Sunday, May 10, 2009

From America's medical frontline

Some emails to Hugh Hewitt from doctors:


I listen to your show on pod cast, so I was unable to comment last night. An issue which you did not mention, but is critical to the situation is the accelerating doctor shortage. I am a senior physician executive who spent 31 years in the Air Force and completed my career as commander at ______ Medical Center....I am currently Sr. VP for Medical Affairs at a small hospital system in ___.

The major problem with every effort to "fix" health care is that they focus on controlling the price that the consumer pays. No one ever takes into consideration the cost of producing that care. This will have a major and increasing impact on the way forward.

Currently, the US is short of physicians and is not producing them at a rate of replacement. Add to that the fact that a 30 year old physician is a completely different animal than a 50 year old physician. Most "old" physicians came into the profession at the time it was considered a calling. Yes, they were compensated (monetarily and otherwise) very well. But for that, they accepted 100 hour work weeks and being on call for months at a time. It was part of the social contract and they just accepted it as part of the life of a physician.

The current crop of physicians do not have the same work ethic. Similar to other members of their generation, these docs expect to "have a life." They are unwilling to work the same hours as their elders - at any price. Additionally, 50% of most medical school graduates are women who statistically have a much shorter career. You can see that every time one of the old guys retires, you need more than one new graduate to cover the load.

The proposed changes that are ahead will undoubtedly encourage many of the old docs that there is no point in working beyond the point that they can retire. Yes, the fact that many of them have been hurt badly in the crash will keep some at work. But not a day longer than they have to. Then it will be harder for all of us to find a physician to take care of us.


I am a pediatric neuroradiologist. I take care of children with severe neurological diseases, tumors, trauma, etc. I am an Associate Professor at the University of _________Medical School and practice at Children's Medical Center in ______. I am also a researcher using state of the art MRI. I can tell you that if we go to a single pay system, it will destroy the kind of healthcare and research which has allowed us to lead the world. Currently we have the best subspecialists in the world and free access and referral for state of the art care. As an example, I was on staff at another children's hospital in a large Midwestern city a couple of years ago and had a young boy with a large carotid artery aneurysm. We did not have the pediatric expertise in our city to treat him, but I have world class colleagues in another city who treat these things for a living, so I made some phone calls. The boy went to UT Southwestern Medical Center in Dallas, was treated and now faces a normal life. This kind of subspecialty referral care will end with rationing. This is unacceptable. Rationing would have forced that boy to "take the best available locally" or would not pay for the expensive interventional procedure which was life changing for this boy. Also, if they destroy medicine, what motivation will there be for the best and brightest to enter medicine.


I am a physician (M.D.) practicing geriatric psychiatry in Texas for the last 16 years. I am a member of the Association of American Physicians and Surgeons ( and am so opposed to government intervention in medicine that, although all of my patients are Medicare recipients, I have "opted out" of Medicare which means that all of my patients must pay out-of-pocket to see me and I cannot bill Medicare for any services. I can work with individual patients so that they can afford my services, and I can treat some patients for free! Under Medicare I am not allowed to do that. I have been active in legislative work in Texas on behalf of psychiatrists and their patients for about the last 13 years. You can read some of my articles at

You asked Senator Kyl why the AMA and other physician organizations had been silent on health care rationing. AAPS mentioned above has been very vocal about government-run medicine. The AMA sold physicians out long ago with their CPT coding and constant bartering with CMS (used to be HCFA) which runs Medicare. They have always betrayed physicians so that the organization could "keep a seat at the table" which to me means getting invited to Washington parties and keeping organizational power. If you look at membership of AMA, it has been steadily declining.

Medical schools are as liberal as their undergraduate counterparts. The medical schools depend on government funding to operate (and the cost of a medical education has risen as a result), research dollars are funded through the NIH (especially now that the "evil" drug companies have been curtailed in their research), and most patients who seek care at medical schools are Medicaid, CHIP, or Medicare recipients. For that reason, these students have never had to be small business owners. At best, they go into practice for huge physician groups that act as agents for the individual physicians, paying their salaries, and speaking for them. Because of all of the bureaucratic oversight, it is difficult to practice solo. Medicare regulations alone are more complex than the IRS, and CMS has more draconian enforcement authority.

I appreciate your work on this issue. I am so tired of having to explain to patients that "government health care" does not mean that they will get the same care they have now with "the government" footing the bill. It means that the government will decide what care you get and you will have no recourse. After all--you're cheaper if you're dead!


I am a 66 year old Pediatrician currently transitioning into retirement. I echo the comments made by the Sr. VP for medical affairs. My junior associate who is taking over has already informed me that she will no longer go to the hospital - too much work, too great a risk, too little return for the effort, etc. The 200 bed hospital I attend at has 0NE Pediatrician left on staff my age who just had surgery and walks with a brace. A new Pediatrician hired by the hospital is one month from joining him but has yet to get her state license - ipso facto cannot see patients. There are three other Pediatricians in the community. None have staff privileges except for a half-timer. The hospital has about 700 births a year and a drawing area of 250,000. God help them.

The hospital has critical shortages of all primary care specialties, i.e. Family Practice, Internal Medicine, and Ob-Gyn. Why? Two reasons. (1)The government artificially distorts the market. 75% of my patients are Medicaid in the first year of life. Who the hell would buy insurance when the government picks up the tab? Many need it, but a lot don't. This is an industrial region, not a farming region, even if it looks rural. My parents work for large corporations. (2) Women doctors. 75% of Pediatric residents and 52% of entering medical students are female. They won't move to small towns and rural zones. They won't work as many hours or as many years. It takes 3x as many women as 2 male doctors to do the work.


1 comment:

Anonymous said...

So today is Mother's Day, but I am no longer a mother - due to our "great" health care system.

I own a small business, and I had health insurance for myself, my family, and my employees. Life was fine - until my son was diagnosed with cancer. The wait to get him care was horrible. I had to fight with our insurance company, and doctors would not do anything until the insurance company approved. I joined an online group for my son's condition, and found that parents in Australia and Canada did not have to wait as long as I did. I waited in emergency rooms for hours and hours - once for nine hours.

The company my husband worked for went out of business, and after a long search, he finally got a job with another company - but they had a 12-month waiting period before employees get health insurance. My insurance company sent me a notice of non-renwal after discovering my son's condition. I could not find another company that would insure us - because I did not have enough employees, they consider the health of the people before they will insure you.

There is no free care at emergency rooms. We had to sell our house to pay our emergency room and other medical bills. I make slightly too much money for medicaid/schip. Our medical system is a joke.

Eventually, because we had no insurance, we could not see the doctors that could help him, and we lost our son.

Happy Mother's Day.