Monday's Philadelphia Inquirer had an article on a coming physician deficiet: "Diagnosis for the doctor deficit".
Then, yesterday, The Wall Street Journal had an article with a map of physicians per 1,000 people, by state. For the Commonwealth of Massachusetts the number is pretty good. More than 1.5.
But, looking to the south and west, it is not so good. Further, in some of those states the population is spread out and thinner, so there is more travel for the person or the physician. For Massachusetts there are 809.2 people per square mile. For Idaho there are 15.64 people per square mile. While Maine has the same number of doctors per 1,000 people, they have only 14.3 people per square mile.
The question we should all be asking ourselves is why this is all of a sudden news? Why did our Representatives and Senators not recognize and talk about this before they voted for the Health Insurance Reform Bill that President Obama signed? This should not have been a surprise to those who were at least reasonably well informed. On the one hand we have been having a bit of a shortage of Primary Care Providers (PCP) for a while now. My PCP told me that Lowell is below the recommended number. And this is not just about Democrats. Where were the Republicans to warn us about this?
The problem is compounded by the fact that we don't all have the same common understanding about health. Some of us don't understand about how the medical system works and what we should be doing about getting shots and visiting our physician from time to time for a checkup. Some of us don't understand about taking medicine until the pills are gone, rather than until you start to feel better. And going to a PCP when something first shows up, rather than going to the Emergency Room when it gets bad. And, the common wisdom that you can catch things in a hospital, which you might not pick up in your PCP's office.
So, could we have done something about this by legislation? I would think so. What about providing education benefits via the US Public Health Service and having graduate Physicians, Physicians Assistants and Nurse Practioners pay back by working in areas where PCPs are in short supply?
Regards — Cliff
6 comments:
A form of this was attempted some years ago and what was discovered was that the beneficiaries simply "served out their time" and move on the moment their contract was fulfilled. One of the unintended consequences was that the PHS facilities were looked on as welfare clinics, staffed by folks who really didn't care using old equipment and supplies.
I think that going to the legislative well only provides us with less resources for maintaining our lives because we are required to turn over more of our paycheck to support a never ending growth of government doing for us what we should have and could have done for ourselves.
Having been an AF medic, and having to cope with the daily "sick call," government sponsored or provided medicine is the worst delivery system as it invites and nurtures an attitude of irresponsibility for one's health. I can recall vividly being chewed out by an AF Major because I told him that he could get cough medicine at the BX or Commissary. He was apoplectic that he couldn't get all his "medications" at AF expense in the hospital pharmacy. In the ER, we were treated daily to the consequences of "my health is your problem." We had folks arrive after the dinner hour with acute STDs and want us to cure them that night. We had mothers dragging an entire brood of kids into the ER demanding that the MOD (medical officer of the day) give her something to make her child's nose stop running and throat stop being sore. I can tell you, in spite of all the professional dedication humanly possible, after a time, this sort of onslaught simply and profoundly wears you down. As one of the docs lamented one day, "After sick call, I need to go to sick call."
Neal -- thx for the vignette of the angry Major. It's just amazing how *entitled* people can become when they think something is an entitlement in a bottomless trough sort of way.
The other day I heard an elderly man ranting about how messed up things were...so of course I inquired, 'Why?' His answer -- "I've paid over half a million lifetime in taxes to the government, so why do I still have to pay for prescription drugs?"
I didn't even get into the details of what his copays were or what the drugs were.
But to the bigger point -- HUH?
I mean, what makes a person assume that all of [insert product] should just be completely free, always?
Also, that Major had no business chewing out an NCO over that if his issue was with Tricare, right or wrong.
I recently had to listen to a fellow O-3 go bonkers over a $2.30 charge for a meal at the mess hall. The worst part? E-3s and E-4s were within earshot.
I think there's a VERY narrow range of things Officers should be allowed to complain about in front of their troops...just curious to hear your opinion on that as a retired NCO..
Regarding Neal's first paragraph, the first part doesn't bother me and the second part speaks of bad leadership and bad formation of the health care givers. But, it is a danger when one is near the edge of socialism.
Regarding Greg's point, and I can not provide the insight Neal can, but as far back as when I was in the California Cadet Corps, I head that one of the rules of leadership is "Never explain, never complain". The never explain referred to when one was being reprimanded for doing something wrong. Accept it and move on. Don't try to explain your way out of it. The other part is self-evident.
None of this is to preclude positive examination of a situation and formulation of solutions. And no leader elevates himself by tearing down those above him in front of his own subordinates. But that is just my personal opinion.
Regards — Cliff
Cliff, I like that rule of thumb from the Cadet Corps.
When you're wrong "own it" -- I know that could apply to anyone but esp. for the guys who wear the big rank and take home the big check.
Also, like you said, never tear down superiors in front of subordinates...as they saying goes (rightly) praise in public, criticize in private. That applies in all directions -- up, down, and laterally.
I can't tell you the # of times I've been burned after saying something "in confidence" to someone I thought I could trust --
So what's the takeaway? Rather than keep touching the hot stove and wondering why my fingers hurt so much, I've developed a firm rule that I will talk TO people rather than ABOUT them.
It would damn near take an act of Congress for me to bad-mouth a Guardsmen in front of another.
When I met my wife and contemplated marriage to her, I was a young, wet behind the ears, know it all, stupid "skeeter wing" (in the AF....the smallest dumbest thing that flies with ONE wing.....a mosquito). Then her father came home from a TDY and I got to "meet him." I'd never seen so many stripes in such a short distance. He was a CHIEF......back when they were revered as a god.....and pretty much had the same powers. "Growing up" under this Chief was a study in leadership. He WAS a god....was a crew member on the B-17 that produced the first AAF MoH of WWII.....I was still sucking mother's milk and making my diapers yellow. When I would screw up somehow....I managed to make that a routine.....he would look at me and smile and say, "Neal, why are you selling yourself so short?" That was my chewing out. Later in my career, I heard Chappie James give a talk on leadership, and a key phrase he said was, "If you didn't build it, you have no right to tear it down." That goes for building those who come behind us. We didn't build them to that point, so we have no right to tear them down. Couple that principle with the old axiom that "If you treat a man as he is, he will forever remain as he is. If you treat a man as what he can be and must be, he will become what he can be and must be."
For an officer, or a senior NCO, to complain about anything is a self serving act. It tears down something that they didn't build and the only option to them at that point is to make it better. Leadership is about inspiring people to be better than they are, and a good leader provides the template for doing so. Nobody wants to follow someone who is negative and self-absorbed with what is wrong in their world. We follow people who make lemonade out of lemons and bloom wherever they are planted.
When I made Chief and was informed of such at 5 AM in my Wing Commander's office, the FIRST phone call I made was to wake up my father-in-law.....and it was the most emotional, proudest moment of my life.....to be so priviliged to step into those giant footprints and try to be better.
On a related note, my grandparents were anything but rich, but they lived rich lives and required nothing from anyone else. When they retired, they spent less time at the grocery store because they grew most of what they ate, and when they got ill, they mended themselves with long standing home remedies. I can remember stepping on a very long rusty nail..went all the way through my foot. My grandmother poured a bunch of iodine over the wound and then every hour, I had to sit with my foot in a bucket of hot water laced with epsom salts. Never got infected. When I got a chest cold, she draped my chest with an old diaper after smeaing me with Vicks. Never got pneumonia.
As a nation, we have lost the ability to care for ourselves. Kids and adults don't know how to raise even simple vegetables, or how to look up something in a book in order to get something done or fixed. I can remember going to farms and picking "left over" corn and then shucking it into milk cartoons, taping them shut, and putting them in a freezer. Same with apples and pears and cherries.....get them off the ground...peel them....freeze them....and chickens.....the only thing we didn't save was the cluck.
Read an interesting article the other day that posits that almost 75% of our pharmaceutical intake is because of "invented" illnesses. What did people used to do if they "got depressed?" My father used to tell me to get up off my butt and go help someone.
I think we are selling ourselves short.....and we are paying for it.
Neal -- wow. Thanks for writing that. I will keep all of that in my back pocket, esp. the part about not tearing down what you didn't build. -- Greg
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