Complicit (and Guilty as Charged)

By T Michael White MD FACP

“Things are in the saddle. And ride mankind.” Ralph Waldo Emerson

“The road to perdition is paved with good intentions,” Apocryphal

Sunday, November 24, 2024

Dear Mr. President, Honorable Members of Congress, Distinguished Staff and Fine Citizens,

U.S. Health Care is in a serious, complex muddle. I recognize only you are positioned to design and implement dramatic, necessary change. I wish to facilitate your efforts. Let me do so by getting right to the point — I (and other fine physicians like me) am the problem. My career efforts have made me complicit.

My guilt accreted in stages:

Stage 1: my World War II hero uncle became our family’s sainted general practitioner. I was encouraged (expectation > aspiration) to grow up and be like him.
Stage 2: junior year of high school my father took me aside to clarify that there would be “no money for college.”
Stage 3: despite partial scholarships, after eleven years of abject poverty called college, medical school and residency, I had accrued monumental educational debt.
Stage 4: immediately upon completion of training, I became a well-compensated physician.
Stage 5: naïve, I would have to be informed that my educational loans were not tax deductible. My taxes and loan payments were significant. I came to understand that indebted physicians are high income, low wealth individuals.
Stage 6: initially, I idealistically ran my own practice and took care of all-comers in my community. Not once did I send a bill for collection. Things worked out.
Stage 7: exhausted by solo practice, when recruited to enter teaching and administration, I jumped at the chance. My patients became the subset of patients served by the teaching hospital that employed me — primarily the insured;
Stage 8: over time, I had increasing administrative responsibilities. As the lead physician, I oversaw the delivery of (value = quality and safety ÷ cost) to patients served. It never occurred to me to ask if we were serving all in the community requiring care — we were not. Many were left beyond ready access to care.

I stand guilty as charged.

Today, essentially all young physicians entering practice: 1) are employed by institutions who serve selective (generally paying) parts of the community; and 2) are significantly in debt. No matter how well-intentioned, such physicians are unable to act independently. As a result, citizens without means and/or insurance are unable to access care.

My point? 1) the system as described creates a two-tiered (haves versus have nots) health care system for our fine citizens; and 2) physicians must be assisted to leave college, medical school and residency debt free so they may be positioned to serve the greater (not just the institutional) good.

Respectfully submitted,

T Michael White MD FACP

Fixingushealthcare.com

Copy to: We The People (at fixingushealthcare.com)

1 Comment

Guest

Nov 30, 2024

Not for profit hospitals often are perceived, understandably, as not making a profit. However, such is not the case. If they don't make a profit (income in excess of expenses) they would not be able to replace equipment, buy new technology, etc. "Not for profit" actually means that there are no shareholders, and so, in principle, all profits are re-invested into the hospital operations rather than being paid out to shareholders. It also means that the hospital, in lieu of paying taxes, is owned by the community and provides charitable care to underserved patients. Their Boards of Directors represent the community to ensure the communities' interests are attended to. As you point out though, many not for profit hospitals inexpl…