For over two decades I had a front row seat to the slow-motion train wreck that is the American healthcare system.  I know how screwed up it is.  I have seen it from the bottom up and I fought a losing battle for expanded access to quality care all the way down the hill.  

I have seen a side of health care that most people have no idea even exists.  When most people hear ‘public health’ they think of the health department, but only have a vague idea what the health department actually does besides keep track of  STD rates and a few other statistics that most people never have occasion to think about.

When I hear the words ‘public health’ I think of how to say “OK, there’s going to be just a little stick now” and “I’m sorry” and “What a beautiful child!” in ten or twelve different languages.  I have worked in the trenches of public health.  What started as youthful idealism and an altruistic bent evolved over the years.  At times I felt a deep sense of pride, and at others I felt cynical, or put-upon, and frequently I was pissed off.  At the end, all that was left was defiance.  

I have watched as the ground beneath the system crumbled.  But when it was just public health, not too many people paid attention.  Their doctor was still there, taking appointments and passing out samples and ordering all the right tests and writing the designer prescriptions that their years of Oprah-watching had ‘educated’ them to know they needed.   And as long the status quo held, they were disinterested in the health of the healthcare system itself.  

But now that the tentacles that have strangled me and my kind for the last two decades have snaked their way into the suburbs and started to affect the internal medicine group practices in those banal suites in the beige, nondescript office parks, the problem is starting to garner a little attention.  

At age 51, David Wilt calls himself “the young one” at his medical office.

Wilt’s colleagues are in their 50s and 60s. Retirement is on their minds.

And that could mean big trouble for Kansas City area patients in need of a doctor.

The area’s physician population is rapidly aging, and many practices are having a hard time recruiting young doctors.

It is a predicament that puts the area at a serious disadvantage just as experts are predicting a national shortage of physicians that will grow steadily in the years ahead.

In the Midwest, we are double-whammied.  Not only are we getting hit by the lack of interest in new docs to go into internal medicine or family practice, we are also a net-exporter of medical students trained in our area.  Kansas City has two medical schools and an osteopathic college as well.  Nearly all of our hospitals have residency training programs.  But as soon as they graduate they look for residencies in other areas, and as soon as the residents who train here are done with the program, they are outta here.  

And we are about fifteen years away from physician attrition taking down the whole system.  

So who wants to know how to fix it, before it’s too late?  Because I can tell you how.  But there is a down side.  It’s going to cost money.  Those who are allergic to the notion of paying taxes should stop reading blogs this instant and go study up on how to tincture herbs.  


Because these things unfold in slow motion, the tipping point is rarely recognized other than in hindsight.  We may have reached it.  But if we haven’t, we are damned close to it.  

We need a whole new way of thinking about not just how health care is delivered in this country, we need to rethink who is delivering it.  The AMA has set those rules for over 160 years, and along the way they have fought against Medicare and Medicaid, the licensure of nurse midwives, nurse practitioners and every other expansion of duty on behalf of allied health professionals.  That organization has been on the wrong side of too many issues for too long for us to have to suffer the indignity of letting them continue to set the agendas and make the rules.  I’ll say it here and I’ll say it to their face, too.  I don’t kiss doctor butt.  I come from the one part of medicine where the doctors are intimidated  because they know that we are the smart half of the exchange…I come from the lab.  Without us, and our science and our analyzers, they might as well have a jar of leeches and an amulet.  We take the guesswork out of their job, and most of them will tell you that if they had been required to go beyond O-Chem or basic calculus, they wouldn’t be doctors.  We, on the other hand, have to not just pass exams and balance basic equations, we have to actually be able to do math and science.  We have to be able to set up and run metabolic panels by titration, and do the accompanying manual calculations if the analyzers go down, or be able to step in and do manual blood counts and crossmatches for transfusion protocols.

I could recruit ten people to become primary care physicians within 90 minutes, but only if they could take another path to get there than the one that currently exists.  There are a lot of people like me who have finished that first career and still have a lot of years left on the calendar.  

I would be a kick-ass doctor, and sometimes I think about going to med school and finally making my mother proud.  But then I come to my senses and shake off that nonsense.  I’ll be damned if I am going to go a hundred grand in debt and not only not increase my living standard appreciably, but give up a lot of my quality of life as part of the bargain.  Fuggedaboudit.   And I am sure as hell not going to take a bunch of abuse at the hands of some snot-nosed punk masquerading as a teaching doc when I remember full well that I used to have to go find their sniveling ass when they went and hid in the supply closet to cry when they were a resident.  

Now if the state and the medical schools could get together and set up a program tailored to allied health professionals who meet a set of criteria and train to specialties and license the graduates to work in conjunction with  M.D.s and D.O.s like nurse practitioners and physicians assistants do now.  Can you think of anyone better to help a Hematologist (specialist in blood disorders) pick up the slack than a person who spent the first decade or two of their professional life as a blood banker?  I can’t imagine a better second career for a radiology tech than as a practitioner in an orthopedics practice.   For that fact, we could redefine what constitutes a general practitioner and create an abbreviated medical curriculum for nurses and allied professionals with bachelors degrees and confer full physician rights upon completion of classroom and clinical requirements.  

We have an aging population and we have a lot of burned out health professionals.   I know both of those facts first hand – I can see fifty from here, and I qualified as the latter before I was a member of the former.  

I have time, and I have inclination.  What I don’t have is money to burn or the patience to jump through a bunch of hoops that are ultimately pure and utter bullshit.  But if the lege would codify some new rules into law, and fund a program, I would gladly go through it and spend at least a decade, maybe even two, as a front-line provider in an underserved area or specialty.    Unfortunately, if they do get around to doing something like that, it will be so far into the future that I will be too old to participate.