Has medicine become politicized ”” weaponized even ”” in America in the age of the coronavirus?
With the World Health Organization and the federal Centers for Disease Control and Prevention under attack for early missteps; controversy over mask-wearing still raging; and the tense relationship between Dr. Anthony Fauci, America”™s leading infectious disease expert, and President Donald Trump, medicine would appear to be under siege in the Situation Room and the emergency room alike.
“When did it become acceptable or seemingly the norm to attack the medical community for simply doing our jobs?” plastic surgeon Robert E. Tuchler wrote in a blog post on KevinMD.com, which bills itself as “social media”™s leading physician voice.”
“I understand that corporations, notably big pharma, and all politicians have inherent biases as profits, constituents and election campaigns influence their agendas.” But, he added, “If our findings and opinions don”™t suit partisan, religious or industry needs, we increasingly find ourselves being publicly discredited, humiliated, threatened and at times physically attacked.”
Some local experts, however, think the medical community is immune to such attacks.
“I don”™t think (medicine is) under siege at all,” said Dr. Edward C. Halperin, Chancellor and CEO of New York Medical College in Valhalla and a pediatric radiation oncologist.
“While medicine has always taken place in the context of the social mores of its time and place, doctors like to think they are above the fray.” Indeed, he adds, they are doing what they have always done ”” going about the business of healing people. Politicians may be politicizing the coronavirus. “But doctors? No,” he said.
Dr. Ezriel E. Kornel, a top neurosurgeon in the metropolitan area and a Covid-19 survivor, agrees.
“I don”™t think there”™s been a politicization of the coronavirus that has affected medicine directly,” he said, adding that if anything, the pandemic has made people trust their health care professionals even more.
We have, of course, seen the signs ”” literally ”” those dotting suburban lawns thanking health-care heroes for their courage and sacrifice in the face of a biological foe that has at times unleashed a scenario out of Dante”™s Inferno. There are other signs of confidence in medicine as a profession as well: Applications to medical school continue to increase, Halperin said, with 13,000 alone for 212 places at New York Medical College and 2,600 applications for 114 seats at Touro College of Dental Medicine at New York Medical College in Hawthorne. (The college will use a hybrid approach of online and small, in-person classes this fall.)
One way, however, that the coronavirus has adversely affected medicine, Kornel said, is that “physicians are not seeing as many patients come in.”
On the one hand, some are reverting to telemedicine ”” which Kornel has said is the wave of the future, offering patients greater access to their doctors in those situations not requiring a physical examination. On the other hand, though, some patients are playing a waiting game or avoiding office visits and hospitals especially altogether. This has put some doctors under financial constraints. Kornel said he knows of one doctor in New York City who had to downsize after three others in his practice left. “He could no longer afford such a big space.”
Meanwhile, Westchester Imaging PLLC in White Plains closed its doors during the height of the pandemic, transferring its patients”™ records to Hartsdale Imaging.
The high cost of medicine is something doctors become aware of the moment they set off on their career path. A student will spend at least $50,000 a year to attend medical school with an average graduating debt of $170,000. A recent article in U.S. News and World Report, in which Halperin was quoted, stated that the medical profession “isn”™t appropriate for someone whose primary motivation is earning a high salary.”
The mean salary for an American physician, according to a Medscape Report, is $294,000 a year ”” which would put him, or increasingly her since more women attend medical school than men, in the top 2 percentile of income in the United States.
Nevertheless, the cost of being a physician ”” including malpractice insurance, which can run anywhere from $7,500 to $50,000 a year for a surgeon ”” has led many doctors to join the increasing number of large health-care networks.
“I don”™t think it”™s for the better,” said Kornel who adds that the trend limits resources and a doctor”™s individuality, thus restricting medical care.
But Halperin calls the notion of “free-market individualism” a myth.
“We have this idea of a (TV show doctor) Marcus Welby in solo practice going in a horse and buggy to make house calls.” Instead what has made medicine very effective, he said, “are large pharmaceutical companies and large hospitals” with centralized authority. What enabled Germany to succeed in handling the coronavirus, he said, was a scientist-led, centralized response.
With all the challenges ”” the politics, the controversies, the insurance hassles, the relatively inadequate financial returns, not to mention the emotional toll of caring for desperately ill people that the pandemic has revealed ”” why do it?
“Because I see people come in who are suffering and I have an opportunity to alleviate that suffering,” Kornel said.
Halperin added, “I am a pediatric radiation oncologist. I take care of children who need radiation for their cancer. To have the most important work there is, what more do you need?”
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Surgeon Alejandro Badia weighs in on the costs of becoming a doctor
Alejandro Badia is a board-certified hand and upper extremity orthopedic surgeon with the Badia Hand to Shoulder Center in Florida, author of the new book “Healthcare from the Trenches” and a frequent contributor to WAG magazine, sister publication of the Westchester and Fairfield County Business Journals. So we were delighted that he took the time to answer a few questions on the subject of the high cost of becoming a doctor today:
Dr. Badia, a recent U.S. News & World Report article talked about the cost of becoming a doctor, but what about the emotional and financial costs in the age of the coronavirus, with doctors feeling overwhelmed or having to downsize or even close their practices? Do you think these will dissuade students from attending medical school?
“History is replete with episodic encounters with a variety of illnesses, often infectious, that naturally bring concern and even hysteria. Some more warranted than others. A true healer will not be dissuaded by this but rather want to help on either the treatment side, or the prevention side, i.e. epidemiology, virology, research, etc.
“The greater concern is the ”˜epidemic”™ of bureaucratic/administrative/legal interference in the classic doctor-patient paradigm that is a major reason that most physicians no longer recommend their own children pursue a medical career. This is what we need to address as the current viral pandemic will soon be historical. Health-care delivery challenges are what should concern us more and may dissuade our brightest from pursuing the rigors of medical education and training.”
There is beyond the financial cost and the emotional toll a political one with the profession seemingly under siege as the virus becomes more and more politicized. Do you think this affects doctors on the frontlines or would put science students off from becoming doctors?
“Politics has always been present but certainly more polarized currently. I do not imagine that politics will interfere with one”™s career choice unless one particular party will threaten the viability of the health-care professions. There is, however, valid concerns about the increasing interest in ”˜Medicare for All”™ since most young physicians understand that full government control of health-care brings its own challenges.”
Will the increasing use of telemedicine make the office visit effete?
“No. Telemedicine will have a greater role for allowing easier and more immediate clinician/patient communication, such as discussing test results, or routine follow-up visits after an effective procedure but is no substitute for the special personal interaction between a doctor and patient. Physical examination has been diminished due to our reliance on certain tests, i.e. MRI imaging, but is crucial to pick up subtle findings that experience will detect. Certainly, office visits will become increasingly efficient and focused on initial care and resolution of complex problems.”
What role has the consolidation and commercialization of hospitals played in dampening ardor for the medical profession? What about high insurance costs for both doctor and patient?
“The growth of large health-care systems has often diminished the role of physicians to become expendable players in an impersonal environment that physicians increasingly resent. This will likely be temporary and there are already signs of pushback from the current ”˜employed doctors.”™ While many will succumb to this, others value the freedom of not working ”˜on the clock”™ and will realize that they should not be pawns in health care but rather direct care.
“Insurance costs have become outrageous and both patient and physician realize that increasing patient responsibility to bear a major cost of care, sans catastrophic conditions/injuries, is on the upswing and we will likely see this forcing transparency in the medical cost arena. This is part of the consumerization of health care and will paradoxically drive down costs as we take third parties, who contribute nothing to actual care, out of the equation of healthcare delivery.”
With all the challenges facing the profession, what still gives you joy?
“Caring for my fellow man. In my case, restoring function and alleviating pain in the critical hand and upper extremity. For others, saving a patient”™s life is reward enough. The issue is that the education and time spent on these endeavors must be commensurate with reimbursement, like any other honored profession. Despite our challenges, most physicians put patients”™ first and that is the primary reason there remains high job satisfaction. Furthermore, this very fact is what allows others to prey upon a physician”™s altruism and place the barriers to deliver care that frustrates doctors so much. Fortunately, there is a strong movement afoot to no longer tolerate this. Some call it Healthcare 3.0.”
