A Case Study: The Decline of American Medicine

Imagine this. You are a high school student with superb grades and a disciplined nature. You want to help humanity while simultaneously ensure a secure financial future, one in which you will be capable of sending your future children to college and even graduate school. You even plan to retire someday. You love science and technology and you therefore embark upon the most arduous academic road imaginable, a career as a physician. The road ahead will be tough but the rewards will make your journey worthwhile. And so, understanding the competitive barriers of medical school acceptance you attend the best (and most expensive) college possible. You work assiduously and achieve superb grades. You apply to, and are accepted in, Medical School. Again you select the best Medical School that has accepted you. This too is obscenely expensive. But it will be worth it. You struggle through four years of post-college schooling and then decide to embark on a specialized career. Now you have committed to another seven or eight years of training, a period during which your entire non-career life is placed on hold. But it will be worth it. You marry during residency and your wife works hard as your income is very low (in fact your pay is actually below minimum wage) but again you repeat your mantra, “it will be worth it”. Finally in your mid-thirties you begin your professional career. Although your classmates already own homes; enjoy fine vacations; and have settled into their adult lives, you are just embarking upon yours. You have been socially and economically dwarfed by your chosen profession. But it will be OK. And then you begin your practice. You are a junior member of your group and hope to make partnership by the time you’re forty. You save lives and feel satisfied. You are doing god’s work, helping mankind, and beginning to pay back your loans. You are fortunate. Your parents have paid for much of your education so you have only $200,000 to repay, not the close to $400,000 that some of your classmates bear. But it will be worth it. And then the rules change. Reimbursement falls. Your fees are fixed by the government and insurance companies as well. Governmental regulations grow at an alarming, almost viral rate. You are being crushed economically, emotionally, spiritually. The leader and even savior status you thought you’d earned has been stripped from you. You are no longer a physician; you are a “health care provider”. You are the same in the eyes of payers as others with half your skills. You cannot save money for your children’s education. You are drowning in self-pity, sadness, anger, and despair. Finally, your older partners can no longer tolerate the economic and emotional strain and so they sell the practice to your hospital. Now you are an employee. You are not the master of your own destiny. And you never will be. You are not the gladiator you’ve trained to be. You are a slave. You are a ghost of the man you’d envisioned you’d be. How do you feel? How would anyone feel?

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