I had dinner with an old medical acquaintance the other evening. Seated to my right, were together at a fund raiser for medical scholarships. He graduated a year ahead of me and our paths seldom crossed while at school. Now he is, he tells me, in family practice. Seated to my left was another doc, one I had not met previously and also a graduate of my school, also in family practice. Both docs work in low to low middle income areas of Los Angeles within just a few miles of each other. Both docs are non-white. But it is there all similarities end.
On the one hand, to my left, the doctor and his wife run a busy family medical practice in which he provides care for patients from early childhood to late-in-life elderly. Over 70% of his patients are welfare or no-pay. He works 6 days a week in order to provide care for his large and needy patient base.
On the other hand, to my right, the doctor runs a busy family practice. Frustrated with low re-imbursement and administrative hassles he has created a niche practice helping patients with weight loss and "wellness." Only cash paying patients are seen in this practice. He and a partner have 3 clinics, one of which is his sole domain. He works 3 or 4 days a week. He does not see diabetics or hypertensives or children. He sees overweight people and people interested in pursuing "wellness."
On my left I saw a physician who was obviously dedicated to his oath as a provider of services to the sick and those in need of healthcare. On my right I saw a man who was obviously interested in providing for himself and had found a clever way to accomplish that goal using his medical degree and license.
On my left I saw both the best and worst in U.S. healthcare: A provider who is dedicated and who places the needs of the community first. His life is consumed, six days a week, working to meet the healthcare needs of his patients. For this he receives about $14 per visit almost 70% of the time. He is capable, available, and committed. At the same time he is overworked and underpaid.
On my right I saw the worst we have to offer: A provider who has elected to use his skills and station to place himself before the needs of the community, his needs before the needs of patients. He is convinced he is offering an important service and is helping hundreds of people, but it is only the population that needs rescue from their own excess. And, it is only that population which can afford to pay the cash price per visit, a price which is many times beyond a paltry $14. He bursts with pride at his comfortable hours, his high re-imbursement, and his hassle-free life.
I left that dinner amazed that one could find so much of what defines, and undermines, healthcare in the U.S. embodied in just two doctors. They sat within a few feet of one another, worked within a few miles of one another, but practiced a world apart. As JFK once said, so pointed and plain, "We can do better."
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