Question for Doctor D:
Why does it cost so much to see a doctor?Great question! There are lots of good explanations, but Doctor D's gonna give you a revisionist history lesson that will open your mind:
Doctor D's gonna take you way back to the US over a hundred years ago: There were lots of doctors and visiting them was cheap. Doctors made a middle class living and medical schools worked like apprenticeships. Doctors did their best, but they didn't have most of the cool lifesaving stuff doctors have now.
But big change was coming...New biomedical research was going to alter medical practice forever, and "The Man" saw the opportunity to create a cash cow medical-industrial complex that would swallow the US economy whole. But first The Man had to knock the little guys out of the action...
The newly incorporated American Medical Mafia Association made its move, hiring the intellectual hitman Abraham Flexner to execute their takeover.
That shady Mr. Flexner visited every medical school in the country. He knew exactly how to break the legs of the competition: Science.
The Flexner Report: An offer you can't refuse.
Medical science was bringing wonderful new knowledge into medicine, but in 1910 Flexner demanded that every doctor should be a scientist too. Every doctor must do years and years of basic science training before ever caring for patients. Flexner also recommended in his report that every medical school that wasn't associated with biomedical university research should be destroyed!The mafia power play worked. The Flexner Report was hugely influential. The American Medical Mafia Association was given control over every medical school in the country. Don Flexner sent almost half the medical schools to "sleep with the fishes." With the little medical schools out of the way, the mafia now had complete control of who got to be doctors.
New Doctors: Nothing personal. It's just business.
The personable old "doc" of the past was replaced with the new scientific physician who knew more about organic chemistry than human interaction. New student doctors were taught to approach their patients with the cold objectivity of a scientist watching an experiment.
With the warmth and kindness of the doctor-patient relationship gone the study-weary doctors had no one to identify with but each other. Doctors became less a part of their communities and more a society unto themselves—making them easier for the medical mafia to control.With total control the medical mafia cut supply to increase demand. With fewer doctors the price of a visit skyrocketed. Even doctors who might want to work for cheaper couldn't because of the massive debt from their new med-science education.
It's All About Control
The medical mafia keeps a tight stranglehold on medical schools. This country's population has gone way up in the last 100 years, but the medical mafia has been keeping a tight lid on the number of doctors. You might think with the current doctor shortage they would be begging every smart young person to go into medicine. Nope! 
You want to be a doctor? You have to get excellent grades in lots of brutal courses, do a bunch of work on cells in a laboratory, be the president of some student organization, study like mad for the MCAT although it has nothing to do with medical practice, and promise them a decade out of the prime your life. Even still they're likely to say "No!" Every year thousands of bright students are refused entry to medical school even though they would make excellent doctors.Why?
Refusal gives them power. It makes the ones that do get into the club special, powerful, and always in demand. With a stranglehold on the doctoring business the Medical Mafia has its fingers in every clinic and hospital in the country.
Ever wonder why the United States has to import doctors who barely speak English? Now you know. It's the only way to circumvent the Mafia's blockade on doctor supply.
But couldn't we just train more American doctors, shorten the length of medical education and lower its costs, and allow medical visits to be affordable and doctors to return to the middle class? You think The Man would let us get away with that? Forgetaboutit!
Abraham Flexner"Kiss the ring, bitches!"
So next time you or your insurance shell out $600 for a visit to a specialist remember the Medical Mafia and Abraham Flexner. Don Flexner has been dead fifty years, but trust me he still owns us little guys.
Show some respect! The Medical Mafia is just taking your money for your own protection!
So what do you think? Most of medicine still sees Abraham Flexner as a hero. Doctor D's story may be silly, but most of the facts are true. How do we undo 100 years of history? How do we recreate quality medical care that doesn't bankrupt the country?
Doctor D looks forward to your ideas and observations in the comments.
20 comments:
Little off topic, but my parrotlet broke her leg and then needed a toe amputated related to that same injury -- cost of bird $150. Cost of her medical care -- over $1,000. I about fell over when I wrote that check. Then she showed her appreciation by biting me.
Don't know if I am better off seeing a people doctor or a vet with regards to cost :) -- well, at least I have insurance.
Never really considered why the cost of medical care is so pricey. Interesting post.
I am a Pharmacist. Soon after I graduated, the powers that be decided to require a PharmD for every RPh coming out of school. I'm not a doctor and I don't want to pretend to be one. All the schools now can charge Graduate School fees to those attending pharmacy school. Getting into pharmacy school wasn't easy when I attended, now it is that much harder. I love being able to counsel on prescriptions, administer vaccinations, and be able to provide easy convenient healthcare advice. Managed care cutting costs everywhere has forced pharmacies to rely on volume to make money. Drug store management continually seems to be cutting staff. I imagine it is the same with doctors. You gotta cram as many patients into a day as possible in order to make a profit. Fear of lawsuits drives docs to order more tests and fear of the HMOs drives docs to hesitate when some procedures are necessary. We are slaves to fear and formulary. The medical profession is collectively screwed right now.
Loved the post.
Canada is in a similar boat--only the culling of our herd happened in the '80's instead. Every time I tell people the story of getting into medical school and all it entails they have to pick their jaw up off the table.
We currently have one of the worst doc/patient ratios in the developed world--for mostly the same reasons as you mentioned above.
Because I was fed up with that system I had to move to a different country and shell out $65 000 per year (*in tuition* alone) to become a doc.
Now I am told that I will likely not get a residency in Canada because of my "International Medical Graduate" status...yet every small hospital I have worked in the past 6 years has been staffed by >50% South Africans*. Huh?
Sorry for the rant but the whole thing is a little bit of a sore spot for me right now (hence why I will likely be coming to the US for residency etc.)
*I LOVE South African docs BTW, that is not meant as a disparaging remark toward immigrant physicians. It's just that when I look at the hoards of qualified Canadians who are turned down every year for medical school because of things like calculus grades or MCAT scores--I want to rage. Why can't we use a little common sense? Sigh.
Regarding the finding a fix to the costs of medical care, it’s probably too late for that. It just seems as a society that we want an immediate ‘fix’ for all our ailments when our bodies are pretty good at healing itself. I am very recent to reading these medical blogs and I can say that my eyes have been opened. I had no idea what goes on and what drives people to the ER or even an office visit. A friend of mine spends an inordinate amount of time (IMO) visiting her doctor and being prescribed medication for a common cold. I was always under the impression that a cold or a flu is a virus and antibiotics is of no use in this case and despite that, unless there is some other reasons such as age or other factors, an otherwise healthy person will get over the cold or flu on their own. I know drunks are taken to the hospital instead of the drunk tank (a cop friend of mine said they are required to do that, they don’t have a choice) but it seems a waste of money to watch a drunk get sober in an expensive hospital ER. I don’t know, it just seems that collectively, as Americans we have lost our common sense and seek medical attention for the silliest of things. Maybe I’m a bit cynical, but it just seems that if we didn’t overuse the system for non essentials, perhaps the costs would not be so out of control. Several hospitals in the state in which I live have closed their doors because they cannot afford to keep them open. I just read about a guy who showed up in the ER via an ambulance at 2:00 a.m. after eating saltine crackers and his throat felt scratchy. That was the sum total of his symptoms.
Whether this overuse has any bearing on prices doctors must charge to stay in business and have a decent salary, I don’t know. Whether this is fixable, I have no idea but personally I think we’re beyond the point of no return. At least it won’t be fixed if we take the position that an ambulance ride to the hospital ER is necessary because of a scratchy throat from saltine crackers instead of using common sense and having a glass of water to wash down the crackers. I’m pretty sure medical school is not necessary to figure that one out. Maybe I should quit reading this stuff – the saltine cracker guy’s story really, really annoyed me. It’s no wonder the cost of my health insurance goes up.
Albino black bear pretty much said everything I wanted to say and much more articulately, so instead I'll say that I loved the pictures and captions - especially the 'kiss the ring - bitches'. I wonder how fast I'd be fired if I said that...
Also, I work with a security guard who was a cardiologist in Iran. She has shilled out quite a bit of money to write the Canadian exams but so far no luck.
The physician shortage is being addressed... some what: http://www.nytimes.com/2010/02/15/education/15medschools.html
I think the Flexner report may have done away with a lot of smaller medical schools but wouldnt the centralized power also allow standardization in training? Assuming it was available at the time, would have been interesting to see the clinical outcomes of students graduating from med schools prior to the AMA being put in place.
I agree with Maha--the 'kiss the ring bitches' was a nice touch.
:P
i third it - "kiss the ring, bitches"....hee.
Yeah I almost deleted it. Then I thought "Why blog anonymously if I can't have fun with rude language?"
Speaking of totally bad-ass rings for kissing: check out this ring. It is the real class ring of a medical school in Georgia and has a skull and crossbones on it. I saw it on a doctor's hand and said to myself, "Now there's a doc who knows to put the fear in some patients!"
K: Yeah, I saw that NYT article the day I posted the medical mafia piece. You squeeze too much money out of your racket, and you might get busted. Don't you worry. The mafia has other plans now for controlling power.
Anonymous 2:07: Yeah that's part of the scam. We make patients Doctor-junkies, who think everything in the world needs a doctor. They can't survive a runny nose without a doctor visit.
"Doctor-junkies" are an interesting phenomenon and shall be the topic of a future post.
***
I'm shocked no one has come to the rescue of poor Abraham Flexner being libeled in this post. Most medical history textbooks make him out to be a knight in shinning armor. Good to see the up an coming generation in medicine is finally willing to stick it to the man!
Which med school in georgia has that ring? Evil Medical School of Georgia?
I really look forward to reading your post on "doctor-junkies." I'm relatively new to the med-blogs (about a month now). Stumbled upon one by accident and one thing led to another by clicking on links. I have discovered a whole new world and to be honest, I'm shocked at what I'm reading. It's no wonder we're in the mess we're in. I had to do my own rant otherwise I'd be needing medical attention for rising blood pressure :)
hahaha, such an awesome post. I want to see some "Kiss the ring, bitches" t-shirts available for purchase =P
I don't even know how to fix the mess we're in, other than starting off with allowing more fine folks to become physicians. Well, that and modeling our health care system on something like what the great nation of Sweden has.
It's approximately one year before I sit for the MCAT, I'm now really starting to shake in my britches about whether or not I'll get accepted somewhere. I may follow in Ms. albinoblackbear's footsteps and apply to some schools in western Europe...and possibly stay there!
It's the Medical College of Georgia in Augusta, GA. Here's a closer picture of the official medical school ring.
It is by far the most dangerous looking ring in all of medicine. All patients and other physicians would bow before a doctor wearing this.
Assuming that's pretty accurate, how interesting! Perhaps you should send it to Obama's health care team.
I like how you can add ruby "accent stones" to the eyes on the skull. :)
Wow.
Guess they don't care that it'd be a massive MRSA vessel as well as a class ring...or maybe that was intended, hence the design.
Very interesting "sticking it to the man" post! I'm shocked that Happy Hospitalist hasn't caught sight of this. He would be horrified.
Rubies too?? Holy crap anytime someone said anything to even mildly irk me, I could whip out my awesome skull and crossbones ruby adorned ring and tell those bitches to kiss the ring! It would be even more awesome if the rubies caught the light at just the right angle and glinted during the exchange.
Yeah... clearly I'm in need of sleep.
Just for Josiah: Doctor D spent way to long designing "Kiss the ring, bitches!" Medical Mafia mugs and T-shirts.
Have fun, but be careful: Abraham Flexner is a dangerous weapon!
There actually are cures for conditions like cancer, but the AMA Mafia forbids them. Royal Rife had one, so the AMA destroyed all of his notes and equipment, and chased him out of the country.
The AMA and Big Pharma do NOT want patients to be cured, that would end the cash cow of milking them for more than every last penny that they own. Treated yes, but cured? NEVER!!!
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