Essay: Doctor Shortage - 5/1/2008

I have a close friend who is a family care physician who is still practicing full-time at age 81. He goes to his office every day, and visits two nursing homes where he has been medical director.

His wife wishes he would at least slow down and take a little more time for himself. He has a beautiful home and perhaps the finest private library I’ve ever seen.  But he feels an obligation to his patients, some of whom have been with him for fifty years.

Naturally, he also loves what he does.  But he isn’t happy at all about what is happening to his profession.

“The corporations want to destroy the doctor-patient relationship,” he tells me.

“Places like the Detroit Medical Center don’t want you to have a relationship with a doctor, They just want you to have a relationship with the institution. They don’t want you to pick your own doctor, they just want to assign whatever one is next to see you.”

He thinks the managed care world wants to reduce physicians to something like the anonymous mechanics who will change your brakes at Sears.

He is a physician of the old school. He spends as much time with each patient as he thinks justified, which means that his waiting room resembles a backed-up airport terminal in a snowstorm.

For him, the assembly line model was meant for Plymouths, not physicians.  To be fair, medicine is changing, and his model of doctor-patient relationship may no longer work in today’s world.

Yet it isn’t clear that the corporate model is working very well either. After my friend moaned that “American kids don’t want to be doctors any more,” I introduced him to a young woman who planned to go to school to be a physician’s assistant. He snorted.

“So she wants to be a nine-to-five doctor,” he said. Medicine is a sacred calling to him, and real doctors are on call 24/7. 

That may be a bit extreme. Still, if you are a physician who is an employee of a  walk-in clinic, it is probably harder to see yourself as engaged in a long-term relationship with your patients.

Huge changes in health care are coming. All three remaining presidential candidates agree that far too many people are left uncovered. The tide of public sentiment and the aging of the baby boomers means health care will be a major topic soon.

What form health care reform will take is unclear, except that there will be some kind of movement towards universal coverage.

That means we need to train lots more doctors. Common sense indicates that the government should establish financial incentives aimed at making becoming a family care physician attractive.

If anyone objects, the bill’s sponsor should proclaim that this is a matter of national security.  Granted, funds are limited.

But if you had a clear choice between spending money on the war in Iraq, or spending to establish enough doctors for our future needs, where do you think our priorities should be?                                                                                                                                                                                                                                                                                                                                     

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Comments

[John L]

I just listened to you comments on the doctor shortage in Michigan and as the husband of a doctor, I need to comment.

My wife graduated from a Michigan medical school and did her residencey in Michigan, finishing last year. We now live thousands of miles away. At graduation last June of the group of residents in her school, I was shocked to see that almost all the graduates have accepted jobs outside Michigan. There was almost no attempt by anyone within the state to recruit her.

The hospital she works for now actively recruits across the nation, offers a great program where they do all the paperwork and employ all the staff, leaving their doctors to just do their medicine.

It troubles me to see that Michigan wants to create a new medical school and expand residency programs, and then let almost all the graduates move away.

[Anonymous]

As usual, a deafening silence from Mr. Lessenberry on at least one point that Dr. Forzley mentioned specifically: medical malpractice reform. It is a non-starter for most of the Democratic politicians that Mr. Lessenberry supports.

Michigan has a pretty good history of 20 years of medical liability reforms. The credit for those reforms goes to former Governonr John Engler, a Republican legisltature, the Michigan Chamber of Commerce and the Michigan State Medical Society. All persons and/or institutions that Mr. Lessenberry regularly criticizes. And in accomplishing those reforms, Republicans were opposed at every turn by Democrats and the trial lawyers who provide them with much of their funding. (See, e.g., United States v. Fieger, et al.)

Yet still, anyone familiar with medicolegal work, either as a healthcare provider or as counsel for healthcare providers, knows -- more and more doctors say that even when their malpractice premiums are not going through the roof, the litigation system has taken a lot of the enjoyment out of their practice. It's no fun to practice medicine when you look at your patients as potential plaintiffs.

How in the world Jack Lessenberry managed to avoid that issue, and yet still find a way to work "the war in Iraq" into a commentary on healthcare is something that perhaps only he can explain.

[Shaheen Lakhan]

Some argue that the physician shortage is partially due to the increased number of female doctors. They claim they have less longevity than their male counterparts, take more time off for maternity and family matters, and work less hours and take less overnight call. Brain Blogger recently wrote about this issue.

Sincerely,
Shaheen