by Robert Klassen
by Robert Klassen
I don't know why anybody would want to become a medical doctor these days; it's a losing proposition. Assuming that a student gets through high school knowing how to read and write, and also knows the basics about physics, chemistry, and calculus, that student may achieve a bachelor's degree with high grades in three to four years. Then it's four years of medical school, plus two to six years of medical residency. That's a ten to fourteen year delay in earning an income above subsistence. The poverty isn't easy to take, the work is punishing and endless, and it costs money, a great deal of money. It is not unusual for a young M.D. to complete residency at the age of thirty-two in debt to the tune of a quarter-million dollars. Contrast that with the smart computer science graduate who could be earning that much per year by the same age. Medicine is a losing proposition. (From 1992 to 2002 annual enrollments in US medical schools ran between 65,000 and 66,000, while annual graduations averaged 15,500, an attrition of 75%. http://www.aamc.org/data/facts/start.htm).
Personally, I never wanted to be a doctor; I needed a job, and a hospital was hiring, so I wound up working in hospitals for forty years. Consequently, while I've always admired and respected doctors, I've also wondered if they weren't a little crazy to work so hard. For example, for some years I worked with a skillful ER doc who grew up in a Native American orphanage, and who eventually put herself through engineering school, but she had "always wanted to be a doctor," so she then put herself through medical school. Exceptional? Not really, not when you get to know doctors, but a little bit crazy, maybe.
Once out of residency, the young doc has a critical decision to make. I would guess that private practice looks attractive to the mind's eye; it has a noble tradition, after all, but it also has steep startup costs and astronomical risks. Safer to join an established group, and the larger the group, the safer it appears. The group has its own billing department to track the ever-changing rules imposed by government and insurance bureaucracies; the group has malpractice insurance, and that alone could eat up the first year's earnings; and the group rotates call, meaning the young doc actually gets some free time for the first time in fifteen or twenty years. It looks like a good deal.
Some folks say that a child chooses a lifetime career somewhere between the ages of nine and fifteen, if at all. Assuming that's true, and assuming the choice is medical doctor, then that child is in for a couple of decades of focused hard study and work. At what point, and for how long, does that child find the time for, or acquire an interest in, political philosophy? And to what political philosophy is the child exposed in school? From grade school to post-graduate medicine the sole philosophy purveyed is socialism. Who challenges the medical resident for ordering the latest tests, and the most costly medications and treatments, for terminal homeless indigents? Nobody. Who pays for it? Don't ask.
Sometime back in the sixties I was scrubbing in for surgery alongside two doctors, one in his forties and one in his twenties, and the young doc was complaining about the horrendous income taxes he had paid after his first year out of residency. The older doc couldn't stop laughing, but finally he said, welcome to the real world. That a young doctor did not understand what he'd gotten into was a revelation to me, and I've seen it on countless occasions since then. That bright, proud hopeful who enters medical school for the first time after a hard struggle to get there has no idea what he or she is getting into, and nobody warns them in advance.
When the doc is no longer young, and has acquired a spouse and children, a mortgage, car payments, office overhead, insurance, taxes, and is still paying for med school after all these years, suddenly the real world changes faces, and the doc sees the trap that was sitting there all along: the reality of socialized medicine comes home. Where did it come from? How did it get here? How can I get out of it?
That last question is the tough one. Medicine, that is, health-care, or care-giving, is not a profession like engineering, or auto-mechanics, or law, its point of view is completely different. Becoming dedicated to care-giving is easy for some people, while to leave it behind is nearly unthinkable. Those who would rule the doctors, and make them their slaves, know that, and count on it. But once a doctor understands that she has been trapped by her own good will, brains, best intentions, and competence by a system that steals her life, her liberty, and her pursuit of happiness, a subtle change begins to occur. Anger at the system, of course, and bitterness at being cheated, perhaps a sense of guilt or foolishness over youthful socialist notions, but beneath all that is a calculating search for alternatives.
How many times have I seen it? A doc turns forty-something, and there is a new look in his eyes, a questioning, the furrows in his brow deepen, and his hair turns grayer. Then I hear he has bought a farm somewhere, or he as turned a hobby into a business, or he has inherited a little money and now he's going to retire. At forty-five? Or maybe she just drops out of the group, or resigns from the hospital staff, and I hear she has opened an office in her home, or she works out of her SUV: Cash Only. Doctors are disappearing. (I Google searched "physician shortage" at this point and found too much to include.)
When Ayn Rand made this part of the plot-theme in Atlas Shrugged, it was already happening in Western Europe. The massive post-war socialization of medicine drove thousands of physicians to America; some countries even tried drafting them into the military to force them to stay put. Remember "the brain drain?" Europe was desperate to stop it. The US would be too, if the docs were fleeing to a free country, but there aren't any left on the planet, so the docs are simply quitting, one by one.
People want to believe the fairy tale that the good doctor will be there when you need him, that is, the doctor will be there because you need a doctor. Who needs whom? The doctor does not, in fact, need you. I imagine that many vacancies will be filled by nurses in the near future, at least while hospitals stay open and nurses stop disappearing too. But thanks to Medicare and Medicaid and their conniving insurance companies, hospitals are bankrupt, so we can't count on them. Maybe health-care will go underground eventually, and we can get to see a real doctor for the exchange of real money in secret, but that will be illegal too, naturally. Then there will be nothing. That's the socialist dream: perfectly equal, perfectly free, nothing. Like I said, it's a losing proposition.
July 30, 2003
Copyright © 2003 Robert Klassen