I was just alerted to this thought-provoking essay by Massachusetts
attorney Paula Hall, directed towards American medical students,
entitled "Please don't become primary care physicians!!". I am
posting it here with her permission. Please feel free to forward this
onto any interested parties.

Paul Hsieh, MD
Freedom and Individual Rights in Medicine (FIRM): www.WeStandFIRM.org.

====================

http://msthink.blogspot.com/2008/07/open-letter-to-medical-students-please.html

"An Open Letter to Medical Students: Please don't become primary care
physicians!!"

By Paula Hall -- 09 July 2008

All the talk about the health care crisis is about the costs. All the
solutions proposed to the health care crisis are aimed at making it
more affordable.

No one ever talks about access to health care. And with good reason --
because everyone knows, in their heart of hearts, that access to
health care means access to physicians, and the only way to even
attempt to guarantee access to physicians is to enslave them.

What is missing is a proud and open statement by physicians that they,
too, understand that guaranteed access to health care -- government
socialization of health care -- means enslavement of physicians.
Physicians as a group need to stand up and be proud of the decades of
hard work it took for them to become a physician -- and ask everyone
clamoring for universal healthcare if they can conceive any mechanism,
even brute force, that can make someone learn to be a doctor.

Many doctors are leaving the profession, because the bureaucracy is
crushing them, preventing them from spending time practicing, and
because they aren't getting paid enough for what they do. It is a
senseless and useless argument to claim that doctors are being greedy
and should accept whatever low payment we healthcare-needing consumers
are willing to pay. It doesn't matter. There is nothing that can be
done to stop a doctor from leaving the profession. You wouldn't even
want to force a doctor to stay in the profession -- ask yourself if
you would be willing to operated on a surgeon who didn't want to do
the operation and was only there because he was threatened. Could you
possibly trust the advice of a practitioner who hated what he did?
Does anyone truly believe a mind can be forced, that good judgment can
be elicited at gunpoint?

The healthcare access crisis is acutest at the primary care level and
for the elderly on Medicare. Primary care physicians are the
gatekeepers for all the bureaucracies and bear the burden of all the
regulations and requirements. (Do not go on about how HMOs and
insurance companies are greedy private concerns. They are subject to
thousands of laws and regulations telling them what services they may
or may not offer, what things can and cannot be covered. Anyone making
this objection should know that, since they are the ones lobbying for
all the laws.) Primary care physicians receive the lowest
compensation. And primary care physicians are the ones everyone needs,
they are the ones who get to know the patients and refer them on to
specialists.

People clamor for more primary care physicians while at the same time
clamoring for regulations and costs that drive them out of business.
And no one seems to get what is happening, or be willing to admit what
is happening. But it's happening -- we're losing primary care
physicians. And we're losing the doctors who treat the elderly. I'm
middle-aged. By the time I am elderly, there will be few doctors
available to treat me. And I am scared. I am scared that primary care
physicians willing to treat the elderly will be hounded out of the
profession. And I cannot blame them one bit for leaving. I am
completely sympathetic to the medical student who chooses a lucrative
specialty, like plastic surgery or dermatology, over primary care.

I think perhaps the most effective means to get the message to people
that the only way to increase the number of doctors is to free them
is: drastically to decrease the number of doctors on the explicit
grounds that they are not free. So, medical students of today, I beg
of you -- don't go into primary care! Let everyone know that you are
avoiding primary care because it is too regulated and doesn't pay you
enough. If you are a primary care physician, find a way to quit, and
scream from the rooftops the reason why! Doctors and doctors-to-be,
find a way to leave the primary care profession altogether, because if
you try to go on strike while retaining your right to practice, the
bureaucrats will use the antitrust laws to destroy you. Just leave!

And hopefully, when there are no primary care physicians in a few
years, everyone will see what must be done. Only when everyone sets
the doctors free, should they come back to primary care. Hopefully,
this process will be quick -- so that when I am old, I will be able to
find a good doctor.

(Inspired by a column by Senator Tom Coburn (R-OK), appearing on the
Real Clear Politics website at
<http://www.realclearpolitics.com/articles/2008/07/senate_leaders_holding_doctor\
s.html>
-- and which does not go nearly far enough in making the case for
doctors.)

Paula Hall
E-mail: paula.hall@...
Website: http://msthink.blogspot.com