This NYT essay on ‘do doctors dress too skimpy for their own good?’ is like a fill-in-the-blanks blog post just waiting for somebody to come along. I mean, there’s a little data there about patient preference for professional-looking physicians, but on the whole, the whole essay seems mostly like an excuse for the Times to post a few Hello, Dr. Cleavage photos. (There is a passing mention of some male doctors going unshaven when they have no excuse, but that’s about it.)
One of the things that caught my eye when reading up on tonight’s State of the Union address is the claim that 1,500 U.S. counties lack an obstetrician because malpractice lawsuits are forcing physicians to stop practicing. There’s great debate about the relationship between lawsuits and insurance costs, though most research associates rising premiums primarily with declining investment revenues for insurers (for example, see this article from Health Affairs).
But what I really want to consider (albeit briefly) is the question of distribution. It’s likely correct that 1,500 counties lack an obstetrician, but it’s highly unlikely that this is because of high premiums. Instead, it’s about geography and the broader structuring of medical professions. More than half of the approximately 3,100 counties in the U.S. lack a pediatrician, and one county in twenty has no physician at all. Physicians, especially those in specialty fields, tend to practice in more urban areas, where facilities are newer, support is better, and salaries are higher. There are numerous incentives to bring new physicians to rural counties, such as partial forgiveness of student loans, but it’s tough to compete with the benefits that come from large hospitals and happening downtowns. Medical specialists simply aren’t distributed evenly, and it’s not a new phenomenon.
The issue of distribution further complicates the debate over the prerogative of pharmacists or physicians to refuse to provide certain services. There are plenty of places in this country where patients cannot simply go to another provider because there’s just nobody else to see. The privileges that come with being a physician (edit: or pharmacist) are not free, but come at the cost of an ethic of service that accompanies professional work.
Update: The Tucson Weekly this week has a story on rural health care, which adds a bit more data to the discussion:
Statistics from the National Rural Health Association reveal that Mariposa is hardly alone in this struggle. While a quarter of Americans live in rural areas, those areas are served by only 10 percent of the nation’s doctors. For specialized care, the gap is even greater, with only 40.1 specialists per 100,000 residents in rural areas, compared to 134.1 specialists per 100,000 in cities.
The NRHA is the same organization to which Jeff links in the comment, by the way. Double coincidence!
Fafnir and Giblets, with the definitive response to this week’s health care talk on the blogs, take FreedomCare on the road:
Across the street the french Médecins Sans Frontières show up. “Socialized medicine!” says Giblets. “Vive la révolution!” says the french. They grab a guy with heart disease an start operatin on him: redistributin his wealth, controllin the means a production. He’s just gettin worse! We try to resuscitate him by stickin a couple SUPPORT OUR TROOPS stickers on his forehead but the french shoo us away. The patient goes into cardiac arrent! One of em shoots a passin czar but it doesn’t seem to help an the patient dies on accounta Socialism Doesn’t Work. When will society learn!
Or, you may already be Physician of the Year!
I see from today’s Daily Wildcat that two local doctors have received a prestigious award, Physician of the Year! According to the Wildcat,
Dr. Ronald Weinstein, professor and chair of the Pathology department at the UA College of Medicine, and Dr. Anna Graham, professor of Pathology at the College of Medicine, received the awards for their extensive work in Arizona health care and services.
Good for them. We should all be proud of their selfless dedication to sound medicine and health care services. More physicians should aspire to such heights.
Turns out, it’s not hard to get there. All it takes is cash. According to stories from ABC News and the American Medical Association, the Physician of the Year Award is less an honor than a fund-raising tactic used by the National Republican Congressional Committee. Okay, it’s entirely a fund-raising tactic. Recipients of the award don’t receive an honorarium; they pay the NRCC a thousand bucks for the privilege. In return, they get lunch, a handsome plaque and the chance to see the hon. Tom DeLay speak on the importance of (surprise) medical tort reform. But physicians shouldn’t expect their newfound Best Congressional Buddies to open up for a real forum on health care. From the ABC coverage:
Mueller said most of the talk at the sessions was about marketing, lawyers and taxes, and that he was met with silence when trying to raise the issue of the lack of affordable health insurance.
“This is the real crisis,” Mueller said he told the congressmen on one panel at the events. “Please, I am begging you.”
The congressmen said nothing and quickly called for a question from another Physician of the Year, Mueller said .
The NRCC gets to show off its auditorium full of hundreds of pro-reform doctors, all of whom can pay yet more to be an Honorary Chairman of the NRCC’s Physician Advisory Board and get the opportunity to have their name used in NRCC promotional materials. I hear that for an extra thousand bucks, doctors are elegible to receive a Extra Special limited-edition leatherbound directory of all of the year’s honorees, complete with a Certificate of Authenticity. No word yet on how much it costs to get one’s integrity back.