Sunday, February 20, 2011

Health Care Reform in the Crosshairs

Last summer, at the Cleveland Film Festival, I saw a movie called The Lottery, which is still swirling in my head. It is a documentary about the enormous obstacles that true education reformers confront when they try to help our kids learn. The film was raw and powerful and made me angry. It led to many family discussions about the state of education in America and a search for a way forward. The film is certainly not a balanced view on this issue, and teachers’ union supporters who view it will need to have industrial strength antacids available. I found The Lottery to be more powerful than the more popular movie Waiting for Superman, which addresses the same theme.

Assuming the facts are as presented, viewers are shocked to learn how long and how expensive it is to remove an incompetent teacher.

The New York Times reported that governors across the country are seizing on the public mood and are working to dismantle the teacher tenure system, where jobs are protected regardless of performance. As an aside, the Times’ headline reads G.O.P. Governors Take Aim at Teacher Tenure. You recall after the recent tragedy in Tucson, committed by an evil madman, some had criticized prior political ads that included crosshairs superimposed on political adversaries. Yes, these were Sarah Palin’s political ads. Critics suggested that these ads were not only tasteless, but created a climate of incitement. Should the Times’ phrase Take Aim in the headline above have been sanitized? Who knows? Someone might read ‘take aim’ and think it is a call to arms!

I was asked recently if the medical profession had a mechanism to verify if our older practitioners had the necessary cognitive and technical skills to practice medicine. The answer is, no we don’t. While other professions have mandatory retirement ages, we physicians are firmly on a tenure track that has no endpoint. Physicians can continue to treat patients, and even operate, without any limitation of age or requirement to certify that our skills are sufficient. I think a reasonable argument can be advanced that we could do better.

There is an emotional aspect of the argument advocating periodic assessments of physicians because lives are at stake. But many professionals who don’t wield scalpels or colonoscopes can also put our lives at risk. If an engineer, for example, designs a bridge and miscalculates, a tragedy could ensue. Before we all agree that physicians starting at age 60 should undergo testing every 5 years, let’s consider which other professions should be included in this effort. Nevertheless, I feel we have an obligation to our profession and to the patients we serve to assure them that we still have the right stuff.

Teachers’ unions have been recalcitrant and oppositional for decades and they have squandered the public trust. Their enemy is not the GOP governors or a public who is now hostile to them. Teachers are victims of their own self-interest. The medical profession has failed many times by not reforming ourselves proactively. Then, outsiders ‘reform’ us and we gripe about our loss of autonomy. Haven’t we learned what happens when outsiders heal us? I think that medical reform needs to be square in our own crosshairs before someone takes aim at us.


  1. OK, you've gone from preaching to meddling with that one.

    Do you have any objective Evidenced Based Research for choosing 60? Why not 65? Why not 70?

    My CME requirements are not waived because of my advancing years.

    The QA committees have not whited out my name because I'm approaching your arbitrary thresholds.

    Do you think one's age excuses them from the recertification process (OK, I've set that one up for you as I'm one of a literally dying breed of certificants who was "grandfathered [so sexist! why not grandmothered?] and doesn't need to take recertification tests. Perhaps that should change)?

    My toes are sore from you stomping on them. I've been finishing up a tedious CME called GESAP and I might be more up to date on the material than, heaven forbid, someone who is only an immature 45 and resting on their young laurels.

    Just this morning I was discussing with my wife an essay about the travails of the aging gastroenterologist. You have just provided me with more ammunition (is it OK to say that? I guess that is so horribly a violent metaphor) for my writing. If I win the essay contest I'll give you a shout-out, you young whippersnapper.

  2. Great comment!Sorry re your toes. Glad I wasn't wearing my cletes. You ask if I have any objective evidence? May I remind you that I am a blogger who is duely licensed to spew out opinion and commentary which occasionally may be evidenced related. Finally, I suspect that the age gap separating us is narrower than you think. Best, MK

  3. Nice article, thanks for the information.

  4. Here is comment from A. Bailey, which because of a vast right wing conspiracy did not appear.

    A. Bailey has left a new comment on your post "Health Care Reform in the Crosshairs":

    Other than making me reach for the smelling salts and Metamucil, it seems that absolutely no one has found much of interest in your latest offering. I was anticipating at least Leisure Guy telling me to retire early because I'm a Republican, but even he has nothing to add to your comment count.

    I guess it's up to me.

    On the recent GESAP a question references an arterial Doppler flow device which can be put through a biopsy port to assess risk of ulcer rebleed. I whiffed on that question; indeed, I considered early retirement because I wasn't even familiar with the technology. The reality is I suspect this is similar to endoscopic confocal microscopy - exciting new technology that will never find a useful clinical role because it's totally impractical.

    What do you think?

  5. Interestng stuff, A. Bailey, though I am troubled I had to personally post your erudite thoughts. I agree there is much endo technology that will be searching for clinical utility. However, if EMR doesn't send you out to pasture prematurely, then I don't think the technology will scare you off!

  6. One of the top needs of the people in a country is about health concerns. Malnutrition and poverty are getting wider because of lack assistance from the government. If there will be some laws and bills about health care that will be implemented, it is a great help to minimize such problems.

  7. Health insurance should be given not only on the employee but for all. Budget on health insurance should be in a amount that everybody could avail on it. Government should conduct studies on this on how they could come up with better results.

  8. These health care reforms could have massively far reaching consequences, I think sometimes people forget how comfortable they are compared to others and how privatisation can actually drive the cost of health insurance up rather than down. Considering the breadth of reform in the US and potential reforms considered currently in the UK, I would be interested to see how much international health insurance is affected.

  9. Thanks, Jim, for the comment. I am in Canada now. I was sitting next to a Canadian woman on my flight from the U.S. She has complicated Crohn's disease. She waited a year in Canada to see the specialist of her choice.