The Draw of Dermatology?

March 20, 2008

This piece in the New York Times focuses on a married couple, both Harvard Medical School students, who are in their fourth year and waiting to find out about their residency placements. Like many medical students around the nation, they’re competing for competitive placements in specialty fields instead of going into less lucrative (and possibly less intellectually stimulating?) fields such as family practice and internal medicine.

And the competition is expensive:

Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.

The article makes me a little sad in general. I had a conversation at CGI U with a med school student who warned me about the “vortex” of med school. Paraphrased: “Everyone’s the same. You get to med school all idealistic, wanting to help people and stuff. Then you spend years and years studying and working, and you see the people ahead of you getting money. You see the doctors with the nice cars and comfortable lives, and you start to wonder when you’re getting yours? And you get into so much debt that you realize you have to practice, and practice well if you want to get out of that hole.”

I’m certainly idealistic about why I want to go to medical school. In fact, the struggle for me is deciding between larger scale health policy work–doing research, designing disease control programs, advocacy, etc.–and traditional clinical work, or how to balance both. I’ve never seen myself as one to get into private practice, or really even treating patients full-time as a traditional clinician. But the vortex sucks many people in.

The problem is ultimately not with the medical students who are drawn to dermatology and plastic surgery for the better pay. Medical students will inevitably be drawn toward the specialties that combine interesting work with the highest pay. From the NYTimes again:

“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.

The market simply isn’t working here. We need more (many more!) primary care physicians. There’s a lot more demand for services there. But people who have the money to pay more for cosmetic treatments and surgery skew the demand away from those who don’t have the money to get adequate treatment for more life-threatening conditions like diabetes and high blood pressure.

I’m not sure what the solution is either. I know it would need to be a large-scale systemic change; merely getting pre-med students to read about Paul Farmer isn’t going to change everyone. Maybe having a single-payer system where doctors are compensated as much or more for basic services as they are for cosmetic services? Or maybe a loan-repayment situation where medical school is even more expensive, but all loans are automatically repaid by the government for those not going into specialties. Who knows. Suggestions?


Focus.

March 11, 2008

Many Doctors, Many Tests, No Rhyme or Reason

All of our investments in high-tech medicine and tons of tests, as well as the drive toward further specialization, aren’t really having an impact on public health indicators like life expectancy and child mortality. But for those who want to go into medicine (like me) the sexy, intellectually-stimulating, cutting-edge, fiscally-rewarding work is in those specialties.

We need to have a different focus.

“In an age of explosive development in the realm of medical technology, it is unnerving to find that the discoveries of Salk, Sabin, and even Pasteur remain irrelevant to much of humanity.” – Paul Farmer

“The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” – Rudolf Virchow


Quoting King

July 8, 2007

I’m currently reading Shane Claiborne’s Irresistible Revolution. I’m sure I’ll blog on it more fully once I’ve completed my leisurely perusal, but for now I’d like to highlight some quotes Shane brought to my attention. These are from Martin Luther King, Jr.’s “A Time to Break Silence,” a speech given on the Vietnam war in 1967 at a meeting of “Clergy and Laity Concerned” at Riverside Church in New York City. MLK’s concerns went beyond his (incredible) devotion to civil rights in our country, to an even broader view of social justice. And it’s always good to reflect on values that should bring rich and poor, Christian and humanist, theist and athiest together.

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[It became clear that the war in Vietnam] was sending their sons and their brothers and their husbands to fight and to die in extraordinarily high proportions relative to the rest of the population. We were taking the black young men who had been crippled by our society and sending them eight thousand miles away to guarantee liberties in Southeast Asia which they had not found in southwest Georgia and East Harlem. And so we have been repeatedly faced with the cruel irony of watching Negro and white boys on TV screens as they kill and die together for a nation that has been unable to seat them together in the same schools.

Funny how these words still ring true today:

As I have walked among the desperate, rejected, and angry young men, I have told them that Molotov cocktails and rifles would not solve their problems. I have tried to offer them my deepest compassion while maintaining my conviction that social change comes most meaningfully through nonviolent action. But they ask — and rightly so — what about Vietnam? They ask if our own nation wasn’t using massive doses of violence to solve its problems, to bring about the changes it wanted. Their questions hit home, and I knew that I could never again raise my voice against the violence of the oppressed in the ghettos without having first spoken clearly to the greatest purveyor of violence in the world today — my own government.

And here a call for a brotherhood of man, rooted in King’s own Christianity, though it could as easily be read as a call for a global humanism (in fact, King might have been closer to that than most of the Christians we know):

This I believe to be the privilege and the burden of all of us who deem ourselves bound by allegiances and loyalties which are broader and deeper than nationalism and which go beyond our nation’s self-defined goals and positions. We are called to speak for the weak, for the voiceless, for the victims of our nation and for those it calls “enemy,” for no document from human hands can make these humans any less our brothers.

King also has this quote from a Buddhist leader on the war in Vietnam:

Each day the war goes on the hatred increases in the heart of the Vietnamese and in the hearts of those of humanitarian instinct. The Americans are forcing even their friends into becoming their enemies. It is curious that the Americans, who calculate so carefully on the possibilities of military victory, do not realize that in the process they are incurring deep psychological and political defeat. The image of America will never again be the image of revolution, freedom, and democracy, but the image of violence and militarism.

If you will, rephrase that quote for me with Iraq in mind instead of Vietnam (not the analogy is a perfect one, but analogies never are… this particular quote however makes a useful point):

Each day the war goes on the hatred increases in the heart of the Iraqis and in the hearts of those of humanitarian instinct. The Americans are forcing even their friends into becoming their enemies. It is curious that the Americans, who calculate so carefully on the possibilities of military victory, do not realize that in the process they are incurring deep psychological and political defeat. The image of America will never again be the image of revolution, freedom, and democracy, but the image of violence and militarism.

And here he waxes prophetic. One could make the same claim today about US militarism:

The war in Vietnam is but a symptom of a far deeper malady within the American spirit, and if we ignore this sobering reality…and if we ignore this sobering reality, we will find ourselves organizing “clergy and laymen concerned” committees for the next generation.

And another gem:

On the one hand, we are called to play the Good Samaritan on life’s roadside, but that will be only an initial act. One day we must come to see that the whole Jericho Road must be transformed so that men and women will not be constantly beaten and robbed as they make their journey on life’s highway. True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring.

And here’s another quote, though this time I’ve replaced “Communism” with “terrorism”:

This kind of positive revolution of values is our best defense against terrorism. War is not the answer. Terrorism will never be defeated by the use of atomic bombs or nuclear weapons. Let us not join those who shout war and, through their misguided passions, urge the United States to relinquish its participation in the United Nations. These are days which demand wise restraint and calm reasonableness. We must not engage in a negative antiterrorism, but rather in a positive thrust for democracy, realizing that our greatest defense against terrorism is to take offensive action in behalf of justice. We must with positive action seek to remove those conditions of poverty, insecurity, and injustice, which are the fertile soil in which the seed of terrorism grows and develops.


The Language of Abortion

July 5, 2007

Fred Thompson

And again (with a little more detail)

Interesting how this will play out for the uber-conservatives I know who support him.

Here’s one with a (compassionate) quote from Barack Obama, made by a conservative Christian (enjoy the music from Jaws especially):

The amount of in-fighting between Christians on the issue of abortion can be truly vicious. This sort of clip reminds me again and again how Obama’s worldview is closer to my own than to the majority of self-proclaimed Christians I know.

Rudy Giuliani on public funding for abortion (you can bet this one will end up in campaign ads for pro-life Republicans if it hasn’t already!):

And finally, Hillary‘s response on reducing the number of abortions (with some odd sidetracking, like saying ‘the free market has failed’–wtf?, but overall good):


Connection

July 1, 2007

I work at a store. Many, many people come through my checkout each day, though the dominant group is Southern, middle-class, middle-age white women. So when someone different comes through my line, I often take interest.

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Two nights ago a black man with an accent came through my line. The accent was strong and from Anglophone Africa (and I’ve met a few people from Ghana in my town), so I asked “Do you mind if I ask where you’re from?”

“Over there in neighborhood X,” he said, referring to a place right down the road.

“Ah, ok.”

“But before that, South Africa.”

“A beautiful country. Where are you from in South Africa?”

Pauses for a second, thinking I’m probably just asking to be polite and won’t know wherever he names. “Have you heard of a place called Soweto?”

“Yeah, I’ve been there.” His eyes light up with amusement.

“Oh really? Where you living there?”

As I hand him his change, “No, I was just working as a volunteer for a few weeks.”

“Great, where at in Soweto?”

As I hand him his receipt, “Well, mostly outside of Soweto, but I was at Baragwanath Hospital several times.”

“I lived right by the power station near there, do you know it?”

“No, sorry.”

And then he was gone. If I hadn’t had another customer in line I probably would’ve asked what brought him to America, and especially to Searcy. There just aren’t many (black) South Africans in my town (I know a few white ones) and I’m always curious to hear the path that brought people from so far away. I enjoyed the brief little connection of shared knowledge of a place, even in Small Town, USA. Maybe he’ll come back through.


On Domestic Violence

June 28, 2007

It’s everywhere.

The Observant Woman writes on a true story, “Our Disturbing Brush with Domestic Violence.”

A shelter for women that does excellent work I greatly admire is Rose Brooks in the Kansas City area. If more cities had a place like this, it would go a long, long way.


What if the Women of the Bible Had All Been Feminists?

June 26, 2007

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Lately I’ve been enjoying Amy Richards’ Manifesta: Young Women, Feminism, and the Future. I’ve been meaning to read something by Amy ever since I heard her speak this spring, and Manifesta hasn’t been letting me down. Amy is the brain behind the Ask Amy advice column at Feminist.com, and a long time proponent of equal rights and empowerment for women. As a male who has lately begun to come to grips with all the varieties of sexism and patriachy present in the conservative Southern town in which I was raised, Richards’ writing is truly a breath of fresh air.

While Manifesta does everything from summarize the history of feminism to describe what still needs to be done by the so-called Third-Wave of feminism and outline resources for community activism, it also has some hilarious moments. Since a healthy chunk of the examples of sexism I can recall from my upbringing involve religion, I particularly liked the section where Richards and Baumgardner (the coauthor) raise a question: “How would Biblical history have been different if the women had been feminists, and had gotten together for a good girl talk now and then?”

After the ladies loosen up around the table, Mary Magdalene would begin by talking about sex workers’ rights, and returning belly dancing to its origin as an exercise for giving birth. Leah and Rachel would resolve their longtime sisterly competition by ditching Jacob, the man their father married them both to, and agitate for women to be able to inherit their own property. Rather than being synonymous with evil, Jezebel would be lauded for her business acumen. Hagar would receive palimony and child support from her lover, Abraham. Sarah, Abraham’s wife, might even befriend Hagar, Abraham’s concubine and Sarah’s slave; at the very least, she would empathize. Bathsheba, tired of looking for love from a poetic boy who couldn’t commit, would have the presence of mind to leave King David. Delilah would teach them about orgasms and exhort her friends to make sure they got what they needed in bed. Lilith would be full of first wives’ club advice for Eve, and Eve would be pontificating about the politics of housework. Eve would also recognize that she had been framed, and refuse to take the Fall for her man or her God. Ruth wouldn’t be saying “Whither thou goest, I will go” to her mother-in-law or anyone anymore; she’d be blazing her own trails. Meanwhile, they’d all begin to question why the hell Lot’s wife was turned into a pillar of salt when her husband was busy offering up their virgin daughters to the marauders. (And why the hell she didn’t have a name.)

Man, I wish I wrote that. I mean, woman