"Why not make a week or two of community service a condition of medical licensing? If you want to practice medicine in California, let's say, you would need to volunteer every year," volunteers LA Times columnist David Lazarus in his column suggesting mandating doctors to do "pro bono" work as a partial solution to our healthcare crisis. http://www.latimes.com/business/la-fi-lazarus16-2009aug16,0,6320144.column.
Gee, David, what a simple solution, wonder why I never thought of that. Maybe I was too exhausted from being up all night as a medical student or resident, putting in my 36 hour shifts caring for patients, many uninsured, in the ERs and the wards for the privilege of learning or, when paid, paid at a rate a third of the minimum wage. Or maybe I was focused on nursing sailors and marines back to health during the four years I served my country as a doctor in the Navy. Maybe shooing flies off my ICU patients at DC General, cramming to learn Spanish so that I could reassure a frightened 16-year-old immigrant mother, driving lonely streets and singing myself awake so that I could make a house call at 2 am, etc, etc," I am a licensed doctor who has dedicatedly been seeing patients for over 30 years, many who could not pay for health care. I drive an early model Prius, send my daughter to public school, and, work over 60 hours a week for a salary that barely pays the bills. Hate to say this, but I'm tired. I will continue to pay my taxes, of course, but, beyond that, I kind of think I've done enough.
And, I've got news for you, David, I know more doctors struggling to make ends meet, to survive in practice, to provide high quality medical care while drowning in paperwork and insurance company intransigence, than I do catering to rich celebrities in Beverly Hills, TV news notwithstanding. Most doctors donate a portion of their time and a part of their practice for pro bono work""and write off bad debts from patients and denials from insurers as a routine part of business. Many of my colleagues have had to hang up their stethoscopes, some settling, as I have, for administrative jobs so that we can achieve a semblance of work/life balance, or leaving the field entirely. Mandatory volunteering, an oxymoron if there ever was one, would be the proverbial straw.
You gloss over the malpractice issue by suggesting that doctors would be safe with a Good Samaritan law and a signed waiver from the needy patients. A capable lawyer would quickly be able to undermine such agreements, and I don't think I'm being cynical when I speculate that some patients, even if their volunteer medical care provides good outcomes, might try to explore legal counsel to see if they have a shot at financial gain. The costs of defending against such clients would be dwarfed by the financial hit from the barrage of hungry lawyers seeking remuneration for those poor souls whose brief contact with good volunteer health care cannot prevent them from succumbing to unfortunate outcomes.
Your idea has an even more critical omission. I didn't see anything in your column about voluntarism as a shared obligation. Where is the call for mandatory volunteering among insurance company executives""go out into the community and provide free insurance to the underserved for two weeks a year? And what about bankers""no-interest loans this week so you can afford to buy health insurance? And the politicians""schedule the lobbyist next month, tomorrow I have to go to Watts and help build a community center. I'm sure you yourself have a strong record in voluntarism and philanthropy""and have your two weeks of community service already planned for the next five years.
Our healthcare system needs reform. Healthcare is a right, not a privilege, and we ALL must dig into our pockets to help make quality care available for all. I would hope that most doctors would choose to consider a balanced salary position with a good work-life balance as an attractive way to practice""at the side of nurse practitioners, physicians' assistants, and other providers. I would hope that most doctors interested in money would find a way to satisfy their entrepreneurial ambitions outside of basic health care""through specialization in elective options or non-health-related businesses. I would hope that our government would find the resources to open the doors of medical schools to every qualified and eager candidate, and fund their education in return for a promise of salaried service in an underserved area for a few years.
Then, let us rest and live our lives without projected guilt. Most of us did not create this economic and human crisis we are faced with today. And, the perpetrators, in McLean or Crawford or", are not going to stand in line with us to "volunteer". Mandate "community service", and long prison sentences, for those who stole rather than gave.
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