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Follow-up on removing bankruptcy protection for the neurosurgeon in Florida. A physician writes about the effects if this was the case:

To expel this physician from practice, as one of his bitter former patients advocates, would leave Palm Beach County with insufficient numbers of neurosurgeons to run its trauma system and take care of all the non-trauma neurosurgical emergencies that get sent to St. Mary’s. Society must make the choice between indemnifying every last patient injured in the system or not having medical care when it is needed urgently.
The implied threat of the article, removing bankruptcy protection from physicians, would exacerbate the situation to an unpredictable degree. Among doctors in training, Florida already has the worst reputation of all the states for being hostile to physicians going into private practice. We have not had one internist going into private practice join the staff of St. Mary’s in more than four years, let alone neurosurgery applicants.

Comments

Criminallopath
“To expel this physician from practice, as one of his bitter former patients advocates, would leave Palm Beach County with insufficient numbers of neurosurgeons to run its trauma system and take care of all the non-trauma neurosurgical emergencies that get sent to St. Mary’s.”
This is the unfortunate Faustian choice that we are left with secondary to our domestic medical oligopoly. Either no health care or allow barebacking incompetents to provide the substandard care that they do provide. I hope that the populace is happy with this “bad outcome.” It is the well deserved result for their idolatry.
Anonymous
And where is it ever stated in the letter that the doc was incompetent?
Okulus
So what is your solution to your rantish “idolatry” problem, Mr. Criminallopath? Should we throw open the doors to training programs that don’t exist so that those applicants we only assume are willing but somehow denied entrance to programs for training can then seek training? How certain can we be that there will be all that many takers? A neurosurgery residency is usually at least seven years long. They are competitive to get, even then, which is a good thing. (Would you rather there be so many they went begging? And what quality would you expect if that were the case?) The things you write convince me that you really do not have any useful understanding of the dynamics of medical training, only some odd and abstract ideas about supply and demand and personal bugbears that equate selective training opportunities with “idolatry.” In all, pretty juvenile.
For all your posting, you have never once said anything about how things should really be different with any sort of concrete proposal as to what those changes would look like or how they might work. And no one has denied you the opportunity. So can we all assume that while you don’t like things as they are, you also don’t have a clue as to how to change things for the better in a way that would actually work? It’s easy to squeal and rant on a computer keyboard. No one expects a thing from you.
Faustian choice? Hardly. People in this Florida community won’t pay for a highly trained and hopefully competent practitioner to work in a very high risk field, liability-wise, who can afford adequate insurance coverage and still earn enough to make the stresses and efforts of practice in that particular place worthwhile, or at least more worthwhile than practicing somewhere else. That is why the doctor has eliminated his malpractice premium. That is why he chooses to be employed by a hospital. That is why he chooses to practice after filing bankruptcy. If this is such a good deal for anyone else, why aren’t they trying to break into this market and push out this supposed “incompetent”?
Maybe there just aren’t any takers.
Neurogurgery is notoriously high risk. Patients who need a neurosurgeon are usually in real trouble. Bad things frequently happen even with best possible practices, it is the nature of this kind of medical practice. Well trained neurosurgeons have to be not just skillful-nearly always–but also have to have extraordinary judgment. Paying them well and being very selective is the way that these sorts of people have been found in the past. I don’t see how any solution you might propose to somehow make more neurosurgeons that would be able to do any better.
I do not think that lesser-qualified and less thoroughly trained pratitioners is the answer, that is for sure.
“Idolatry?” Is that your peevish and resentful term that from a better person might be considered simple respect? I’ll take the “idolatry”, clay feet or not, to any silly wooden-headed alternatives you might propose.
Anonymous
How is this a bad thing? There is no oversupply of Neurosurgeons, this man can leave and find a good job somewhere else in the country, forcing the Florida system to break that much quicker.
When there is enough of a shortage there the system will correct itself.
Anonymous
” Among doctors in training, Florida already has the worst reputation of all the states for being hostile to physicians going into private practice.”
Information regarding “reputation” is not terribly useful. Physicians’ abilities to process information and utilize it in decision making is pretty suspect outside diagnosing patients.
Criminallopath
The first step in the process is to shift Federal dollars around in the health care pot to open new residency positions. The next step is to remove the CME from the admissions process and from the process of establishment of new medical schools. While I agree that guidelines are a good thing, the CME has shown little interest in even attempting to balance the needs of the populace in regards to having a sufficient number of providers to meet the health care demand vs. keeping the supply of providers low in order to keep physician compensation rates high. I would push for the allowance of the establishment of for profit medical schools and schools with regional accreditation (similar to the non-ABA accredited law schools in California). Students graduating from regionally (on a state basis) accredited schools would only be allowed to practice in their state of graduation and thus preclude the standard extortion tactics of “fleeing” (aka patient abandonment) that has became the routine course in many of these debates. Finally, I would allow the decoupling of medical schools from large research institutions. Having foreign trained providers (including the first two years of the provider in question,) that obtain their education from institutions with less than stellar research records, who can and do pass the requirements for domestic practice shows the fallacy in forcing all domestic trained providers to pass through the bottleneck of “research institution” only medical schools.
Removing one provider from the ranks of this specialty would not equate to a crisis in regards to access to care if there existed an adequate number of providers. Also, patients should not have to choose between no access to care or care from one such as this provider. The system is clearly broken and needs to be fixed. I make no apologies for putting physician financial compensation and oligopoly market position at the bottom of the list of the issues that are of import in this discussion.

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