Thursday, June 19, 2014
NORTHAMPTON — There are at least two things that I can imagine might keep doctors from signing on to work at Department of Veterans Affairs medical facilities. One is income.
Nationwide, there is a great deal of hand-wringing about the delayed or denied services offered to American veterans. The VA hospital in Leeds is one such medical provider.
A recent chart in the Daily Hampshire Gazette showed there were an average 72 days of wait time to see a primary care doctor in Leeds; a 67-day wait to see a specialist; and a 28-day wait for mental-health care. Staff turnover, recruiting difficulties and increased patient load were cited as some of the reasons for malfunction.
A Merritt Hawkins 2014 study found that American civilians wait an average of 18.5 days for a doctor’s appointment. In Boston, the average wait for a family physician was 66 days, while the average wait for various specialists was 45.4 days.
When I compare the VA statistics with my own medical care, I am appalled. Over the years living in Northampton, I have been treated by excellent, adequate and lackadaisical physicians. Through it all, I have been fortunate to have some insurance coverage. But the need for my care was rarely more compelling than the need for care that a veteran might experience. As an American, I am mortified by my good fortune.
And I’m more embarrassed still that my country’s delivery and outcomes in medical care of its civilian population lags behind a longish list of other countries that spend far less and provide a professionalism any American might envy.
In 2012, Forbes magazine reported that med school students graduated with an average of $140,000 in debt. Primary care doctors, while shouldering the lion’s share of American medical treatment, are the least well-paid at $189,000 on average. Primary care physicians at the VA average about $177,500.
In addition to the financial burden, primary care physicians miss out on the prestige that comes with specialization. An orthopedic surgeon’s $519,000 or a cardiologist’s $512, 000 or urologist’s $461,000 average base salary comes with ... what shall we call it ... a prestigious set of brass buttons, perhaps.
And so, at a minimum, income plays role in why primary care doctors might steer clear of the VA.
But I imagine there is another factor as well.
War is not appendicitis.
Appendicitis is a dysfunction of the body — one that a physician might successfully treat. Like anyone else, a doctor would like to think that his or her healing skills might generate success after the body malfunctions.
When Mr. or Mrs. Jones gets better, it makes that $140,000 in debt worthwhile.
War and its wounds are not inflicted by nature. And the frustration of treating what is clearly a man-made choice — a choice that might equally have been left unchosen — can be both compelling and draining.
The wacky world depicted on television’s long-running series M*A*S*H was pretty funny by way of Korean War zaniness, but not funny at all by way of the grueling, grinding substance of operating on one wounded teenager or 20-something after another. Even on a comedy show, futility took its toll.
War, of course, has its excuses, some of them quite compelling. But few of them are compelling enough to buy into the ballooning pretext of government-approved violence — the undocumented claims of “terrorism” or the “terrorists” who “might” attack us. And so, perhaps, futility and insanity create a one-two punch and an unremitting downer.
But as a means of focusing a more serious attention on war, military involvements and the medical shortages at the VA, here is a small and ridiculous proposal.
Each time a politician votes for military venture or war or any action likely to promote an uptick in the need for body bags and prosthetic limbs and suicides and wrecked families, a $100 co-pay per doctor visit will be added to that politician’s medical insurance. Two such votes will cost $200, etc.
This add-on will likewise apply to all staffers employed by the politician.
And the president and his staff would not be exempt.
The resulting income, while not enormous by comparison to the need, may allow the VA that is left to cope with the fallout of such votes to sweeten the medical pot at its facilities.
Of course, it’s a ridiculous proposal. When was the last time you saw anyone who gave the orders shouldering a straightforward responsibility for the unpleasant consequences?
Of course it’s a ridiculous proposal.
But is it really any more ridiculous than the treatment being received by our veterans?
Adam Fisher lives in Northampton. His column appears on the third Wednesday. He can be reached at firstname.lastname@example.org.