I Believe, the greatest threat to healthcare delivery to sub-urban regions of the United States is the concept of “centers of excellence.” Along with this philosophy of mechanized haste in patient care, where repetitive motion is viewed as improving quality, goes the concept of “Urgi Care” vis ‘a vis Quality Surgical Care. The major premise appears to be that doing more procedures necessarily means doing them better. The minor premise, that doing only one type of procedure means better outcomes. The science is not in on these premises and the conclusion should not yet be drawn.
Further, the current focus in health-care policy threatens, potentially, to undue the four decades of progress in rural and sub-urban health care services since “Hill-Burton.” As a product of sub-urban America, of public schools and rural society, where the need is great and the supply is dwindling, I take pause. While the national trend in U. S. migration is increasingly from urban areas to suburban and rural communities, the focus of legislative oversight seems to be toward funding increasingly large urban centers. This may lead to a reluctance of specialist to relocate to less-well funded regions. The focus on “centers of excellence” threatens the specialty of general surgery more than any other specialty because the general surgeon is tied to the hospital, unlike Family Medicine or Cardiology or other specialists. In the state of Georgia, for example, the legislature has refused to recognize surgery as a specialty, classifying it as primary care ; and, has in the past refused to allow the establishment of privately-owned surgery outpatient facilities, for general surgeons. While, at the same time, surgeons who choose to establish rural practices are often denied incentive student loan repayments, ostensibly because these are earmarked for primary care physicians, and not specialists.
If we are to continue the gains in healthcare services that tend toward longevity and life-quality for all of our citizens we must protect the right and ability of the general surgeon to practice all of his or her skills in any community committed to delivery of that service in a competent and confident manner. Monitoring performance and out-comes, while at the same time guaranteeing par compensation for par performance.
As American society acknowledges the need for some form of “Universal Healthcare Insurance,” it would do well to study the consequences of similar policies in other countries, including our neighbor to the North. Where it is a caveat that if you are above seventy, you will not likely receive life-saving interventions common to septuagenarians and even octogenarians in the United States.
In the mid-nineties it was the young physicians that pushed for equal compensation for newly graduated surgeons, as compared with established surgeons . It may well be this same demographic that will have to demand the right to practice its profession where it is needed most.
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