Doctors for Sale
MARGOLIS, RICHARD J.
DOCTORS FOR SALE by richard j. margolis of Russia; Meredith Wilson's charming music man, Harold Hill, sold mythical band uniforms to the people of River City, Iowa; and now, in another of life's...
...During the past two weeks I placed nine telephone calls to NHS, both to its offices and to the home of its president...
...Dietz did travel to Chicago once on a tip from NHS to interview "a couple of Filipino female doctors...
...NHS advertises in medical journals and via direct mail to small-town hospitals and local Chambers of Commerce...
...In Nauvoo, the citizens had such faith in NHS, upon signing a contract they took down a large sign?Nauvoo Needs a Doctor"—that had been on prominent display for months...
...The agency hopes to more than double that number by 1980, but most of the additional recruits will be sent to urban ghettos...
...In hundreds of rural districts, medical care is inadequate or absolutely lacking...
...We never got to first base...
...He never did...
...On six occasions I got no answer...
...They never sent us a single person to interview...
...There is a universal tendency for physicians to abandon rural districts in favor of cities," observed the American Medical Association in 1925...
...Bearing brochures and spouting promises, the salesman wins the confidence of local leaders, and they in turn sell the proposition to their fellow residents...
...For all I know," says Miss Snyder, "he hasn't passed them yet...
...I mean he's not really foreign like a Pakistani or an African...
...There is little or no tendency for recent graduates to seek practice outside the large centers of population...
...We do have a foreign-trained doctor here," Dietz volunteered...
...When we made the contract," I was told by Harold A. Dietz, the administrator of Memorial Hospital in Carthage, "it looked like we couldn't lose...
...But he's Irish...
...The brochure states: "NHS guarantees you doctors...
...In the interim, NHS sent just one applicant to Nauvoo, a young Chicago osteopath who on two occasions failed to pass the state licensing examinations...
...Doubtless its intentions are superior to its performance, and on occasion even its performance seems to have been up to the mark...
...The town eventually persuaded a German doctor to cross the ocean (at Nauvoo's expense) and set up a practice there...
...Carthage is suing NHS for alleged breach of contract...
...Sometimes they deliver...
...frequently they do not...
...Nearly two years later, the town still needs a doctor, and it is apparently out the $3,500 paid in advance to NHS...
...This is not a rich place, it's a farm community-" The remarkable appeal of NHS —its ability to enter a town, call a meeting and close a contract, all within a couple of weeks—appears to flow from two sources: entrepreneurial ingenuity and rural misery...
...It's just been a mess all around...
...At a conference in Atlanta Dietz happened to run into G. R. Holmes, NHS' founder and president...
...A useful weapon in the salesman's arsenal is his claim that there are "between 45,000 and 60,000 doctors in the United States seeking relocation...
...Perspectives...
...The National Health search organization and its competitors, then, are a response to this health care vacuum and to the failure of conventional institutions to fill it...
...Others have tried it before you, and the courts have always agreed we deserved at least half.' " Dietz said the town plans to bring an action in an Illinois court, forcing the California firm to defend itself far from home base...
...Rather than working on a contingency basis as other agencies do, NHS GUARANTEES to supply the desired number of physicians to your group...
...1 talked to people in Texas, Missouri and Indiana," he said...
...In the Midwest, at least three towns that have contracts with NHS—Carthage and Nauvoo in Illinois, and Chariton in Iowa—are asking for their money back...
...He just smiled and said to me, 'Be my guest...
...The Department of Health, Education and Welfare (HEW) has compiled a list of 1,100 "physician-deprived areas" throughout the United States, and four-fifths of them are rural...
...In exchange for a fee, the firms promise to bring physicians to medically-starved towns...
...In all, 10 million rural Americans live in places that are officially designated as "medically un-derserved...
...To date, the only Federal effort has been the National Health Service Corps, a program established by Congress in 1972, which sends volunteer physicians and other health professionals to rural areas...
...It is a totally new concept in physician recruitment...
...I told him that if we didn't get the full refund we'd sue...
...I trapped him in his motel room," Dietz recalled...
...The one the Nauvoo group signed pledges to refund the full $3,500 fee "if with best and most diligent efforts...
...A large proportion of NHS' "recruits" appear to be foreign medical graduates (FMGs), a category that currently accounts for 20 per cent of the total number of practicing physicians in the U.S...
...In Nauvoo, according to Lillian Snyder, the townspeople were informed that if they hesitated one more week, the cost would jump from $3,500 to $4,000...
...Equally helpful, especially when the citizens ask for more time to consider, is the salesman's warning that the contract fee is scheduled to rise momentarily, so that any hesitation may cost the citizenry extra money...
...As a group, FMGs are neither the best nor the worst of doctors, but many have language problems that make it difficult for them to "relate" to patients, especially to patients in small towns, where ethnic idiosyncrasies are rarely appreciated...
...Nauvoo (population: 1200) is typical of this baneful, long-term trend...
...He offered us half the money back...
...They signed forthwith...
...The clincher, however, is the company's moneyback offer...
...Maybe that'll bring them around," he said, "because that could get to be very expensive for them...
...At present the Corps has 708 volunteers, including 464 doctors, working their two-year stints in small towns...
...They gave us 24 names," George Prusinski, the hospital administrator, told me in a telephone interview, "but only one of those ever consented to come visit us and be interviewed, and he wasn't interested...
...So long as this system remains in force, Carthage will be destroyed—and NHS will feel justified in responding to its detractors with Harold Hill's simple maxim: "But ya gotta know the territory...
...Dietz told me that before he committed Carthage to an NHS contract he checked out the firm's references and found them satisfactory...
...by the '40s they had all either left town or died of old age...
...He was very pleasant...
...It's not really the money, though, it's the principle...
...When the company gets a nibble, it sends a salesman to the prospect...
...Health care attrition in rural America has been going on for half a century—not surreptitiously but out in the open, where experts could take due note...
...From the record, it won't be easy...
...It wasn't what you'd call easy money," says Lillian M. Snyder, who helped raise the funds...
...Nobody had any complaints...
...We're trying to get our money back now...
...Still, one wants to be fair: I singled out NHS not because it was necessarily the worst of the lot, but because it was the first such enterprise I happened to come upon in my research...
...and now, in another of life's imitations of art, an enterprising company on the West Coast may be selling imaginary doctors to small towns throughout America...
...Before Carthage decided to sue NHS, it spent a year in unsatisfactory correspondence with the company...
...physi-cian(s) are not secured within 18 months of the date of this agreement...
...on three I reached an answering service and left a message for Holmes to return my call...
...It came from widows and other small contributors...
...Prejudiced or not, rural beggars cannot be choosers—and that is the main reason why NHS is riding high nowadays...
...A large part of rural America will remain hungry for health care and therefore vulnerable to the blandishments of companies like NHS...
...The contract is explicit...
...The National Health Search organization (NHS), founded in 1972 with headquarters in Northridge, California, is just one of a dozen or so outfits that are working the provinces these days, eager to capitalize on the acute doctor shortage that has long plagued rural people...
...The date of the agreement was June 15, 1976, about 22 months ago...
...In the 1920s it supported three physicians...
...To be sure, the real complaint is not with NHS—shoddy as some of its practices may be—but with the social soil from which it springs...
...What the good people of Carthage and the rest of us ought to be battling is the nation's obsolete, fee-for-service health care system, which allows doctors to monopolize the medical market at the patients' expense, and encourages them to practice what they please where they please...
...I asked for our money back," said Dietz, "and they've been dodging us ever since...
...The shortage of rural physicians has grown so desperate that anyone clever enough to give the appearance of being able to deliver one is likely to prosper...
...In Chariton, Iowa, two years ago, Lucas County Memorial Hospital paid NHS $7,000 for the recruitment of two general practitioners...
...I guess we were wrong...
...Unfortunately, he continued, "they hadn't passed their licensing exams yet, and to tell you the truth I wasn't that interested...
...That the doctors will stick around for at least one year is also assured...
...He left eight years ago, and the town has been doctorless ever since...
...The implication (this is never actually stated) is that NHS knows who those doctors are and where they can be found...
Vol. 61 • March 1978 • No. 6
