The US Medical Brain Drain

An article published May 29th 2015 in one of the daily New York tabloids entitled ‘Why are US doctors quitting’ by Charles Krauthammer dissects and describes the ever worsening exodus of physicians from the US healthcare system. The article is an attack on the introduction of the Affordable Health Care Act otherwise known as Obamacare, and in his opinion the excessive burden placed on physicians as a consequence of the excessive administrative requirements of the legislation. The main point that the author convincingly establishes is the unbelievable fact that the authors of the act passed it into law in the absence of any evidence to demonstrate that it would improve the quality of clinical care in the US.

In developing this argument Mr.Krauthammer centers his analysis on the numerous hours of primarily pointless data entry that physicians will be expected to spend their time performing, as oppose to actually interacting with patients. Judging by his occasionally scathing comments he is of the definite opinion that doctors will be converted into glorified computer technicians. The human element of medicine will gradually evaporate to be replaced by hard cold technology albeit markedly sophisticated with complex algorithms that will only require the humans to enter the data. A grim picture indeed.

There is no question that medicine has changed drastically within the last one hundred years and the rate at which it will continue to ‘evolve’ is not predicted to slow down. One of the main issues missing in the Krauthammer article was the complete absence of any argument in regards to the corrosive effect the insurance industry and the medical malpractice lawyers have had on the once noble profession. There was a time when physicians were shown the gratitude expected of men and women who had committed their lives to the salvation of others and it was tragically the insurance executives, looking to increase their financial profits and fat cat salaries, commenced on a propaganda campaign in the late 1980s characterizing the medical profession as a group of avaricious self serving professionals who were primarily responsible for the elevated healthcare costs in the US. This piece of misinformation was forced into the consciousness of the American people and eventually they began to believe the insurance industry fairytale at which point the profession began losing the goodwill of the people it had spent decades helping.

The article then proceeds to omit any meaningful discussion about the Darth Vader of US medicine, the men with law degrees that prowl the courts, hospitals, chase ambulances and spend money on TV adverts enticing the poor and needy towards the promise of easy earnings. This uniquely perverse thread of American society started with the good intention of the Founding Fathers who desperate to escape the lawless tyranny of the old countries established a constitution and a set of laws that in the goodness of their heart they thought would lend for a more fair and honest society. Unfortunately the outcome was not as intended and the darker side of human nature made sure of that by allowing the US to produce more attorneys per head of capita than any other western country in the world. Now of course they all need to repay their exorbitant student bills and make their political donations to the friend who chose the path of politics, where they could write the laws conducive to the activities of their chums in the medical malpractice arenas. This two ring circus was not the intention that caused the founding of America. One of the reasons that pharmaceuticals are generally ten times as expensive as most other countries in the world is that the companies that develop and manufacture these products are always getting sued for quite often fictitious infractions, which naturally requires the expenditure of large amounts of capital on legal defenses and settlements. The same cause and effect applies in clinical medicine and if only the ‘experts’ drafting the aforementioned bill would have had the courage, fairness to include substantial amendments then it is quite likely the medical profession would have felt a greater sense of peace as the new changes came into effect.

Physicians in their late forties and early fifties are beginning to look for careers in other arenas because the cost of maintaining a private practice has become prohibitive and they would rather not work for a large healthcare corporation where their autonomy would be completely extinguished. Some are looking to move back to the countries they emigrated from decades earlier satisfied that their children have commenced on their own life paths. Within two decades the new generations of healthcare providers will be an amalgamation of individuals with degrees from medicine, nursing, physician assisting and most likely some type of hybrid that the government will have created to serve the enormously expensive system it created.

The other obvious thorn that the Obama administration failed to clip was the life shackling medical school fees that each US student has to incur to obtain the degree necessary to enter the training programs before being considered a ‘proper’ doctor. It will become impossible for students or families to manage these payments on the meager government salaries that the AHCA intends to pay with the consequence being that the bright young beings will pick the tech or finance box on the college applications.

It is easy to criticize but a more challenging task to offer a solution. However in this case the solution to the issue of the forty million uninsured was simply staring them in the face and it was simply this. Take the heads of the health insurance companies; sit them all down in a confortable room with air-conditioning, coffee and some confortable leather chairs around a mahogany table. Once they are settled in commence a presentation that is short and to the point for which a power point may or may not be needed. The opening salvo would include the pleasantries and platitudes that they have grown use to and then they are handed the hard cold fact that if they want to continue to sell health insurance in their respective states then from the goodness of their socially corporate responsible hearts they will donate a small percentage of their vast profits to a fund earmarked to care for the uninsured.

A simple solution to a simple problem but one that would have required a man with a strong political spine and the courage of his conviction. But alas none existed and so came forth the more appropriately named Unaffordable Health Care Act.

Time will tell.