Flashback in Medical Economics

January 25, 2002

January 1927, 1952, and 1977

A Medical Economics Web Exclusive

Flashback in Medical Economics

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25 years ago: January 1977

"Almost every one of us could name at least one acquaintance who could be labeled a ‘sick’ doctor–a doctor caught up in alcoholism or some other form of drug addiction." That was internist Richard C. Bates’ description of a frightening problem that most of the medical profession was reluctant to tackle.

Bates wasn’t. "We have an obligation to act while there’s still a chance to save a sick doctor," he wrote. "Even if we fail to salvage him, we’re morally and legally bound to put a stop to unprofessional behavior in this day of growing public indignation over lax self-policing."

The Lansing, MI, internist (who was "dean" of Medical Economics’ board of Contributing Editors for three decades) told how he had personally intervened when the local medical community ignored the erratic performance of addicted colleagues. In each instance, Bates had confronted the doctor, challenged him to admit his problem, and–by reporting him to disciplinary agencies and local hospital officials–forced the addicted physician to get help.

In almost every case, that tough approach paid off–for the recovered doctor and for the patients he no longer placed in danger.

Despite these successes, Bates cautioned that some of medicine’s substance abusers could never be reclaimed. "Don’t waste a lot of effort on those who defy all attempts at rehabilitation," he advised. "In my experience, they subconsciously don’t want to be licensed, practicing physicians.

"The best service you can do for such people," Bates noted, "is to acquaint them with their subconscious conflict and advise them to get out of medicine and into something else they’d wanted to do but had lacked courage to try."

It’s difficult and unpleasant to sound a warning about an addicted colleague, Bates acknowledged. "But there’s a quiet satisfaction in seeing that the system can be made to work and in contemplating the medical catastrophes that must have been forestalled."

50 years ago: January 1952

Rural medical practice was at low tide: Two-thirds of America’s communities with populations over 100 had no doctors they could call their own. And many of those who did have physicians were faced with the fact that their local practitioners were on the brink of retirement.

Doctor-short counties across the nation were struggling to attract young physicians, Medical Economics found. Not surprisingly, the ones that were most successful were those that held out the biggest incentives.

Consider Elk Horn, IA, where the 486 residents came up with $4,000 in cash, borrowed some more money (with their homes as collateral), and built a small medical facility that was offered to any doctor who’d locate there. "Elk Horn got its doctor," we reported.

Other communities went even further, virtually setting up a new doctor’s practice for him. The merchants in Merillan, WI (pop. 600), made the down payment on a combination home and office, bought a car, and banked enough for a physician to draw on until he got up to speed. Then they sent scouts to dangle that carrot at state licensing board exam sessions. They quickly snared a doctor for their town.

Mississippi used scholarships to lure doctors into the countryside. In exchange for tuition funding, 300 Mississippi natives, enrolled at 22 med schools, committed themselves to rural service for varying periods. Similarly, Illinois put up a $100,000 med-school loan fund that attracted 28 doctors-to-be.

Sometimes, of course, the physician who’d been persuaded that rural practice would suit him fine discovered that he and his family weren’t "country folk" after all. Other practitioners headed for cities and suburbs as soon as their contracts expired.

The military threw a few monkey wrenches into the works, too. The citizens of one hamlet in west Texas built a hospital and quickly recruited two young doctors. Within a month, both were drafted for service in Korea.

75 years ago: January 1927

"Women who seek to be physicians are handicapped from the very beginning by the fact that they are women. Men more or less resent the intrusion of women into any of their chosen fields."

Staff writer Dorothy M. Brown reported on the tribulations of female doctors in the mid-’20s. Discrimination–professional and economic–confronted them from the day they chose medicine as a career.

"Even today some of the best medical schools either refuse to take the women who apply or else make it so difficult that few dare to enter," Brown wrote. The ones who made it through med school found that "many of the larger and better equipped hospitals do not admit women as interns." (Bellevue Hospital in Manhattan and the Women’s Medical College of New York Infirmary were notable exceptions.)

Things got little better once training ended. "After a woman starts to practice, she has other economic differences from her brother in medicine," Brown noted. "A woman physician rarely has as large an income as a man. In general practice, which most women enter, the fees are small and the work not very remunerative." One reason: "Whereas women physicians often refer their cases to men, few men ever refer patients to women. And strange as it may seem, not many women ever make referrals to other medical women."

Another hindrance for female doctors, Brown pointed out, was that they were usually left to their own devices to start practice, "while young doctors of the male persuasion are more often than not taken in by a firm of older physicians."

If there was any light in the tunnel, it was the proliferation of organizations at local, state, and national levels to support female physicians. Besides the American National Association, there were women’s medical societies in nine states, numerous city and county organizations for women doctors, and regional associations for them in New England and the South.

"These associations are formed to bring women physicians into closer contact with each other, both for social and educational reasons," Brown wrote. "When more women come to realize that they owe a certain duty to their sex, when they remember the trials and tribulations they had to undergo in their youth, and do more to make the way easier for those who follow, the economic position of the medical woman will be greatly advanced."

—James D. Hendricks
Executive Editor

 



James Hendricks. Flashback in Medical Economics.

Medical Economics

2002;2.