Okay, as promised in yesterdays post, A Plan For Intelligent Health Care Reform Part 1, today’s post will basically just be a cut and paste of the letter I sent to Dr. Susman in response to his editorial entitled, “What if it’s cancer?”. If you havent read the editorial, please do so before reading my letter below, as things will make a bit more sense that way.
For clarification, some of the abreviations appearing in the letter, which might not be familiar to all readers, are AAFP (American Academy of Family Physicians), AMA (American Medical Association), CMMS (Centers for Medicare and Medicaid Services), and JCAHO (Joint Commission on Accreditation of Healthcare Organizations)
So, Anyway, here’s the letter:
Dear Dr. Susman,
Prior to attending medical school at the University of Mississippi Medical Center, where I also completed my Family Medicine residency, I was in practice as a veterinarian.
Currently I am in practice as a Family Medicine physician on the Mississippi Gulf Coast.
It was from this vantage point that I read with interest your recent editorial detailing your experience with taking your 2-year-old beagle, Lucy, to her doctor.
In response to the final sentence of that editorial, where you state “Sort of makes you wonder if we should emulate our veterinarian friends,” I would reply that in many ways yes, I think our human patient population would be greatly served by emulating many aspects of veterinary practice.
That said, there are certainly some aspects of veterinary practice which I am glad to have left there and not carried over into my current profession.
In the current United States healthcare environment, where a huge focus of political discourse revolves around issues of access to care, healthcare expenditures, medical liability reform, health insurance, medication costs, government involvement, etc., I think there are many lessons that can be learned from veterinary medicine.
As a veterinarian, I practiced in an environment with dramatically less government interference, dramatically less civil liability risk, and dramatically less bureaucracy. In the four years I was in practice, I saw and treated thousands of patients, and they all had one thing in common. Not a single one of them, not one, was covered by any sort of health insurance or government program.
A great deal of the work I did ended up being charitable, as many people brought in animals that they either did not own (strays or wild animals that they found which were in need of care) or quite frankly should not have owned, since they did not have the financial means to properly care for them.
Fortunately, the majority of patients I treated however came with owners attached, who, like yourself, paid the bill at the time of service, and I was thus able to put food on my table. Because that bill was of a reasonable cost, these owners could also put food on their tables (as well as in Fido’s bowl on the floor).
As mirrored by your experience, in my veterinary practice I feel that my patients (and their owners) received much better quality of care and customer service from me and my staff, and at a dramatically lower cost, than I have ever observed in human medicine, as either a patient or as a physician. In my current practice, I try as much as possible to emulate the level of service I was able to achieve in veterinary practice. Unfortunately however, the hurdles imposed by the factors listed above (government regulations, liability concerns, bureaucracy, etc.) render my efforts largely unsuccessful.
The ability to deliver such a high level of service in veterinary practice, as well as the incentive to do so, was created and driven to the greatest extent by the mostly laissez-faire, free-market environment in which I practiced. To be sure, some of the negatives of veterinary practice (which I mentioned above being glad to have left behind) also thrived in this environment, but taken as a whole, I think the positives far outweighed the negatives.
It is thus with great distress that I observe the shifting political winds in this country. Driven along by misleading “news” articles, biased “documentaries”, skewed statistics, and the vague promises of “Hope” and “Change” from our would be leaders, there seems to be a growing momentum in this country to implement even more government control and more bureaucracy on our struggling healthcare system. Rather than “emulating our veterinarian friends” by fostering the same sort of environment in which they are able to practice, we seem to be running blindly, like a runaway locomotive, in exactly the opposite direction.
It is particularly distressing when I observe organizations such as the AMA and the AAFP, organizations which should know better, voicing their loud approval for such glorious Bolshevikian reforms. When I have observed fellow physicians voice similar concerns with representatives of these organizations, the typical response seems to something along the lines of “Thank you for your dues payments. Now please kindly shut up and just go along with what we say. We know what’s best, better than you do.”
In September of 2006, I had the pleasure of attending the AAFP Scientific Assembly in Washington D.C. and was excited by the opportunity to observe the opening ceremonies and speeches from the AAFP leadership. I must say I was rather shocked and dismayed however at the tenor of those speeches. It seemed to be a running self-congratulatory propaganda pep-rally, loudly proclaiming the dire need for universal government controlled (i.e. socialized) healthcare in this country and the need for the AAFP to lead the charge. Speaker after speaker seemed to deliver the same talking points, disrespectfully lecturing the audience as though they were talking to a crowd of 5th grade school-children, rather than the crowd of (dues-paying) practicing physicians that was in attendance. I almost felt as though I was expected to wave my little red book in the air, or something.
The only glimmer of hope I felt was that in looking out upon the crowd of gathered physicians, I observed some, but not much enthusiastic agreement and applause. Rather, I observed mostly a plethora of grim faces on heads being slowly shaken side to side in obvious disapproval. I further observed most of these same disapproving folks promptly stand up and leave the lecture hall as soon as the keynote speaker, Newt Gingrich (who not surprisingly did not seem to express the same viewpoints as the previous speakers), finished his talk. This was in spite of the fact that there were other speakers (a.k.a. party faithful) on the agenda following Mr. Gingrich’s talk.
After the ceremony, outside the lecture hall, I heard sentiments of disgust with the AAFP leadership from many of the physicians I conversed with. Unfortunately, it appears that such voices in our profession are being drowned out by the louder voices of the angry mob outside our profession demanding more government control and intervention.
Dr. Susman, there is nothing magical about veterinarians. For the most part, they are highly educated, caring and dedicated professionals. So are physicians. This is true for me as I assume it is true for you. From your editorial, it also appears to be true of Lucy’s doctor.
The veterinary profession is by no means completely free of intrusion and headaches from outside nuisances, but I assure you, if Lucy’s doctor were forced to practice in an environment dominated by the likes of CMMS, JCAHO, Big Pharma, Big Insurance, John-Edwards-Like Trial Lawyers, etc., your experience as detailed in your editorial would have been much different and less pleasing to you, as well, I suspect, as to Lucy.
Should we emulate our veterinarian friends? In many ways, yes we should.
Will we? Not very likely, I fear.
Personally, I do not advocate a complete 100% copying of all aspects of the veterinary profession or the environment in which that profession is practiced. As mentioned there are certainly some negative aspects to that profession, which I have gladly left behind. As also mentioned, these negative aspects are largely allowed to exist by the same relative freedom from outside interference that allows the positives (that are worth emulating) to exist.
I do think government has a role to play in our nations healthcare, but I think that role should be limited to minimizing the negatives (as experienced in veterinary medicine), without minimizing and/or eliminating the positives. For the most part, the reverse of this seems to currently be the case in our country, and it appears likely to me that this situation will only be exacerbated in our nation’s future.
I do hope this correspondence is received in the spirit in which it is intended. I congratulate you for apparently being a caring and responsible pet owner, and I also congratulate you for an outstanding publication. The Journal of Family Practice is a resource which I greatly enjoy reading and which I feel has a positive effect on my professional practice.
Please keep up the good work and keep them coming!
Samuel *. ********, D.V.M., M.D.
Dipl., American Board of Family Medicine.
So anyway, after sending that letter, and receiving a pleasant response from Dr. Susman, I started doing some serious ruminating on this matter.
I started asking myself the following question. Rather than just looking at what I as an individual physician can do, to try to emulate the level of service provided by the typical veterinarian (something which I try to already do), what could our country do as a matter of policy change to bring that level of service to the health care system as a whole?
What policies and systems could we implement that would bring all these positives seen in veterinary medicine to our human medical system, while simultaneously eliminating (at least as much as possible) the negatives of veterinary practice?
In my mind, I have started formulating a plan that involves identifying the sources of our current health care system’s problems, as well as identifying the sources of the veterinary profession’s problems, and have started trying to envision solutions to these problems that could be implemented.
It is my opinion that if such a plan could be fine-tuned and then put into action, then that would indeed be a plan for intelligent health care reform.
I will discuss some of these ideas of mine in subsequent follow up posts to this one. As I mentioned in yesterday’s post, I am not a health care economist or policy expert or anything of the sort. I am simply a guy who has practiced within both the veterinary and human medical systems. I have had experience with US govt run health care from both the perspective of a patient and as a physician, and I think these experiences have given me a different perspective than a lot of the folks making our policies and
ruining running our country.
That said, my experiences have not given me the tools to come up with all the fine tuning and details that my plan would require in regards to actual financial numbers, etc.
It is my hope that perhaps others who possess these skills will participate in this process and give their input.
Who knows, perhaps we could actually come up with a real workable solution and start some sort of grass roots movement.
So, look for my rough ideas in future posts.