More Evidence Our Infrastructure & Public Health Systems Are Munged
Some Hospitals Call 911 to Save Their Patients
While working as an intern in the MSW/MPH program at St. Louis University (which I never completed because of money), I was placed on task to survey smaller hospitals and urgent care clinics for their needs regarding emergency room physician coverage. Many of the hospitals and centers I surveyed were smaller, rural care centers located within 150 miles of St. Louis proper. Sometimes I would find no ER coverage at all because there just wasn't a qualified physician in the area. Sometimes an ER would be covered on an "on call" basis, which meant that the nurses in the ER would handle most problems that came in after 6:00 PM and call for a physician when the need arise, usually translating into a ten to twenty minute wait before the doctor arrived. Of course, these situations had established BLS (Basic Life Saving) and ALS (Advanced Life Saving) protocols in place, but it was not the same as having a full-time ER-trained physician. In most cases I found centers had a minimum cadre of physicians and often fell short of coverage on a regular basis.
The purpose of the survey was collection of information regarding the marketing of ER Physician Services offered through St. Louis University Medical Center (SLUMC). The idea was that these rural and understaffed centers could arrange ER physician coverage through SLUMC for a fee of $100 to $150 per hour. Of course the physicians did not receive that amount. In fact, they would receive about half that amount. Now that was in 1986-1987. Since then, I am sure the fees have gone up and the problem of ER coverage is exacerbated.
One of the problems we face is physician presence in rural areas. The cause of this problem is our own government. We arrange to send students through medical school for a commitment of 5-7 years service in rural and under-staffed areas of our country.
But more often than not, upon graduation from medical school, completion of internship and residency, doctors find that they cannot work for such reduced salaries while paying their medical school loans and trying to have a life (bills, rent/mortgage, significant others, children... "the full catastrophe"). So these folks renege on their commitment for what most of us would consider valid reasons. While these folks then end up owing more on their student and medical school loans, they are then able to make almost three times as much in salary after only a few years out of residency, which facilitates payback a lot easier.
Still, a goodly number default on their loans while making over $100,000 annually. My last inquiry into the issue of default on medical school loans demonstrated that more student loan money is tied up in default by graduates of law school and medical school... because more money is tied up in the process of getting through these schools and a smaller number of defaults still results in a larger sum of money per graduate/defaulter.
But the bottom line is that our most remote areas, and most needy areas, do not have proper medical care coverage. In many such areas the majority of physicians are foreign born and foreign trained. While I have met a few foreign born and foreign trained physicians that are worth their weight in gold, I find the vast majority of them have cultural, language and caste values that interfere with sound medicine. So these areas are vastly under served in terms of ER coverage and regular medical care.
I make the case for a public health program that pays the full freight of medical school for those willing to actually commit to a ten-year stint, post-grad, in a rural area. I further call for this program to be offered to military medics and corpsman who are already geared up for medical work, many of whom have already seen emergency work (battlefield work) and are fully trained in triage, BLS, ALS, minor surgery, etc. I further call for advancement of the Physician's Assistant career path for these under served areas to aid in filling the gap, including offering a similar full-boat scholarship in exchange for an 8-year commitment, with the smae openings for military personnel.
But in the meantime, if you live in, or are visiting, an under served area, be very, very careful. And, by the way, if there is every a disaster, attack or man-made incident in these areas, just bend over and kiss your sweet ass goodbye!
While working as an intern in the MSW/MPH program at St. Louis University (which I never completed because of money), I was placed on task to survey smaller hospitals and urgent care clinics for their needs regarding emergency room physician coverage. Many of the hospitals and centers I surveyed were smaller, rural care centers located within 150 miles of St. Louis proper. Sometimes I would find no ER coverage at all because there just wasn't a qualified physician in the area. Sometimes an ER would be covered on an "on call" basis, which meant that the nurses in the ER would handle most problems that came in after 6:00 PM and call for a physician when the need arise, usually translating into a ten to twenty minute wait before the doctor arrived. Of course, these situations had established BLS (Basic Life Saving) and ALS (Advanced Life Saving) protocols in place, but it was not the same as having a full-time ER-trained physician. In most cases I found centers had a minimum cadre of physicians and often fell short of coverage on a regular basis.
The purpose of the survey was collection of information regarding the marketing of ER Physician Services offered through St. Louis University Medical Center (SLUMC). The idea was that these rural and understaffed centers could arrange ER physician coverage through SLUMC for a fee of $100 to $150 per hour. Of course the physicians did not receive that amount. In fact, they would receive about half that amount. Now that was in 1986-1987. Since then, I am sure the fees have gone up and the problem of ER coverage is exacerbated.
One of the problems we face is physician presence in rural areas. The cause of this problem is our own government. We arrange to send students through medical school for a commitment of 5-7 years service in rural and under-staffed areas of our country.
But more often than not, upon graduation from medical school, completion of internship and residency, doctors find that they cannot work for such reduced salaries while paying their medical school loans and trying to have a life (bills, rent/mortgage, significant others, children... "the full catastrophe"). So these folks renege on their commitment for what most of us would consider valid reasons. While these folks then end up owing more on their student and medical school loans, they are then able to make almost three times as much in salary after only a few years out of residency, which facilitates payback a lot easier.
Still, a goodly number default on their loans while making over $100,000 annually. My last inquiry into the issue of default on medical school loans demonstrated that more student loan money is tied up in default by graduates of law school and medical school... because more money is tied up in the process of getting through these schools and a smaller number of defaults still results in a larger sum of money per graduate/defaulter.
But the bottom line is that our most remote areas, and most needy areas, do not have proper medical care coverage. In many such areas the majority of physicians are foreign born and foreign trained. While I have met a few foreign born and foreign trained physicians that are worth their weight in gold, I find the vast majority of them have cultural, language and caste values that interfere with sound medicine. So these areas are vastly under served in terms of ER coverage and regular medical care.
I make the case for a public health program that pays the full freight of medical school for those willing to actually commit to a ten-year stint, post-grad, in a rural area. I further call for this program to be offered to military medics and corpsman who are already geared up for medical work, many of whom have already seen emergency work (battlefield work) and are fully trained in triage, BLS, ALS, minor surgery, etc. I further call for advancement of the Physician's Assistant career path for these under served areas to aid in filling the gap, including offering a similar full-boat scholarship in exchange for an 8-year commitment, with the smae openings for military personnel.
But in the meantime, if you live in, or are visiting, an under served area, be very, very careful. And, by the way, if there is every a disaster, attack or man-made incident in these areas, just bend over and kiss your sweet ass goodbye!
Should a hospital be able to handle a medical emergency?
The answer may seem self-evident. But patients at some hospitals may find the staff resorting to what someone might do at home in a crisis: call 911 for an ambulance.
That happened recently in Texas, where a 44-year-old man named Steve Spivey developed breathing problems after spine surgery. No physician was working there when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead a short time later.
The episode occurred at a small hospital that is owned and run by doctors — one of roughly 140 such hospitals around the country, with nearly two dozen more under development, that are set up to specialize in certain types of procedures like heart surgery, back operations and hip replacements.
These hospitals have been assailed for cherry-picking the most profitable procedures from the nation’s 4,500 or so full-service hospitals.
Critics have argued that the doctors have a financial incentive in sending patients to their own facilities, even when those patients might be better off having their surgery in regular hospitals.
But the Texas case, and others like it, have invited new scrutiny from regulators and members of Congress about these hospitals’ ability to care for patients who suffer complications after their operations.
While some of these hospitals are large sophisticated operations, like those hospitals specializing in cardiac care, others are much more modest. For example, small surgical hospitals may not have separate emergency facilities or, as in the Texas case, a doctor on site at all times during a patient’s recovery.
posted by Jim Downey at 6:22 AM
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