Updated from September 9, 2002
If you donít remember, he was a family doctor on a television show. He was a friend and a counselor and a problem solver. He and those who worked with him at his office cared for all kinds of patients in all kind of conditions, in the best and in the worst of times. Some of us were fortunate to have a Marcus Welby care for us when we were growing up.
Did you know that there are still Family Doctors in this nation, and even a number who would qualify for the world class Marcus Welby level? Not only are they out there, but they are better trained than ever.
Did you know that two physicians who died in Desert Storm were family physicians? Family physicians are on the front lines in the military, in inner city urban areas, in rural areas, in the suburbs, everywhere. If we ever, God forbid, have future terrorist acts involving infection, family physicians will be on the front lines before the rest of the nation.
Did you know that Family Medicine doctors are the only doctors that serve in every location in the United States, including the smallest towns where no other doctors go?
Did you know that the US Government has continued over many years to waste billions trying to get more doctors to go to these towns, when all they had to do was choose the right students to go to medical school, ones who wanted to serve their patients, the ones most likely to choose Family Medicine? Did you know that these students were more likely to serve in rotations overseas, and in rural areas? Did you know that these students were more likely to volunteer to serve people in need even while busy learning about medicine?
Seems like serving others is a strong point about Family Medicine. It is a characteristic that you can identify in family physicians before, during, and after medical school and residency. It is also a strong point in physicians doing mental health, geriatrics, surgery, and obstetrics. Not surprisingly family physicians also take on these tasks, in addition to holding up the fine and honored tradition of General Practice.
Did you know that the numbers of medical students choosing family medicine are dropping rapidly? Did you know that top medical school leaders have recommended getting doctors who had broader characteristics, but medical schools continue to choose based primarily on intellectual scores on tests and grades in college? Not surprisingly we have fewer and fewer interested in serving, especially serving in underserved areas. We also have more and more medical schools interested in getting students who will become researchers. After all, the way medical schools get more dollars is by having more researchers, not by graduating doctors who leave medical schools and serve in other locations. Research demands a person with an inward focus, and ability to concentrate and immerse in concepts and data. Selecting for research means selecting away from service and involvement.
Do you think that this might be a reason why you have a hard time talking to your doctor anymore? Guess who leads medical schools in the fight to have students understand the importance of communicating with patients, or trying to prevent disease, or understanding how to serve the elderly, people from other cultures, those who have been abused, or people who are mired in poverty and ignorance?
Medical schools need to know that you must have a doctor who at least attempts to understand you. Our nation needs doctors who work with schools and communities to help solve some of the complex problems that threaten to undermine our nation.
Did you know that the US Government spends billions of dollars and more and more each year to do research that will provide cures for a small minority of the people, but it has cut the dollars that it spends to understand how to deliver health care more effectively? Our problem in health care in this nation is not enough research discoveries. Our problem is that we donít do a good job with the basic health care needs of Americans.
∑ Guess which kind of physicians depend on these health care quality funds to be able to improve the health of their communities and patients, and to continue to teach the next generation of physicians how to be better doctors?
∑ Guess whose training programs get zeroed out every year regardless of who is the president? You guessed it, Family Medicine.
∑ Guess which training programs get the least money for training the right kind of doctors?
∑ Guess whose physicians can ill afford the extra costs of training students and residents, but continue to do so, even when medical schools and hospitals close our programs and departments and clinics?
∑ Guess which training programs continue to serve patients when the for-profit and so called "not-for-profits" have long moved their clinics away from poverty areas and continue to discourage complex poor patients from coming to their physicians?
Is it any wonder that health care and drug and technology costs, all stimulated and supported by your tax dollars paying for government funding of research, are going through the roof, while all of us
∑ pay more and more for insurance and out of pocket and transportation costs,
∑ get less and less actual health care services,
∑ pay more for goods and services because our businesses are crippled by spiraling health costs and some of us lose our jobs,
Poor people suffer the most in the process. Those of us in Family Medicine understand this all too well. Poor people have already suffered cuts in services that they need for basic health and they have been forced to pay for additional costs that they cannot afford, cuts such as necessary prescriptions, mental health, and their basic access to care. Even during prosperous times, the poor did not fare well. Now in less prosperous times, the prospects are even worse.
Did you know that cuts in government programs risk peopleís lives in order to save a few dollars in the short run and these cuts will likely need to increased future health costs?
Medicaid has targeted the expensive medications for special approval programs. This may sound like a good way to cut costs, but look how the programs are implemented. Some programs take away the more expensive non-sedating antihistamines from use by poor patients, but this forces them to go to medicines such as Benadryl that make people sleepy. Isnít it a bad idea to give such medicines to poor kids who already face enough challenges in the classrooms of today? Isn Ďt it a bad idea to have a patient take such a drug and then drive when studies show that the driving performance of such patients is about the same as a drunk driver? Donít you think that doctors are upset about this poor treatment of their patients, the increasing conflict caused between doctors and patients and pharmacists, and the extra risk of being sued for their role in something that they donít believe in?
Did you know that the government has adopted co-pays for the poorest patients, the ones who have little money anyway? They have to pay money so they can even get medicine. Co-pays for Medicaid patients donít save money by taxing poor people for each prescription. Co-pays save money by forcing poor people to choose not to get medicine at all as they are forced to choose between shelter, food, housing, and the limited government money left for personal items. The government saves money because poor people donít get their prescriptions filled.
∑ Of course the ones that donít get their blood pressure medicines will be more likely to have strokes that will cost the government more in the long term. Hospital, rehab, and long term care is very expensive and long lasting.
∑ The ones who have mental health problems will be more likely to cost more for hospital and clinic and emergency room visits, in addition to legal costs and problems for other people. Studies show that government attempts to restrict access to medications in this group actually cost 17 times more than they save, not including costs outside of health care for families, friends, and neighbors who suffer.
∑ Co-pays will decrease the use of needed medication, they will increase the costs of extra visits to the doctor, hospital, and emergency room and they will increase the costs of mental health and long term care in nursing homes and other facilities.
This co-pay insures that the government saves money today, but it also guarantees that people will be sicker, more likely to need long term care, less likely to be mentally stable, less likely to be able to work, and more likely to be frustrated with living in America. I do not fear the terrorists from overseas so much as I fear our own children growing up without hope in America.
Did you know that the family practice doctors who take care of these patients spend many years paying back their medical school loans while the other medical students that they graduated with will pay the same loans off in one or two years? Doctors who started the poorest, and who serve in the poorest locations, are often not able to stay in the locations where they are most needed, even when they want to, because the government and medical schools continue to enslave them instead of rewarding them. One of the greatest impediments to doctors serving as missionaries is the debt of medical education.
What do family medicine doctors want? Family medicine doctors donít want more money, many if not most think that doctors already make far too much. Family medicine doctors want their patients, their communities, and their employees to be taken care of. Family docs are people persons. Family Doctors want relief from things that prevent them from taking care of the people that mean the most to them, because people are their most important consideration. Even Marcus Welby would have a lot more trouble doing what he did in todayís family practice clinics.
∑ Family Practice doctors are tired of being at the mercy of the most complicated health payment system in the world, a system that takes away the resources that would allow them to care for their patients better and penalizes them because they do not do the procedures and surgeries that are done by almost every other specialty. Family physicians deal with a wider variety of patients and deal with more uncertainty, and yet the system fails to honor them for the complex decision-making that they make every day. The system actually penalizes any doctor who does counseling and caring and gets involved with patient needs. It is a system that rewards doctors who are less involved with patients and we know that involvement with patients is a necessary part of the best medical care.
∑ FP docs want nurses and office workers in their clinics to be paid well enough to insure that their patients are able to get to know all of the folks that care for them and get the best quality of care. They are tired of training medical people only to have them stolen by other physicians and clinics that pay them more so that, in turn, these physicians can do less, be less involved with patients, and make more money.
∑ FP docs want to have the good medical supplies and office equipment, to complement their efforts to give the best care,
∑ FP docs want to be able to continue to deliver the prenatal and obstetrical care that their patients need, instead of having to quit doing something that they feel is important to their patients because insurance companies are too greedy and uncaring (more later).
∑ FP docs want elected government officials at all levels that will get the government and lawyers out of the way of good patient care. They want the same standard for these that doctors hold out for patients, ďPhysicians should first do no harm.Ē This is something that the government rarely even considers these days.
∑ FP docs are tired of hired investigators who come in, disrupt patient care for days, and presume guilt instead of gathering information and respecting professionals who have sacrificed many years to be able to give even more at the office and hospital and even when out in the public during their private lives.
∑ FP docs are tired of certifications that do not add anything to the quality of medical care and can disrupt it for days or weeks, before or afterward.
∑ FP docs want to be respected by medical students and those in academic medical centers. It is only in the last 50 years that this has changed. Before that, the general practitioner was the envy of all. Medical schools were based on generalist training. The generalist perspective held teaching as a high priority. The loss of this perspective means that medical education has less priority on teaching students, which means less effective physicians for all of us.
∑ FP docs want students to have the opportunity for students to experience careers of service, instead of careers that distance doctors from patients. How can students respect doctors who serve if they are badmouthed and second guessed in academic centers by professors and medical school leaders who often do not know even half as much about the patient as their local doctor. Some medical students rarely see a family physician during training. Studies show that it takes 6 months primary care training by rural docs who do this all the time for students to become comfortable with the concept of delivering primary care. At 9 months, these students do not want to leave such training. No medical student gets this kind of exposure without extensive personal effort and the sacrifice of a number of family physicians. Medical schools are chopping away at Family Medicine exposures even as we speak.
The loss is not just in medical schools and Family Medicine. Training for our doctors and residents is suffering, and with it the quality of medical care. The way to become a physician is to practice medicine under good quality supervision. This means good teachers who work closely with students and residents and allow them to make decisions. Our liability situation, the environment of medical schools that penalizes teaching, and our health care system that disturbs the doctor-patient relationship is taking away the experiences that students and residents need to be top physicians. Canadian medical students have lost their enthusiasm for coming to the United States because they can do so much more and function more closely like physicians in their own programs.
Family Medicine is one of the best kept secrets in medical education:
∑ Family medicine programs have been shown to reduce public health expenditures in a county by 30 Ė 50%. The value of family medicine is not how much money they make for clinics and hospitals, but how much money is saved by governments, businesses, and people.
∑ Specific programs taught by family medicine docs, are the best medical education programs in the nation. Such programs send medical students out to spend 6 - 12 months with family physicians and not surprisingly, these students do better when compared with those taught in medical school. Even students spending just 2 months in rural preceptorships with family docs rate these as their best learning during medical school.
∑ One of these preceptorship programs has transformed $30 million of state tax dollars into 2 billion dollars in local economic impact for rural areas in Minnesota. This is probably one of the best rural economic development programs in the nation.
∑ One program, directed by a family physician, has transformed 1% of the graduating medical students in the state of Pennsylvania since 1971, into 21% of the rural family physicians in the state, the state with the largest rural population in the nation. Widespread adoption of such programs would mean that we would not need expensive programs to attract physicians to underserved areas.
∑ Another program, directed by a family physician, has improved education, finances, and admissions at 2 small colleges in a state with a large rural population. This program is restoring these breeding grounds of young professionals for rural areas. The success of this program has illustrated that state policies in education play a key role in the declining rural populations of many of our smaller counties. Young professionals represent the best solution for small towns facing these problems. Young professionals mean jobs, services, education, and leadership. Without such efforts, small towns will continue to lose population and services.
Family medicine offers hope, caring, involvement, economic development in underserved areas, and cost savings.
Ask yourself some important questions:
Why is the United States near the bottom of the industrialized nations in terms of health care? We spend more than everyone else, why donít we get more.
Donít you deserve to have a doctor who gets to know you over many years and treats you more like a friend than a fee?
Arenít you tired of insurance delays that cripple your finances for months or years while they make money off of the interest from your money? Arenít you tired of insurance companies treating their clients badly and forcing patients back into poverty and government welfare instead of paying up like they should? So are we.
Arenít you tired of insurance companies who actually run government programs into the ground, and why not? If they did a good job, the public would believe that government programs work and we would not need insurance companies. If insurance companies do a bad job, then people are likely to think that government programs are bad and nothing can be done. The truth is that nothing is more complex than governing the United States of America, and if we trust the government to run the country, we should trust it to provide a good health system also. Insurance companies are out of control, especially since 9/11. The nationís trauma has only allowed them to hike up their rates and remove competitors. They continue to store away millions for their own uses. You think WorldCom was bad, check this out:
∑ Did you know that 100 family practice doctors in California paid nearly 10 million dollars in liability insurance so that they could continue delivering babies and the insurance companies had to pay out only $100,000 in claims? What a lottery they have set up! For every hard earned dollar paid by family medicine doctors so that they can continue to care for patients and deliver babies in areas where no one else would, insurance companies pocket $99 for administrative costs and ďto keep in reserve.Ē
Family medicine would have you know that even though we lost 4 people to anthrax after 9/11, we lost tens of thousands to diseases we have had for centuries. FP docs are battling not only diseases such as AIDS, but setting up defenses to protect people from the killers of today such as drugs, alcohol, tobacco, violence, and AIDS. Your son or daughter is far more likely to die of these than any terrorist act. Did you know that the billions that the state and federal governments extracted from the tobacco companies because they have been killing us for decades, the billions that were supposed to go to save the lives of countless millions of current and future smokers, are not going to free people from this slavery?
"The odds that a boy born in America in 1974 will be murdered are higher than the odds that a serviceman in World War II would be killed in combat." US Sen. Phil Gramm, 1995
We seem to keep learning that military victories against guerrillas and terrorists are impossible, but did you know that teachers, family doctors, and public health experts and a variety of less costly folks can help restore a nation to wholeness so that its people are not as willing to solve their problems violently. The most successful weapon of terrorism, the one that has influenced so many to kill themselves and others with them, is the promise that their families will be better off after they die. Tens of thousands have gone to their families this way. The money is not the important part. It is the fact that they are hopeless and the money offers their family a way out, even temporarily.
The way to restore peopleís faith in the future of their children, the best way to insure that they are around to care for their children, is to restore health care, nutrition, shelter, and education. Yes unstable situations will need military protection so that they can make it through to job training, government reform, and the development of local leaders, but this is the best way to dimish and end the terrorist threat. More super-specialist physicians and researchers in this nation and others will not help this effort. More bioterrorism preparation will not protect us. Training more and better teachers, nurses, and service-oriented physicians will help this effort. Sending more of our best overseas and into our most poverty stricken areas will give these areas the best opportunity to permanently improve. Those who experience poverty will likely find that people in material poverty are spiritually uplifting. They will not forget the lesson that the value of human life cannot be measured in material wealth.
You might ask why family physicians have not sounded such alarms before. We have but few have listened. We have researched and reported and testified. We have learned many hard lessons. We have promoted changes in the health system. Perhaps we have not been successful, because our primary effort is to care for people, not change systems. Now however we understand more fully that to care for our patients, we much change the systems that impact them, and us.
Winston Churchill once said that Americans can always be counted upon to do the right thing, once they have exhausted all other possibilities.
Well fellow citizens, we have exhausted them all. We need a new system of care based on primary care and family physicians, not because we are writing this, but because it is best for the nation. We are also the ones most likely to work with other health professionals who put a priority on service. We need these physicians to be wedded primarily to service. We need to select physicians better and train them better. Being a doctor used to mean choosing the needs of a patient over the needs of the doctor. In return the doctor was given respect and authority. It is not a surprise that doctors are losing this respect and authority, since physicians are not consistently making the best choices for their patients.
Having a dedicated family practice doctor care for you over a number of years is the best basis of health care for you. We also need a form of payment for physicians that rewards service, and preventing disease, and working with schools and parents and communities. We need to insure that all people in this nation feel that their kids will have a better chance for health and education than they had. We can no longer allow out of control health care costs to erode all of these important areas.
I am confident that this nation will not fall to terrorists or nuclear war, but as a family doctor caring for patients in a wide variety of locations and conditions, I am sure that we will not survive the culture of death that we allow in our cities and schools and neighborhoods. It is no longer a matter of choice, it is an imperative.
Oh and by the way, Britain has long had family doctors that actually know their patients and care for them for years. Perhaps this is a major reason that they can actually afford health care over there.
As you can see from the above, changes in the health care system will attract an array of the richest and most well-financed enemies you can imagine. The system that they have developed is so complex that only they can understand it and interpret it, and benefit from it. They will have stored up your hard-earned tax and insurance dollars for years. This is quite a war chest and they will not hesitate to use it and call in many favors from those that they have helped to elect.
Your basic choice is whether it is important for your remaining years of life and for the lives of your children, to have better systems of care, a personal physician, and more resources for other areas in your life and the life of those around you. The nation cannot afford to spend a higher and higher percentage on health care without tremendous impact on many other important areas in our lives.
This is a daunting task, involving millions of Americans and tremendous and consistent pressure from voters, but again Family Medicine provides reassurance.
∑ There would be no family medicine at all if there had not been a public outcry for a personal physician. Family medicine remembers this creation and who created it.
∑ Some of these key Family Medicine efforts exist because key legislators, interpreting the public need, stepped forward to confront medical schools, and thus create new programs, departments, and even entire medical schools.
∑ It is the right thing to do.
You can believe me because I am a family physician who has seen far too much of our society. You can believe me because you understand what happened in ancient Rome and to ancient Israel in the Bible, and at the fall of other civilizations. Try the book of Amos in the Old Testament for a scary prophesy for nations who neglect and abuse the poor. Or you can believe me because of what you see on TV screens, news reports, and other daily traumatic events. I assure you that even more goes on behind the scenes. Our enemy is not a country or a person or a group of people. Our enemy is poor health, poor education, and the culture of death.
The battle will not be fought with weapons of war, but will weapons of peace that restore health, security, and self esteem. Technology: Shaping It or Shaping Us? Hopeless people can and will do just about anything, drive planes into buildings, rob banks, kill children, etc. People with hope will build communities and neighborhoods and rebuild nations.
When will the mightiest nation on earth understand the very principles of government on which it was founded. We were founded because we were abused and neglected by England. We desired a better distribution of wealth and political power. We fought and earned it. We have forgotten those battles and those who served our country so well.
Character, Color, Admissions, and Physicians
Hope: Students From the Underserved, For the Underserved