Steve M. Walsh, M.D.

The debate on healthcare reform now involves us all.  At one time, the debate was limited to discussion at corporate and government conference tables. Now it has expanded to discussions around kitchen tables. The rhetoric, as we have heard, attempts to create villains of the industry. Some of the accusations stick and become apart of future discussion. Others fade away not to be repeated.

We heard the accusation of ENT doctors who remove tonsils for their own benefit and general surgeons who would remove a limb rather than treat the underlying disease. Both of these accusations have faded.  Clearly, this is not what patient’s experience. On this point, the kitchen table discussions, echoed in town hall meetings, did not express distrust for their doctor. What we did hear expressed was a fear of interference between the doctor and patient.  This is obvious from the many surveys that demonstrate over 90% of patients are satisfied with their doctor.  Perhaps this sentiment is echoed by what we repeatedly heard from our President, who states, “if you like your doctor, you can keep your doctor”.

This is indeed a great testimony to our profession. It speaks to the value of the modern patient- physician relationship. It is a result of a uniquely American course of events.

The time around the turn of the 20th century was a time of great capital formation. America was beginning to reap the full benefits that the railways, telegraph, and banking brought to commerce.

In spite of enormous progress and wealth creation in the words of the author Rosemary Stevens, America was for the most part an “intellectual colony of Europe.” Medical training at that time had no standardization. Medical schools to a large part were no more than a proprietary profit endeavor of an individual or small investor group. There was no uniform curriculum or length of training. Awards, like free trips, were given to students who could reliably make their tuition payments. The public had no way to value or trust the service of the person who came to introduce themselves as “Doctor”. 

During the 20 years that surrounded the turn of that century, American doctors set themselves on a path to create the value and trust that the public needed and deserved.

With the rise of American endowments and desire to improve the medical sciences new institutions were created. These newly established institutions created university and hospital complexes. The institution upgraded entrance standards and created premedical education requirements. Medical training moved from the classroom to the bedside and laboratory. These early and notable institutions like that of John Hopkins supervised by permanent professors like Doctors Osler in medicine, Halsted in surgery, Kelly in gynecology, and Welch in pathology were developed.

The American Medical Association was incorporated in 1897 to continue its mission to promote medicine for the benefit of public health. With the wide variation of medical education, the AMA published, in the Journal, success and failure rates for medical schools sending their candidates to examining boards. This gained national recognition for the AMA and by 1905 all state societies except Virginia and Maine had joined.

The need for a greater standard in education, examining boards, and state licensing agencies were needed. The Association of American Medical Colleges along with the National Confederation of State Medical Examining and Licensing Boards were established in order to set minimum standards.  Unfortunately, compliance within states was poor. Greater resources and incentives were needed.

This was provided in a large part by sponsorship from the Carnegie Foundation. Previous attempts to voluntarily inspect and rank medical schools provided little reform. Many of the schools who would allow inspection would insist the results remain anonymous. The results could demonstrate the existence of inferior schools, but no targeted action was possible. This problem was addressed through the Carnegie Foundation who offered pensions to the medical professors of qualified institutions. Dr. William Flexner inspected schools and published his report in 1910. The report listed medical schools by name. The substandard schools were identified with frank descriptions like “very weak”, “miserable”, “dirty”, and “wretched”. The report caused a drastic reduction in medical schools.
A total of 155 schools, through either closure or merger, were reduced to 31. In 1915, the Carnegie Foundation also subsidized the work of Dr. William Rodman in establishing a national examining board through the National Board of Medical Examiners. The reform was well on its way.

The public and medical professions are the true beneficiaries of this past effort. These people were the seminal force. They recognized the components necessary to establish and grow a relationship of trust and value between patient and doctor.

It is a success based upon a steadfast commitment to quality medical education, ongoing assessments by national examining boards and state licensing boards that require at a minimum successful completion of both. It is a standard that is born and maintained by the profession.

As a result, when a physician stands in an office or healthcare facility and introduces themselves to the patient as “Doctor” it is a brand and trademark that is instantly recognized, understood, and trusted.

I have just returned from a one day trip to Washington, DC.  I want to share with you what was, for me, the most significant part of the trip. As I walked the streets of Constitution Ave, Capital Circle, and Independence Ave in my white clinical jacket on my way to various congressional and senate visits, I was stopped by the public. Without them knowing my name, where I was from, or my political position they all expressed gratitude for me taking the time and effort to make the trip. I will summarize the sentiment of those encounters by a man who stated, “Doc whatever you feel is best for health reform is alright with me.”

“Doctor” is our brand.  It is our trademark.  It deserves our utmost vigilance and protection. We can not allow outside influence to undermine this most privileged relationship of doctor and patient. It is an effort that started 100 years ago. It is an effort that must continue today. The public is counting on us to preserve the relationship that they have come to value and trust.  

Docs, You’re on deck! Step up to the plate!