While waiting for my car to be serviced, a friend walked up with the same mission in mind. He brought with him a tome that appeared to be about 900 pages in length. Always curious I asked him what he was reading. It was a text on forensic psychiatry. He will soon be sitting for a recertification exam in that portion of his professional practice. I commented that at his age, maybe he should be grandfathered in, a privilege that was granted to me in my latter days of practice. He said that in some parts of his specialty that was allowed, but not in forensics. I congratulated him on his industry to keep up with his certification but it set me to thinking.
Years ago, there was little control over how doctors practiced. If you passed the state board of examiners, which was ridiculously perfunctory, you could practice any type of medicine you chose, regardless of your skills and competence. Fortunately, those days are a half century gone and all phases of medical practice are carefully monitored with recertification being required periodically, usually every ten years.
The pace of change in medical practice now makes the half-life of knowledge no more than five years, if that long. That means in five years half of what physician knows will be obsolete, thus the need for my friend to work on his forensic text while he gets the oil changed in his car.
The practice of medicine is governed now by many organizations of which the public is usually unaware. The government’s role is frequently misunderstood. Their interest is not in health care, but in the financing of it. The percent of GDP spent on health care delivery is 17.3.
This is nearly two and half times as much as the average economically developed country. While we lead in cancer research and decrease in the death rates from breast and colorectal malignancies we are far behind in life expectancy, infant mortality, and many other areas. While collection of these data on an international basis is difficult and multifactorial, the trend of the United States to lag behind most developed nations is undoubted.
The training and certification of physicians is hard to compare with other countries but I would hazard a guess that on a head to head basis, we would rank very high. There have been monumental changes in the makeup of the gender of doctors. Women are taking an increased role. As of June 2015, there were over 905,000 doctors in the country, 587,000 were male, and 286,000 were female. The number of women has increased dramatically in the past decades. The same trend has been seen in other professions such as law, engineering, and finance.
One can play around with data until exhaustion sets in but the fact remains that for the amount of money the average citizen spends annually on health care (over $8300) we are not getting our money’s worth.
The Affordable Care Act has been terrifically polarizing and much about it needs revision. The recent development of the consolidation of third party payment systems raises the specter of uncontrolled profits by the insurance companies. If you look at countries where medical costs are a fraction of what we pay many have one thing in common: they have a single payer system and it is the government. It is hard to imagine that happening here but there seems to be little on the horizon that will truly bring health care costs under control.
In the meantime we can be grateful that physicians are well trained and keeping their skills abreast of increasingly complex technology. Let’s pay close attention to the financial plans of all the presidential candidates. It may be the most important factor in the election.
Hayden Hollingsworth
