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Good Luck

Good Luck

Twenty years ago, I had this idea that I would create a solo medical practice because I could not find a way to assimilate into the world of corporate medicine. There has always been politics in medicine but in a large multispecialty clinic like UTMG, there were unusual politics. None of the Division Heads got along with each other, and each of them scrambled for the scarce resources that UTMG provided. The loudest voice at the board room table got fed the most, even if their department was the biggest financial failure.

Chairmen who had large budgets were forgiven by corporate administration for their unproductive physicians and staff. No one worked harder than the physicians in smaller divisions because they always believed they could lose their jobs at a moment's notice. Their profit margins were the biggest, their incentives to stay employed were the greatest.

A man was in the desert for six days with no water and no sleep. He wondered aimlessly through the mountains of sand, the atmosphere was hot and dry. On the seventh day, a day he thought he would surely die, a man approached him with a bottle of water. The man asked, "What will you pay for this bottle of water?" The thirsty sunburned man reached out, "ten thousand dollars!" The man with the water said, "SOLD!" The man resembling a raisin in the sun took ten thousand dollars out of his wallet and exchanged it for the water quickly.

The desert wonderer drank the water as fast as possible, careful to ingest every drop. He sighed and smiled. Then another man approached him with a new bottle of cold water, "What will you pay for this water?" The desert man said, "Five thousand dollars!" The water seller replied, "Sold!" The man from the wastelands took five thousand dollars from his wallet and reached towards the man with the water. The exchange was made. The desert man drank the bottled water quickly and efficiently, careful not to spill a drop. Then five men approached the desert man, each carrying a bottle of ice cold water. They shouted, "What will you pay for this water?" The desert man was not so desperate because his hydration had improved at this point. "I will give you five hundred dollars for each bottle." The men shouted, "SOLD!" The desert man took twenty-five hundred dollars out of his wallet and reached out to the men, the exchange was made. The desert man kept the bottled waters. He did not drink them.

A moment had passed, the wind blew wildly for a few seconds, and then one hundred men showed up and shouted, "How much for these bottles of water?" The desert man felt no obligation to these men because he was no longer thirsty, "One dollar a piece." The men said "SOLD." The desert man took one hundred one dollar bills from his wallet and reached out. Each man walked by him, took a dollar and gave him their bottle of water. One hundred times this ritual was carried out. The desert man felt like a king. The men selling the water felt satisfied.

 Medicine. The law of supply and demand. Over the years, medicine in general, has become an immense dispassionate industry. One that has financially preyed on the infirm to the extent of whatever the market will bear. Fifth Avenue marketing firms have made billions of dollars on advertising, trying to convince the public that medical industries cares about them. Pharmaceutical companies, insurance companies, durable goods companies, pharmacies, and hospitals care about us, all of us. But to talk to any patient who has been recently cared for by the industrial medical machine, and they will tell you no one cared.

Healthcare reform is in the fore front of the national news. It appears that our country is in need of an overhaul of the Healthcare Act, but no one can agree on the nature of the overhaul or the direction the country should take. The country is in need of an overhaul of its medical schools more than anything. There is no reason to keep the supply of physicians narrow since medical economics do not follow Keynesian rules. I looked at a letterhead the other day related to a family practice group, two physicians and six nurse practitioners were listed. According to State law, each physician can oversee up to seven nurse practitioners. I wondered what was keeping the two physicians back from filling the office with fourteen nurse practitioners. Was it supply and/or demand?

The medical schools need to think hard, open their enrollments to all of those young men and women who wish to go to medical school and disallow students as they progress yearly by: if you fail the year-end test, you fail going to the next year. Passing or failing in medical school should be based on performance like many other medical schools globally. No one cares about the gender of their physician nor their ranking in their graduating class. In order for healthcare reform to be effective, we need more compassionate physicians to help control the rudders of the healthcare behemoth floating through the Senate and House. Physicians are too busy seeing patients to take a stand and make healthcare operate from a patient-physician worldview.

Those of us with thirty years experience or more, see the practice of healthcare differently than the newly licensed physicians practicing in their first five years. Their interests reside in their time off, compensation and family time. To them, patients are just what they treat when they wear the mask of doctor. My understanding is that the newest generation of student physician wants to go to medical school free of charge in exchange for a lower salary when they leave medical school and start practicing medicine as a licensed physician. I think the tuition for education in general, has reached an intolerable amount, but all professional schools have risen beyond reason, especially medical school. More students, less cost per student. It's just that simple.

The next several years may leave all of us in a drought of healthcare. We may all wonder around the desert of illness, thirsty for answers, hoping that a man or woman arrives with an answer to our pain, suffering and disease. The first one that comes along will be worth everything, but may actually deliver nothing, especially if they’re in the medical system now. Those men and woman who practice medicine because they're meant to be physicians will have compassion as well as knowledge to effectively treat illness. A new healthcare act cannot fix the problems with practice of medicine, only the deans of the medical schools can change the future of medicine. And those old guys ain't changing anything anytime soon.

When it's time, someone somewhere might help you as you wonder around the healthcare wilderness. Good luck in the desert because the first bottle of treatment is going to cost you dearly. Let's hope it works.


Posted by Amanda Sanders at 9:35 AM
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