As I read this piece by Jim Murawski at RealClearInvestigations:
The national movement to eradicate what activists call systemic racism and white privilege from medicine and health care has few public critics in the medical profession. A possible reason: Skeptics who have questioned these efforts have been subject to harsh Twitter campaigns, professional demotions and other blowback.
I could only think what would “equity” in healthcare be? If they mean outcomes, I can only suggest that advocates of equity might want to be careful about what they wish for. IMO different outcomes among different racial groups are multi-factorial with factors including genetics, behavior, cookbook medicine, and, I am sorry to say, racism. I cannot assign relative importances to those factors but I am skeptical that racism as such is the most important factor. I have long thought there were too few black physicians but changing that would require a revolution in medical education.
Some of the earliest posts I wrote here were about medical education. I won’t dredge them up but suffice it to say that “better fewer doctors” has been the mantra of medical education for more than a century and most of that is accomplished by limiting admissions. One of the effects of that has been to limit the number of black physicians. I don’t have facts and figures to back this opinion of mine up but I think that physicians should be prepared to serve the community they plan to serve and there are both advantages and disadvantages to being black and serving black patients.
Ultimately, I’ll leave it to my readers: what would “equity” in healthcare be?
“…what would “equity†in healthcare be?”
Well, from a GAAP perspective it would be total assets less total liabilities. For a guy like me, it would be deemed enterprise value less third party debt.
As commonly pitched by the activists today it is undefined. Some might say its an aspirational concept, but in fact, its a nonsense concept. It neither exists, nor does even an approximation exist. And it has no hope of being manufactured. In commercial law we have highly trained lawyers and judges (or mediators) who attempt to arrive at this concept. But there are always perceived winners and losers.
Of course there are always those interested in pursuing a white whale………….or more to the point, personal financial and power gains.
“IMO different outcomes among different racial groups are multi-factorial with factors including genetics, behavior, cookbook medicine, and, I am sorry to say, racism. ”
You forget class and income as factors. No insurance means no regular medical care, just spotty emergency care.
““better fewer doctors†has been the mantra of medical education for more than a century ”
I have not heard this. The issue is a lack of residency slots. I dont think I have ever heard anyone talk about limiting slots so we can limit the number of docs. Training residents involves a lot more work that is often uncompensated. Lots more paperwork. The main reason people start new residencies now is so that they can capture some of the grads to work in their own systems.
“Ultimately, I’ll leave it to my readers: what would “equity†in healthcare be?”
Mostly access to the same level of care, which is difficult. I have a lot of experience staffing poor, rural hospitals. It is hard to get docs, mid levels and even nurses to live in the areas since by and large the schools suck. Then the hospitals will be small so you can have the same level of comprehensive care. Some stuff needs to be flown out. So a lot of these hospitals are staffed with people who cant get jobs somewhere else. You need to figure out a way to staff the places and staff them with quality people. You run into somewhat similar issues for urban care but it is a bit different. You are more likely to be able to find decent schools but you still run into travel issues. A lot of specialties need to be able to respond within half an hour so can be hard in some cities to find a good place to live within that time frame. Also want to be able to leave the hospital and find your car where you left it.
You do need to monitor outcomes. They may or may not be due to bad or unequal care but if you dont look for it you wont find it and address it.
Steve
Agreed. My list was not intended to be all-inclusive. There are probably many more factors as well.
While that may be true, I think the issue is much more difficult than that. I’ve documented this in the past. There is evidence suggesting that black folk don’t believe they’re getting the same level of care as whites even when they are.
Returning to the matters of class and income, while I believe those are, indeed, factors I do not believe they are dispositive.
“Fewer better doctors” is a quote from the Flexner Report which set the U. S. the path on which it has proceeded for over a century. Here’s the exact quote:
There’s link to the Flexner Report in one of my earliest posts on the subject of medical education here.
Thought that might be the case. Anyway, we arent really using the 1910 Flexner report as a guide anymore. Dont remember the name of the report that comes out occasionally now but it seems to sway between we have way too few docs (recent versions) and we have too many (90s reports). There eis no central authority telling us to create more or fewer rsidency slots. Local economics largely dictate that happening.
Steve
I take equity in healthcare to mean less white doctors, more Black ones.
That could be done with a quota system for medical schools.
If the slots didn’t fill, financial incentives.
Anything less just furthers white privilege.
I take it to mean that but also the same outcomes for black folk as for white. Even with the complete elimination of racism, itself not an achievable goal, I suspect that’s not an achievable goal.
To the factors I would add age.
In my experience Native Americans experience health issues long before whites and rarely live to Medicare or SSI age. They have Indian Health Services though but are IMO not pro-active in utilizing that.
Blacks, by anecdote do as well but must rely on Insurance with large co-pays or Medicaid with it’s waiting lists.
If I’m not making my point, it’s just that it’s easier to manage chronic health issue after retirement. Those of working age, INCLUDING whites, must manage time-off, lost wages, high co-pays.
Some see Medicare for all as the solution, but if you need to work, and by God, somebody has to work, the time issue would still be an impediment.
In our own cases, I like home health nurse visits, most of the time I learn something new about disease management and care issues.
Train more Black nurses.