I'm late at writing this "message." It has been almost too difficult to sit at my computer and compose my thoughts. I feel like a traitor might who is considering betraying his mother country, because I am going to warn college students, who might be thinking about a career in Medicine, of the many dangers to their life, liberty, and pursuit of happiness that medical practice will hold for them.
I am not pleased to be delivering this message, for I have practiced medicine for thirty years now, and have a great feeling of loyalty to my profession. I have actually tried to preserve my profession, by devoting hours of my time to our organization, the AAPS, and indeed, to others. It is apparent to me now, however, that medicine is different than it was only a few years ago. Reality should not be concealed from aspiring students starting down this arduous road, only to discover after years of sustained effort, our government and society have placed them in a subordinate position to that of other citizens, for physicians have become nothing more than government servants, mere pawns in the game of government pandering and government promises.
The same government, which promised medical care to the elderly through Medicare, wants to extend its power and control over ever larger segments of the population. Indeed, there are those who would amend our Constitution to make medical care a "right" of every citizen, and it will be up to you, the future physicians of America, who will feel the brunt of these nefarious political forces.
All of us go into Medicine for the same reasons: We like science, we want to help people, and the road to medicine looks exciting and interesting. Do not believe you are any different than today's physicians, and do not buy into the big lie that older doctors went into medicine "for the money." Most of them, myself included, never thought about money in our idealistic youth.
There was one other, extremely significant motivating force in my choice, and I would wager that it's important in your decision also --- namely, I wanted to be my own boss. I viewed the years of training (after medical school) --- and I didn't know there would be eight of them --- as my key to independence and freedom in a profession. You see, being a "professional" was a valid concept in 1970. Unfortunately, this concept is now gone, along with your economic and intellectual liberties.
Currently, our government has placed physicians in a position that denies them the right to offer their services in a free market. You are told what to charge for your services (without making allowances for rich and poor), and price controls are imposed based on a planned budget that serves only political interests. The politician's promises, the patient's desires (not necessarily needs), and the expenditures are figured into an equation (i.e., RBRVS) that leaves a fixed amount for you to "take it or leave it." Put simply, you will not have the same economic freedoms as other citizens have in this country. You will be subservient, and you will not be offered the benefit of "equal protection under the law" as other professionals.
In this triangulated "insurance" system, where everyone is trying to spend other people's money, the payers, private and government alike, have set up an elaborate ploy of price controls and schemes to challenge and thwart your decisions and efforts at patient care, despite your rigorous education and training. Furthermore, coercive economic incentives will try to separate you from your duty to the individual patient, and they will threaten your livelihood, if you don't follow their "guidelines."
Moreover, the "fraud and abuse" provisions, necessary in such a triangulated system, will leave you to function in an oppressive arena where you no longer dictate letters for the benefit of your patients or the referring doctors, but rather to keep a record to protect yourself from government investigators. Omissions or clerical errors could lead to your professional and financial ruin.
The demand for medical care will only increase as our population ages, further straining this system. If we continue with the same method of financing medical care, and the government does not unleash the forces of the free market, particularly in the form of catastrophic insurance and medical savings accounts --- which would bring freedom of choice to the system --- all of these nocuous forces will only increase. I do not believe that the present administration, elected representatives, and the entrenched bureaucracy in the government have the political will to make the right decisions and extricate us from this destructive, medical insurance quagmire. Again, you will have to live with this future.
Finally, you need to know that taking care of patients, treating their illnesses, and relieving their suffering will give you personal satisfaction that will help to counterbalance the iniquities in the political system in which you as future physicians will be forced to practice. You should, however, not enter this field without considering these realities. You will have to learn to fight and be active in the political arena, to confront these harsh realities and to try to regain your freedom --- all of this while remaining the true patients' advocate.
So, do you still want to be a physician?
Dr. Weaver is a thoracic surgeon in Durham, North Carolina, and president of the AAPS. E-mail: firstname.lastname@example.org.
This article was published in the Medical Sentinel 1999;4(5):165. Copyright © 1999 Association of American Physicians and Surgeons (AAPS).