new facilities and practices.
Perhaps I’ll go to the opera and hear that fat lady sing for myself.
Steven Lomazow, M.D. maintains a practice in Belleville, New Jersey. He is President of the Neurological Association and the Medical History Society of New Jersey. Between 2005 and 2014 he was a member of the State Board of Medical Examiners and is presently a trustee of the Franklin Delano Roosevelt Library.