How Many Oranges does it Take to Make One Apple?

Feminists and the politically correct junkies must be pretty pleased by the recent trend in the US medicine: since 2003 the number of female medical students has surpassed the number of their male counterparts. Hallelujah!

Not so fast! Societies blessed with socialized medicine have long been complaining about problems associated with prevalence of female physicians. Some went even so far as to call training women in medicine a waste of time. Their rationale? Women tend to work fewer hours, take less call and retire earlier than their male colleagues. Women in our society are still widely expected to carry the brunt of child rearing, to take care of the elderly parents, and to keep the home, hence their inability to keep as crazy a work schedule as their male colleagues.

The latest study published in "Medical Economics" journal issue on October 23, 2009 has found that in terms of hours worked per week, there is now practically no difference between male and female primary care doctors. So were our critics wrong? Not really. In that equal number of hours, male doctors saw an average of 102 patients per week, whereas female physicians averaged 78 patient visits per week. So female doctors' productivity was just 76% of that of males, all other factors being equal. In other words, it takes more than one woman doctor to replace a man.

Why this is happening is beyond the scope of this short article. I suppose that women simply take more time to talk to their patients, to hold their hands, to let them cry on their shoulder. Who do you prefer to see as your doctor: male of female? I like females, hands down.

The problem the society is facing, though, is that with more women entering the field of medicine, we need to budget many more jobs for them to see the patient numbers previously seen by men. The matter is further exacerbated by the fact that potentially 30 million new patients will soon have medical insurance, and will be making regular appointments to see their primary care doctors. This will inevitably create a tremendous bottleneck: more patients, and a larger proportion of less productive doctors.

It gets worse. If we want to curb or even cut the cost of providing medical care while throwing 10% more patients into the mix, this means that doctor's compensation will go down. Becoming a physician is a long process of very intensive study. And then in their professional capacity, one has to deal with cranky people at all hours of day and night who are in pain and who expect you to take care of them. If on top of that the pay is not good (and the pay has been going down for the US doctors in the past 10 years - and will inevitably go down considerably with the health care reform), the brightest males start looking elsewhere to utilize their brains. Female dominated field of medicine is what inexorably awaits us in the future. Consider the trend in all countries with socialized medicine: up to 86% of physicians in the Soviet Union were women, half of all doctors under 40 in Canada are females, etc. And once the brightest males stop coming to the medical schools, the caliber of students will become to degrade, and mediocrity will start creeping in. This vicious circle will keep feeding on itself. Eventually, just like every people have the government they deserve, every nation has the quality of doctors commensurable with their compensation from the society. There is no such thing as a free lunch. Somehow we all understand that bankers deserve the $50 million bonuses - the industry argues, that if you don't pay them, the most talented [crooks] won't come. (And how much do they exactly have to study to become the most talented crooks on Wall Street? Four years? Wow!!!) Do you seriously expect the best and the brightest people in the nation to spend at least 11 years of exhaustive training to be getting less than $100,000 a year in return? Dream on.

Tu l'as voulu, George Dandin!

Clear Vision

We had company over last night. One guest who is an ophthalmologist (eye surgeon) was telling how she recently outraged a family by refusing to do a cataract surgery on their elderly mother. The elderly woman was in a nursing home with a far progressed Alzheimer's, and the family knew her vision was down due to a cataract. So they brought her in with a request of restoring her vision surgically so that their Mom could have a few more months or years of enjoying clear vision while senselessly staring into the ceiling or wherever her gaze happened to fall. The doctor said that upon the examination, the patient was totally unresponsive, sitting in a chair and banging her forearm against her chest repeatedly. She would not make an eye contact, she would not answer any simple questions, and the doctor had no way of examining how bad her eyesight was. A surgery - WHICH THIS PATIENT WOULD BE ENTITLED TO FOR FREE UNDER THE CURRENT SYSTEM - would have meant that after the procedure she would have to be restrained and wearing a helmet to prevent her from rubbing her eyes for a period of time. There were also some other medical ramifications which made the survival of the surgery and the recovery process very problematic at best. Bottom line - this was an unnecessary procedure, it was not going to enhance the patient's quality of life in any way, and it was medically dangerous. The family was furious with the doctor's decision and accused her of refusing to operate because the patient had Alzheimer's (duh! hello, Sarah Palin with her "death panels!"). The doctor has referred them to a different physician who, in her words, would operate on a corpse.

Things like that run up the cost of our health care without helping the nation to feel better. A girl with diabetes working two part time jobs would be without health insurance coverage for her preexisting condition for a number of years even if she buys a policy, while some nonagenarians in a vegetative state qualify to get a heart transplant for free. What use is clear vision to an Alzheimer patient whose brain is gone?

I want to mention two excellent books, both written by physicians, which explain what makes the American medical system sick (beyond the run amock malpractice system which alone accounts for 25% of the unnecessary spending on defensive medicne). The authors were not supported by grants from any special interest groups, like pharmaceutical or insurance companies. Both books refere to multiple studies the results of which are so often twisted and fed to the public in the altered form to justify bigger spending (but not better results). So here are those books:

John Abramson, M. D. "Overdosed America: The Broken Promise of American Medicine. How the Pharmaceutical Companies Are Corrupting Science, Misleading Doctors, and Threatening Your Health." HarperCollins Publishers, 2005.

Nortin M. Hadler, M.D, "Worried Sick. A Prescription for Health in and Overtreated America." The University of North Carolina Press, Chapel Hill, 2008.

Separation of Church and Conscience

For a few weeks now, I have been floowing an email-based discussion of the health care reform by our local medical community. Lately, a participant shared a quote by one Adrian Rogers which reads like this: "You cannot legislate the poor into prosperity by legislating the wealthy out of prosperity. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is the beginning of the end of any nation. You cannot multiply wealth by dividing it."

Another physician remarked that this quote is inconsistent with Adrian Roger's role as the most prominent Baptist minister of his time who supposedly spent his life spreading Christ's message regarding "leaving the worldly goods behind and following him on the path of righteousness."

To which the original participant of the discussion retorted: "That is called separation of church and state."

I should admit that my jaw dropped, and I am still struggling to bring it back up. This may be the reason why I can't just shut up on the issue. But to admit that what is taught at the church stays at the church made even my jaded self shocked. This is more than separation of church and state. This is separation of church and conscience.

OK, but suppose he is right. We go to church, love our neighbor sitting on the same pew, smile and think happy thoughts of righteousness and goodness, and then leave the church, undercut our neighbor in our haste to get out of the parking lot and speed up to worship the green buck. Nothing wrong with that - separation of church and state, you know, democracy, principles of our forefathers, and stuff. But interestingly enough, those same people who would argue for the separation of church and state in this particular instance would not accept the same logic when discussing government funding for abortions. Sorry, guys! You can't have your cake and eat it, too!

I am advocating consistency, please. If it is acceptable for a Baptist minister to make a successful career spreading the word of our Lord and then, in his off-duty pronouncements promote something completely opposite due to the principle of separation of church and state, then please leave your religious beliefs completely outside of the discussion of whether or not government funding for abortions should be allowed. Fair is fair.