Doctor Needed….Under Control


S.Q. Lapius was trying to snooze, but I could see no purpose in allowing him to do that so close to bedtime.  I rattled the paper and was greeted with a snore.  Then I threw back my head and started to roar with laughter.  He cocked an eye at me.  “My sleeping amuses you, Harry?” he muttered impatiently.


“Not really, S.Q.” I said.  “It was merely the position of articles in the last issue of Internal Medicine news.  On top is another surreptitious attack on doctors by Dr. Edwards, Assistant Secretary Of Health for the Department of Health Education and Welfare (HEW).  The say,  ‘We are now questioning very seriously whether it is appropriate for the federal government to bear so substantial a share of the cost of preparing individuals for careers that offer about the highest earning power in our society.’”


“What do you expect from federally funded secretaries, even if they are doctors?  In any case,” Lapius, trying again to doze off, “What’s so funny?”


“What’s funny,” I said in a loud voice, “is that the headline right underneath reads, ‘SUICIDE RATE OF MD’S HIGHEST OF THE PROFESSIONS.’”


“Of course,” said Lapius.  “With friends and colleagues like Drs. Edwards and Altman to lead us, suicide is about the only way out.  Congress ought to pass a law that anyone who has not seen a patient for five years should not be permitted to flaunt the M.D. degree.  They should be stripped of their shingles, the caduceus ripped from their shirt collars, and their diplomas should be returned to the fuzzy sheep from which they came.  They are upset because the government has subsidized the medical schools to the tune of 3 ½ billion dollars in the last ten years, or 350 million a year.  They are afraid that we will have too many doctors by 1985 if the number of foreign graduates licensed in the United States grows at the same rate as in the past.  Their solution?  To cut down the number of American graduates.  What a time bomb.  We will soon be dependent on foreign graduates to supply us with medical services.  This is like the army depending on Russia to supply it with guns.  The sensible solution, it seems, would be to restrict the number of foreign graduates and open the doors of the medical schools to Americans.”


“You read the article?”


“Not only read it but anticipated it.  The government subsidizes about $20,000 of the $25,000 that it costs yearly to train a medical student.  Now they want to take the money from the medical schools and use it for loans to medical students instead.”


“Doesn’t sound like a bad idea,” I said, sorry now that I had awakened Lapius.  He was building up steam.


“Well it is a bad idea.  The subsidy to the medical schools should continue.  Otherwise the quality of education will diminish and the future of the profession will be jeopardized.  I’ll never understand this continuing attack on the medical profession, or the foolish notion that we can best serve the country by destroying the standard of excellence that has served so well in the past.”


“But the loans to the students is a good idea,” I said lamely.


“Of course.  But there is a catch.  The government will vacate the indebtedness of the student if the student who borrowed money, will, upon graduation, serve in areas that need physicians.”


I was becoming annoyed with Lapius.  His conservative approach had a distinctly antipopulist ring.  “That’s not a bad trade, Simon,” I said.  “After all, a free education for a few years of service.”


“Think about it though, Harry.  This will be foist only upon the poor students.  I think it would be more equitable for the government to set up clinics in the areas of doctor shortage and ask ALL medical school graduates to serve a year --.”


“That’s ridiculous, Simon.  The government has always filled what it considers the national need by bribery.  They populated the west with homesteaders.  They subsidized the railroads, truckers and airlines to serve the national purpose.  If they need doctors in underserved areas what’s wrong with a little incentive to attract the doctors?”


Lapius grunted.  “Does that mean you agree with me?” I asked.


“I think you’ve made a good argument, but I’m too tired to debate it.”


I guess it was the first time I had ever had that concession from Lapius but I might be right about something.  It was quite a victory.


“However,” he continued, “my point is that the government shouldn’t support the students at the expense of the medical schools.  It should do both.  However, it doesn’t really matter what I think or what you think.  The die is cast.  Did you finish reading the article?”


“No, not yet,” I said.


“Then listen to the last quote from Dr. Stuart H. Altman, PH.D, Assistant Secretary For Planning And Evaluation of HEW.”  Then Lapius brushed off his remarkable memory, focused his eyes on a point on the ceiling to sharpen his concentration, and quoted, as if reading, ‘We are moving towards a controlled medical system in which it will be necessary to offer financial incentives to encourage potential physicians to enter medicine despite federal controls on the practicing physician’.’”


I followed the text.  Lapius hadn’t missed a word.  “And that, Harry, is why the suicide rate amongst physicians is the highest of the professions.”