Louisiana has lost 5% of it’s population to Katrina.

Louisiana has lost 4% of it’s physicians to Katrina.

So where is the problem? Well, it is one of other ancillary personel for one. Doctors are not nealy as mobile as nurses for example. With property investments and long delays in liscensure, moves are not quite as easy.

Also there are disruptions in systems of care that go beyond mere numbers. The continuum of care for the chronically impaired population between nursing home, hospital, and outpatient services has been disrupted. The cash flow has been disrupted even where care is provided. Transient construction workers, many in the country illegally, are not reliable payors for operations unable to collect up front. Long standing patients are often just surviving sort of camping out in damaged homes without a job or insurance or with a job but home restoration expenses soaking up every dollar when it comes in with none left over for the doctor. Many docs have left New Orleans since the storm because of the difficulty, despite the hoopla about a shortage, of making a living. It is not more doctors that the Gulf Coast needs, but effective leadership in supporting and retaining existing institutions.

Dr. Scott is right to point out the oddity that 20 months later, recruitment grants are offered, when much more modest but timely efforts to sustain existing institutions would have made more of a difference.

An example. Gobs of federal money was spent on bringing in paid and volunteer counselors from all over the country, with the contract handled by an outside firm, to go into schools and churches and drum up misery with “crises counseling”, while the critical psychiatric treatment infrastructure built up over more than a century collapsed for lack of cash flow. It made no sense to gin up psychiatric cases while the people who could then handle the cases uncovered were having to go elsewhere to eat. It would have been far far more rational to contract with local institutions with their existing networks putting them to work. They know the population, they know the culture, they know the resources, and doing so would have kept them alive and viable so they they would be still going now.

The complete absence of leadership at every level of political authority has been shameful in everything related to Katrina. Volunteers were wonderful, and still are. But as for government, except for a few isolated agencies like the Lousiana Department of Wildlife and Fisheries, it has been one vast society wide carpet of shame.