What People Like You and Me Are Doing to Get Better Health CAre
Hapgood, David
What People Like You and Me Are to Get Better Health Care by David Hapgood It’s that impatient condescension. The doctor will listen to us briefly, even though we speak barbarous...
...In 1975 Dr...
...some were Americans who couldn’t find a place in school at home, but the great majority were from countries short of doctors, people who were lured here by better pay and amenities...
...Eugene G. McCarthy and Ann Susan Kamons of Cornell Medical School, which had set up the panels of surgeons to provide the second opinions, reported on what had been accomplished...
...According to Blue Cross, this can cut two days off the average hospital stay...
...Producer Abby Mann was aided in preparing “Medical Story” by Dr...
...Currently about two thirds of Blue Cross plans offer some form of home care, and the savings can be dramatic: the Rochester, New York, Blue Cross reported, for example, that 220 of its members were being treated at home at an average cost of $18 per day, compared to $1 16 in the hospital...
...It was certainly a surprising act for the organization traditionally known as the hospitals’ friend...
...the classic example is the doctor who, when one kid shows up with a sore throat, schedules all the children in the family to have their tonsils out on the same day...
...That statement is less than com-plete-it does not take into account the role of preventive medicine-but it serves to remind us that our health depends less on scientific medicine than we usually tend to think...
...Accounts of physician extenders’ assignments tend to focus on the exotic: Mary Breckenridge, founder of the Frontier Nursing Service, galloping off to deliver another baby...
...You could tell that the PAS had arrived when, having broken into the guild-ridden industry, they promptly formed a guild of their own: the American Academy of Physicians’ Assistants...
...Economist Gelvin Stevenson suggested that he might make his living as a consultant, giving opinions about surgery instead of wielding the knife, especially if he can convince health insurers of the need for a third opinion, to be known as the “tie-breaker...
...And what of the poor surgeon, already in surplus...
...But Blue Cross was being tormented with bad publicity over another rate increase, and less surgery is one way it can hold its premiums down...
...Because they come much cheaper than doctors-most nurse-practicioners and PAs earn from $12,000 to $29,000-they will have, and we can afford, time for those ordinary problems, boring to the physician but of consuming interest to us, that are the common coin of health care...
...The success of the abortion clinics undoubtedly has been a factor in persuading people that many much simpler operations can be done with-out overnight hospital stay...
...Their acceptance to date has been excellent...
...It is called, for want of a better term, the physician extender, and, for reasons of historial accident, it comes in two versions, distinguished by sex rather than function: the nurse-practitioner, female, and the physicians’ assistant, male (though there are exceptions to both...
...The current boom in malpractice suits measures, as on a barometer, the public’s rising desire to fight back and the willingness of some doctors to tattle on their colleagues...
...Many are indeed willing to go to locations too distant from the country club to attract doctors, but they are also moving into the mainstream where they will meet the average person...
...almost 700,000 of these operations were performed in 1975, resulting in about 1,200 deaths -from 15 to 40 per cent, depending on who’s making the estimate, were avoidable...
...In Superior, Wisconsin, workers in grain elevators found that more than half their number were coming down with respiratory disease...
...health economist Victor R. Fuchs quotes a physician writing in Medical Economics: “Fully 80 per cent of illness is functional, and can be effectively treated by any talented healer who displays warmth, interest, and compassion regardless of whether he has finished grammar school...
...That leaves only ten per cent in which scientific medicine-at considerable cost-has any value at all...
...his eventual settlement was for $45,000...
...There would, the announcement said, be eight one-minute commercials per hour...
...Hysterectomies and orthopedic operations were rejected at a considerably higher rate than other kinds of surgery, and specialists in those areas were found to be reaching for the knife more often than general surgeons...
...With outside help from the University of Wisconsin, they uncovered the usual lax enforcement of inadequate standards and were able to force the employer to install new safety equipment...
...in these cases the second opinion was made voluntary...
...With Silver’s experience as a model, the pediatric nurse associate has spread to other states and now makes up about half the nurse-practitioner population...
...Some viewed the nurse-midwife as a welcome change from a person in whose behavior they saw the classic male chauvinist pig...
...By mid-1975,37 states had legitimized the PA (nursepractitioners in most states were able to function under their nurses’ status without new legislation...
...For some the calculation is economic: the nursemidwife costs less than half the obstetrician’s price...
...Henry Silver’s experiments in the mid-sixties at the University of Colorado in training nurses to assume some of pediatricians’ work...
...Richard Smith, designer of the imaginative MEDEX program for excorpsmen, toured the back country of the state of Washington looking for this prototype: a doctor with military experience who was chained to his practice because he was the only physician in that small town...
...This has been pioneered mainly in New York City, and the results to date are dramatic...
...When the birth rate’s falling...
...These two occupations have multiplied so fast that they seem certain to be an essential part of tomorrow’s health care package...
...If that were to happen, if the United States were to stop looting other countries’ health manpower-a good thing for both, since a doctor usually performs better in his own culture-the effect on the domestic medical market would be to cancel out the entire increase in American medical school production and guarantee a shortage of doctors for many years to come...
...Prominent among these is Dr...
...In three years the second opinion had avoided 594 operations, which was no fewer than 28 per cent of the cases that had been considered...
...Some problems missed by doctors have been caught by PNAs, not, in all probability, because the PNA is more skilled but because she devotes more time to each case...
...Progress has been made on some fronts...
...The payoff was $100, our overhead was $400, so that left us with a net profit of $500...
...But medical malnutrition hasn’t been observed anywhere recently, certainly not in the suburbs, thou’gh surplus surgeons are forced, if they cannot find anyone to operate on, to the occasional indignity of treating organs instead of removing them...
...the price is right because, as one administrator said, “Whenever we purchased a patient, he never got out the door until he ran the bill up to $1,000...
...After years in which the network reading of popular opinion dictated that doctors must be cast in the heroic mold of Kildare and Welby, NBC in the fall of 1975 launched “Medical Story” and “DOCtors’ Hospital,” programs that portrayed doctors as being as afflicted with error and greed as the rest of us...
...Within the profession, it has been discussed for decades, but only in the last few years has the message been broadcast to the laity by dissident insiders...
...As for the pediatrician, he was able to carry a greater patient load, and that, a federal evaluation politely stated, “proved to be an economic boon to the physician...
...Progress has been made on some fronts...
...The city began sending nurses to Cornel1 Medical Center for PNA training as recently as 1972...
...He’ll work his miracles of modern science, if only we’ll hurry up, and shut up, and pay the bill...
...Malpractice claims are running close to 20,000 a year...
...And, above all, don’t waste his time with questions...
...And right now I don’t know what that is...
...the nurse, in particular, threatened to brain him with a bedpan, or a lawsuit, if he got between her and the doctor...
...She is succeeding both the old granny midwife, who still practices in some parts of the South, and the lordly obstetrician, product of the era of scientific medicine...
...some of the Surgicenter operations cost less than half the hospital price...
...Another way is a second opinion by another surgeon who has no financial stake in the decision...
...The public is getting at least a fingertip on the levers of power, and the industry itself is responding in various ways to the demands on it...
...They may even save money...
...More than 4,000 PAS were in practice by 1976, and they were being graduated at the rate of 4,000 a year, with that output sure to increase as training programs expanded (and drew on women and men without military experience...
...The AMA didn’t mind during the halcyon days of the doctor shortage: its members would get the suburban practices, while the Pakistanis worked the night shift in the city hospitals...
...the producers of Marcus Welby, who would never dream of committing any medical sin, get their cues from the American Medical Association...
...Wolfe estimated that 17 per cent of all operations are unnecessary, which works out to 3.2 million operations a. year...
...According to Margaret O’Brien, the director of Public Health Nursing who selected and supervised them, the PNAs have been fully accepted by parents, and on at least one occasion, a mother whose child saw a doctor because the PNA was absent called the PNA at home to ask if it was all right to follow the doctor’s advice...
...surprising amount of change can be seen...
...Sidney M. Wolfe of Nader’s Health Research Group, a leading critic of unnecessary surgery...
...The physician extender, coupled with the rising output of the medical schools, may restore the Golden Age of American Medicine, that legendary time before World War I when there were enough doctors to go around...
...The way of the PA was not easy, for, unlike his female counterpart, who grew out Of the familiar figure of the nurse, nothing resembling the PA existed in the rigidly guild-bound health industry...
...In 1972, the small Storeworkers Union, with 8,000 members employed at Gimbels and Bloomingdale’s, added a required second opinion, by a panel of salaried medical school doctors, for elective (non-emerThe Washington Monthly/October 1976 gency) surgery under its health insurance plan...
...doctors, it was said, would be given free receivers for their network, which would broadcast “medical information” 24 hours a day...
...Dare they let an underling read those rattling bones...
...The savings are equally impressive...
...In Washington, D. C., Blue Cross was taking ads to tout same-day surgery under the headline: “In by nine...
...Health insurance often pays for hospital treatment but won’t pay for the same or an alternate treatment outside, and the health financing system generally has offered few incentives for keeping Insurance that pays virtually all the costs of a hospital stay is also responsible for our choosing too often to go to the most expensive institution in reach: the operation may only be on the toenail, but, if the insurance is paying anyhow, why not choose the teaching hospital with the heart-lung machine instead of the lower-cost community hospital...
...Tomorrow,s primary care will come not just from more doctors, but from a new kind of health provider who is taking over part of the physician’s job...
...Blue Cross, perhaps the single most important force in the field, has moved in various ways, often under pressure, to reduce unnecessary hospital use...
...One mother, a pediatrician herself, saw no place for a physician-“trained to treat the abnormal”-in a healthy childbirth...
...Thus the growth of prepaid health plans with salaried doctors is one way that unnecessary surgery is being reduced...
...If we are to be more demanding of our doctors, we need an adequate supply of them, particularly in primary care...
...As recently as 1973, almost half of all newly licensed doctors were graduates of foreign medical schools...
...The consolation to the taxpayer, as he examines the bill handed him by a doctor he helped put through medical school, is that the bill would have been even higher if the federal subsidy had not increased the supply of doctors...
...When New York State legalized abortion in 1970, and it was clear that it was first going to happen on a large scale in New York City, hospitals lobbied to restrict the action to their premises...
...That at least is the experience of Roosevelt Hospital in Manhattan, where since 1974 five nurse-midwives have been attracting a growing number of middle- and upper-middle-class women...
...the first to offer same-day service was Butterworth Hospital, in Grand Rapids, Michigan, in 1961...
...As a Baltimore specialist said: “Some of us aren’t making a living, so out comes a uterus or two each month to pay the rent...
...He is the expert in full bloom...
...Out by five...
...They also made it possible, financially, for us to have several social events including a very enjoyable evening aboard the Goldenrod Boat...
...his eventual settlement was for $45,000...
...He spelled money in their pockets if they charged their rate for his lower-paid work-anyone could see that, and doctors knew better than anyone else how overtrained they are for most of their work...
...But money is not the only, or even the primary, consideration...
...But far fewer than half who sue actually collect anything, and, as Klaw points out, the true rate of malpractice is far higher than the number of claims, since many victims are reluctant to sue or are unable to find a lawyer willing to take their case...
...By 1976, PNAs were handling one quarter of all patient visits in the city’s network of 80 child-hedth stations, and they were beginning to supplant doctors in giving school physicals...
...If it seemed that doctors were scarce, we were told, it wasn’t a shortage, just maldistribution: too few doctors in the slums and the boondocks, too many in the fat suburbs...
...It 24 happens because the nation has too much hospital capacity-the surplus of beds is variously estimated at from 67,000 to 250,000-and empty beds act as magnets attracting occupants...
...First on that list is unnecessary surgery...
...Various ideas on how to make civilian use of this person coalesced into the concept of the physicians’ assistant: someone to whom a doctor would delegate some of his tasks while always retaining ultimate responsibility for what the PA did...
...Their record for safety is evidently good: one of the oldest, Phoenix Surgicenter, has performed 26,500 operations in five years without a death and without an emergency transfer to a hospital...
...Salaried physicians cut less often without valid reason than their fee- f or- s ervice coun terparts-that’s why surgery rates are much lower in Britain y d Sweden...
...For others, the objection to the obstetrician was medical: he was more likely to use drugs to induce labor, and forceps in delivery, for his personal convenience...
...A couple of dozen surgical clinics do only walk-in surgery for about 40 simple operations...
...Some are in private practice with pediatricians, but more are in public health institutions, with the largest single concentration being the 70 PNAs in the New York City Health Department...
...Blue Cross also increased its benefits for home care...
...The nurse-midwife, the second most prevalent type of supernurse, is a modern throwback...
...indeed, the cost has gone up faster than the verdicts, since malpractice insurers pay out only one dollar in claims for every three dollars they collect in premiums, the rest of the money disappearing in overhead...
...Yet, down below the headlines, a David Hapgood is a contributing editor of The Washington Monthly...
...It is a reversal of the centuries-old trend toward more specialization and longer training for the same work...
...Another way of minimizing our need for the health industry’s services is to reduce the hazards of the workplace, where each year 100,000 persons are killed and many times that number disabled...
...When the group took on the case of Cleam Caldwell, a District of Columbia Metro tunnel worker who had contracted silicosis and then been fired for “unreasonable questioning of safety on the job,” all Caldwell hac gotten as compensation was $75O-plus an offer of reinstatement in the same hazardous place...
...In The Great American Medicine Show, Spencer Klaw cites a government survey that found about half the claims to be “legally meritorious...
...Although they were approved by the American College of Obstetricians and Gynecologists in 1971, when business was better, many obstetricians think nurse-midwives are a lousy ideahaving just shoved the old granny out 30 the back door, they find her daughter, dressed up in a diploma and, can you believe it, a goddam stethoscope, coming back through the front door...
...Indispensable to this process of change is a more informed, more skeptical, more healthy view of this most mysterious of the services we get from the experts...
...There is still a chronic shortage of primary-care doctors that makes most people glad to get a scrap of a physician’s time, and encourages an attitude of unquestioning gratitude on the part of patients...
...Wolfe of the Health Research Group...
...By the 1960s, the AMA’s resistance had weakened, 27 new medical schools were started, and in 1975 enrollment was up by 70 per cent from 10 years earlier...
...The first PAS, graduated from Duke University after two years of postmilitary training, were required to work only in the university hospital...
...A b o r t i o n is an operation that now, after an initial period of uncertainty, is done primarily outside hospitals...
...The extra cost of each such decision is of coume third-partied back onto the general public...
...More than ten years ago, the thought occurred to a few people that the civilian health industry could find a useful place for the thousands of medical corpsmen being discharged by the military services...
...Our thanks go to these companies...
...But progress did not always come easily...
...For children, the leading unnecessary operation is tonsiUectomy...
...The program had cost $200,000 to run, and it had saved hospital costs of $1.5 million, plus a necessarily unknown number of lives...
...The result of unnecessary hospitalization was illustrated during a doctors’ strike in San Francisco in early 1975 when hospitals were closed except for emergency cases: the hospitals found there was no noticeable public demand for their missing services, and they concluded the public had been “spoiled...
...Much of the time it seems that nothing is happening: a new national health insurance plan is announced...
...The obstetrician hasn’t been able to slam that door, and as time goes by, childbirth will be available to more women on better terms-financial, yes, but also that “something else”-than it is today...
...Pressmen at Washington newspaper plants brought hearing specialists to measure the din at work, who determined that more than half the pressmen had suffered hearing loss...
...In Who Shall Live...
...The city had also trained ten nurse-epidemiologists to investigate cases of infectious disease...
...Johnny Carson and the authors of “Maw Hartman, Mary Hartman” take repeated jabs at the medical profession...
...And you could tell, beyond any shadow of doubt, that the new guild had arrived from the following item from an account, in their newsletter, of the 1975 PA convention in St...
...We are beginning to abandon the exaggerated expectation-foisted on us, mainly by ourselves, during the years of optimism-that the health industry can solve all our problems...
...G e t t i n g what we need from the health industry begins by not accepting what we don’t need...
...Nor was he welcome...
...These corpsmen were produced by a remarkably efficient training system, for, though the military squanders our money with the abandon of the Emperor Caligula, time is too precious to waste when training men who will only be in service for a intense training stints interspersed with active service, the military pro- i ent duty corpsman, someone who is capable of supplying the health needs of a group of men, with only radio contact (if, for example, he is on a small ship) with a physician...
...Hysterectomy is what surgeons like to do to women...
...This article is adapted from his book The Average Man Fights Back, written in collaboration with Richard Hall, to be published next year by Doubleday...
...Silver demonstrated that the pediatric nurse associate, as she is usually called, can replace the pediatrician for about three quarters of his duties, and that the clients-mothers as well as childrenquickly came to accept, and sometimes prefer, a visit with the PNA rathei...
...The miracles of modern medicine are of limited application...
...The beginnings of change are visible...
...prices keep going up...
...Physicians in practice were up by 50,000, with considerably larger increases expected in the next two decades...
...Even within his own sphere, the doctor’s infallibility is being increasingly questioned...
...than the M.D...
...This is a major goal of the Health Research Group, but it is not easy to make headway when safety in the workplace appears to be of as little interest to most unions and government inspectors as it is to em ployers...
...The price tag is 16,000 deaths a year and a waste of $4.8 billion...
...at this writing, not a single malpractice case involving a physician extender had been reported...
...First the witch doctor divided into priest and physician, and later the barber-surgeon separated into his component parts...
...The director of the hospital’s midwifery service, Dr...
...Wouldn’t life be easier, Smith suggested, if you had a skilled assistant, like those corpsmen you knew in the service, remember...
...Beyond that, I’m sure we’ve tapped much more-something else...
...it vanishes down the drain like its predecessors...
...Governmental efforts to regulate safety at work, never more than a tiny fraction of what was needed to make any dent in the annual carnage, seem to be both rising and falling: the federal government’s somewhat greater effort in recent years has been used by the states as a pretext to do even less than they were doing before...
...After five years the clinics’ safety record is as good as the hospitals’, and certainly far better than the bad old days: in 1974 just one woman died during abortion, while in 1969, the last year before the law was changed, illegal abortions took the lives of 24 women...
...A dilation and curettage, for example, in 1975 cost $121 compared to $265 in a Phoenix hospital (the prices do not include doctors’ fees...
...Walk-in surgery is increasingly available...
...Though the idea isn’t new-the Frontier Nursing Service has been providing most of the primary care in a thousand square miles of Appalachia in eastern Kentucky since 1925-the modern era dates from Dr...
...So persuasive was Smith that the law legitimizing his program was pushed through the legislature by the state medical society...
...The increase in medical school enrollment has been fueled by federal subsidies that supply almost half the cost of the future doctor’s education...
...Avoiding an operation you don’t need is ultimately a personal decision, but it can be powerfully influenced by the ground rules that surround the decision...
...The barriers began to fall rapidly when the AMA put its seal of approval on the PA, gaining thereby a hold on his throat by which one day it may be able to strangle him...
...But by 1976 there were mutterings about restricting the entry of foreign doctors...
...This lordly image of the physician, so different from the kindly family doctor of the half-forgotten myth, is at the center of the growing struggle for more public control over the vast, expensive, and admittedly inefficient health industry...
...The doctors, though not happy about the turn of events, have made no organized effort to block the gradual erosion of what was once their exclusive territory...
...But, on the other hand, could they share the mysteries of the witch doctor...
...Thomas F. Dillon, had this to say: “We have tapped a group of people to whom economy is important and we have tapped a group of people that are women-oriented...
...The idea went nowhere...
...The ad concluded: “If programs like these succeed, they’ll lead to improvement of health care for everyone...
...In 197 1, Herbert Denenberg, the famous Pennsylvania Insurance Commissioner, blocked a Philadelphia Blue Cross rate increase of 50 per cent and demanded that Blue Cross renegotiate its hospital contracts to reduce costs...
...Using comparisons between the United States and 22 Britain, and among Americans in different kinds of health plans, Dr...
...In any event, the step taken by Blue Cross in New York put the second opinion in the big leagues for the first time, and what is now on its way to being standard practice in New York is likely to spread rapidly to the rest of the country...
...Medical Story” only lasted a season, and doctors still rate highest in the polls on which-profession-do-y ou-most-respect , yet, if televison either mirrors or molds public taste, what is appearing on the tube in 1976 seems to herald a shift in public attitudes toward doctors...
...Then, as the nurse-midwife began serving more than just a poor clientele, it became evident that quite a few women preferred her services to those of the obstetrician...
...with the help of the Health Research Group, the pressmen made enough noise of their own to force the newspapers to install sound-reducing devices...
...the improved standards resulting from the case will apply to 100,000 grain-elevator workers around the country...
...The reasons are clear enough: the nation has too many surgeons, surgery pays better than other medical work, and, under the fee-for-service system, the doctor who decides the operation is needed is also the one who gets paid for doing it-the legal equivalent would be for a judge to have a financial stake in the cases that come before him...
...Pressmen at Washington newspaper plants brought hearing specialists to measure the din at work, who determined that more than half safety on the job,” all Caldwell hac gotten as compensation was $75O-plus an offer of reinstatement in the same hazardous place...
...Avoiding the medical care we don’t need does not, of course, guarantee us the care we do need...
...They come in two forms: going to the hospital when you don’t have to, and staying too long when you do have to go...
...The fact that a lot of operations are unneeded has only recently begun to sink into the public mind...
...Today they number about 10,000, and they are being turned out at a rapidly increasing rate...
...Here greed is not the only factor: the poor provide most of the patients for teaching hospitals, and there just aren’t enough sick organs around to supply the practice needed by interns and residents in surgery...
...The fact that abortion is now legal by Supreme Court decision, and in practice ever more widely available, is of course a great success story in the politics of health...
...Blue Cross spending rose only 2.5 per cent in that year, less than the rise in the cost of living, compared to 67 per cent in 1969-71...
...some 100 more such clinics are planned...
...Louis: “Several drug companies sent representatives to the convention, where they distributed a great deal of literatur e and pertinent information through their exhibits...
...The chief victims, not surprisingly, are women, children, and the poor...
...Bow, organized medicine asked, could you make the student repay money that he had never seen, it having gone directly to the medical school instead of passing through his pocket...
...The logic was feeble even by AMA standards, for, if the suburban practices are overcrowded, some doctors out there should be starving...
...Most of us will, in not too many years, be getting at least part of our health care from a nurse-practitioner or a physicians’ assistant...
...Doctors have been howling in pain as the cost of their malpractice insurance has gone up in proportion to the judgments against them...
...But Gordon Chase, then the city’s Health Services Administrator, pushed successfully for allowing non-hospital clinics to do early abortions, again at less than half the hospital price...
...This did not mean the drug companies were neglecting the doctors...
...As a result of the tougher contracts, nine per cent fewer Blue Cross members were hospitalized in 1972, and those that were spent seven per cent less time there...
...But the projection of an increased supply of doctors depends on the United States continuing to rob other countries who for years have been supplying the nation the doctors denied it by the AMA...
...Later the HRG set up a clearinghouse of hearing specialists to help other unions interested in muting the workplace...
...Now a new occupation is moving onto the doctor’s turf...
...T h e physicians’ assistant is a byproduct of war...
...Some of the mothers who chose the nurse-midwife suggested what that something else might be...
...An increasing number of Blue Cross plans provide for pre-admission testing: you have presurgery tests done as an outpatient, and come to the hospital only when the operation is scheduled...
...They were soon joined by District Council 37 of the Municipal Employees Union, with 108,000 members, and an assortment of smaller unions with another 65,000...
...That takes a lot of courage,” Barney Tresnowsky, a vice president of the National Blue Cross Association, had said of the idea when it was under consideration in New York...
...As for the poor, a 1975 study found that Medicaid patients are operated on at two-and-a-half times the rate of the rest of the population...
...The evidence comes in many shapes, including that of your television screen...
...At its extreme, most notoriously in the Los Angeles area, hospitals buy patients from doctors at $50 to $100 a head...
...The doctor will listen to us briefly, even though we speak barbarous English instead of his medical Esperanto, but his entire manner makes it abundantly clear that he can barely wait for the dialogue to be over...
...The reduced-time surgery program of Southwest Ohio Blue Cross-known as “Verticare”-saved $250,000 in its first two years, and its members avoided more than 4,000 hospital days...
...Other estimates reach roughly the same conclusions...
...At the present rate, the nurse-practitioner will in not too many years outnumber the doctor in the largest public health system in the nation...
...If the number of doctors stays constant, any national health plan will only repeat the experience of Medicare and Medicaid, which increased demand for medical services without providing an offsetting increase in supply, and hence led to higher bills that the government and the average man footed...
...She is childbirththat’s 85 to 90 per cent of cases-with a physician available in case of complications...
...When it was suggested in Congress that once he had joined the nation’s highest-paid profession, that doctor might repay the taxpayers’ money that got him to that exalted position, the AMA roared in indignation...
...At first the nurse-midwife served mainly the poor, and with notable success: a number of big-city clinics used them, and in Holmes County, Mississippi, the introduction of nurse-midwives led in three years, from 1969 to 1972, to cutting the infant mortality rate in half...
...The AMA, which had recognized the shortage it created for only about 45 minutes, now joyfully proclaimed that the problem no longer existed...
...1975 was also the year that six big companies banded together to start something called Physicians Radio Network...
...Another ten per cent of illness is wholly incurable...
...PA Steve Brooks on the North Slope of Alaska, scraping injured pipeline workers off the frozen tundra...
...The nurse’s practitioner has moved onto the scene with little fanfare...
...The effect of the various efforts to keep us out of the hospital when we don’t need to be there began to be felt in 1975 when, for the first time in many years, the number of hospital admissions fell slightly, while the use of outpatient clinics rose...
...Both these moves by Blue Cross took courage, as the man said about second opinions, because they can only reduce business at hospitals already suffering from empty beds...
...The sponsors were aiming at having 28 FM stations in the network by 1977...
...Some 2,000 hospitals are geared to do simple operations without an overnight stay...
...T h e great leap forward came this year, when Blue Cross of New York began offering a free second opinion to some groups among its nine million members in the metropolitan area...
...The new contracts provided that Blue Cross would not pay for patients kept too long and would reduce its payments for costly underused equipment, of which the most notorious example is idle open-heart surgery units...
...Unnecessary hospital stays are, if less dramatic than the operation you didn’t need, another great waste of people’s time and money...
...The doctors viewed the PA with mixed feelings...
...The scarcity of doctors will soon be easing, it seems, almost three quarters of a century since the AMA instituted occupational birth control with its 1910 Flexner Report, which de-accredited half the nation’s medical schools, keeping our doctor supply permanently insufficient...
Vol. 8 • October 1976 • No. 8
