The Changing Practice of Medicine

Hayden Hollingsworth
Hayden Hollingsworth

This past week I had lunch with a group of retired physicians. There were about 25 of us and that represented almost a thousand doctor/years of practice in Roanoke. There was much reflection on the changes that had taken place in the half century some of them had been in the profession.

In the 1950s there had been five hospitals in the city: Roanoke Memorial, Jefferson Hospital, Lewis-Gale, Burrell Memorial, where the black population received their medical care, and the Veteran’s Administration Hospital. Most of those present started in solo practice and when the idea of medical insurance, let alone a government sponsored program, was nothing more than a gleam in the eye of insurance executives. My, how things have changed!

The solo practitioner has long since passed into history. The idea of a stand-alone group practice is on the border of extinction having been replaced by a clinic model, long in place at Lewis-Gale and in the last decade at Carilion. The advantages of such a system are obvious. Economies of scale increase the purchasing power of medical professions, particularly when provided by a clinic that has much more bargaining power than a small group of physicians. This is particularly true in negotiating reimbursement schedules with third-party payers. Volumes have been written about those topics.

Of more interest to this group was the unbelievable advancement in technology. It cuts across every specialty in medicine, but none more dramatically than in radiology. When most of these physicians came into practice, simple X-ray was the only technique in place. The invention of ultrasound, computerized tomography (CT) scans, positron emission tomography (PET) scans, magnetic resonance imaging (MRI), and most recently functional MRI have expanded imaging to a scale that would have seemed pure science fiction just 50 years ago.

Cardiac surgery was in its infancy and who could have predicted the delicate procedures that today are routine with heart valve replacement being accomplished through a catheter and almost any surgery carried out through a few tiny incisions with the aid of the laparoscope. Joint replacement has revitalized millions of patients headed toward a sedentary life. Outpatient surgery has become the common way to the OR. The list is endless.

None of this could have been brought about without an enormous investment in research, development, and implementation. It required large institutions with almost unlimited capital to bring all this to fruition and today such care is available to almost everyone. How to pay for it is another matter.

As amazing as all these gains are, there have been casualties. The cost of medical care in the United States as a percent of GDP was 17.9% in the last available data; that’s doubled in the last 20 years and is the highest in the world. One would think that we would have the best medical care in the world but according to a broad-based survey by the World Health Organization, America ranks 37th when multiple factors are included. France is in first place.

We can be justly proud of the advances we have made and they have been shared with the world without a monetary return on investment, but literally billions worldwide have benefitted from the work done in this country.

Our problem now is to bring the costs under control and improve the quality of care delivered. Were that a simple problem, it would have long since been solved. We can hope that the next fifty years will reverse these trends. For those who are just beginning their medical careers it would be interesting to hear their reactions fifty years down the line. I cannot imagine!

Hayden Hollingsworth, MD

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