A Chat With My Doctor About the State of Medical Care in the United States

"Younger people in this country aren't entering the medical field because insurance companies have made the competent practice of medicine in this country virtually impossible."  

This discussion came after the doctor told me that he was going to refer me to another physician to treat an underlying condition they had discovered after some tests were run.  My wife has had some major difficulty with back pain, and has waited more than three months for an appointment with a pain management physician.  We have also both experienced long waits to see our general practice physician and this is happening in a large, metropolitan health care system that operates three hospitals, and is directly connected to a university medical school.  

The condition I'm being treated for requires immediate attention, and so I was concerned, when he mentioned the referral, of how long it would take to get in to see the doctor.  He assured me that I would be on a priority list, and would be able to bypass the normal six to eight week wait to get in.  That prompted my question of why, in a large hospital system connected to a medical school, does it take so long to get in to see a doctor.  

His response was that there is now a shortage of doctors because the number of younger people entering the medical profession, and specifically to become physicians, is waning.  He entered private practice himself just three years ago, and in the medical school he attended, numbers were down.  And he said, specifically, that one of the primary reasons for this is the way insurance companies now dominate and control the practice of medicine in the United States, including what they choose to pay for, what they deny, and even down to what treatments they will allow doctors to prescribe for patients, based solely on the cost factor  

Training doctors to care for patients and make their needs a priority doesn't fit well with either corporate profit goals of insurance companies, or with the profit required by the major corporate ownership of most hospitals in the United States, including the one where he is affiliated.  The end result is that the number of students entering medical school is dwindling, and at the other end, a lot of doctors are retiring in their fifties, rather than continuing to do battle with the insurance companies who control the practice of medicine. 

As an educator, I added my own opinion that the quality of American education was an obstacle because many American students don't have the academic skills to meet the admission standards of medical school.  He completely agreed with that, noting that more than half of the doctors in the hospital system in which he works are foreign born and foreign educated, mostly Asians, including himself.  

I have been going to the doctor in this particular health care network for eight years.  It was a nonprofit system, originally operated by an order of the Catholic church.  Three years ago, they were bought out by a large corporation that owns multiple hospital systems in several midwestern states and since then, I have noticed the increased wait times to see doctors, even our general practice physician, who is in a practice that once had four physicians and now is down to two, with one nurse practitioner.  

The delays to get in to see doctors is partly the result of an exodus of physicians that took place shortly after the corporation bought the system.  They haven't replaced many of those who decided that was their signal to retire, or to leave, whether they can't find enough applicants, or whether there aren't enough out there to fill the vacancies.  Three months is a pretty standard wait time to get an appointment, and in some areas, like oncology or cardiology, it can be as long as five months.  

So what is the point?  

The point is that the overall practice of medicine in the United States, like just about everything else, has become more about making profits than caring for people.  And the end result of that is a major decrease in the quality of medical care and a major increase in its cost.  That's what capitalism has done to medicine.  And it means that half of the money Americans spend on their health care doesn't go to their care, it goes to the profits of the 1% who now control 99% of the country's wealth.  

And it means that we are long past the time when major reforms, overhauls and changes need to be made in American health care.