Dr. David C. Goodman, a member of the Dartmouth Atlas of Health Care which recently scolded doctors for being liable for America’s health care crisis, gave invited testimony in March 2009 to the United States Senate Committee on Finance, the committee that will be largely responsible for what passes on health care reform.  Director of the Dartmouth Center for Health Policy Research, Dr. Goodman presented his affidavit “Linking Workforce Policy to Health Care Reform” to the committee chaired by health care reform zealot Senator Max Baucus of Montana among others. Dr. Goodman gives us his prescription for how to solve what he calls the “indiscriminant growth in physician numbers” in areas with already arbitrarily adequate physician supply. Lamenting that physician per capita numbers vary from region to region in the U.S. he states-“This variation in physician supply is not explained by differences in patient illness levels or in population health but by where doctors prefer to practice and live.” If you read the full testimony you will realize that this is meant to be pejorative. Who is to blame for this? Well, doctors, of course, but not just any doctors. He lays this at the feet of the doctors involved with physician graduate medical education (GME). Something must be done.

The Council on Graduate Medical Education (CGME) was originally charged by Congress to oversee the training of doctors and to insure that the physician workforce would meet the country’s needs. It does not have conniption fits about where doctors choose to live and contribute to their communities. Originally funded for years at a time it is now is subject to annual review for appropriations through its relation to the budget of the Department of Health and Human Services. Max Baucus could call for a budget hearing on the CGME on a whim. Dr. Goodman stating that the CGME’s charter “..has impaired its effectiveness.” – calls for change. CGME’s higher ups are almost exclusively physicians which does not settle well with Dr. Goodman who hails for a “permanent health work force commission.” He goes on-“The membership of the commission should extend beyond physicians and include experts in public health, patient centered care, as well as nurses, consumers, health care systems and payers.” and “Effective policy requires a dedicated staff that is independent of professional societies (read doctors) and trade associations.” Therefore, we can assume that Dr. Goodman, who lives in New Hampshire because he is needed there and would prefer to live elsewhere, is trying to convince a very powerful group of Senators that doctors shouldn’t be allowed to live where they want and are incapable of safe guarding the public and their own profession. You can imagine for yourself which groups of people he would prefer to have a permanent seat at the workforce policy table. He bemoans the fact that we are not more like “…Canada, the United Kingdom and Australia” when it comes to workforce planning. Lastly, he wants this commission to have power. “Congress should provide the commission with an increasing degree of regulatory responsibility that insulates reform from the self-interests of training programs and clinicians.”  How would they put such powers to work? There are examples.

In 1985 in British Columbia, Canada, Bill 41 was passed into law as the Medical Service Amendment Act.  Having been defeated earlier in other forms of legislation it was rapidly pushed through before the medical profession was able to mount another effort to defeat it. Sound familiar? Originally developed by an advisory committee of the Ministry of Health, not unlike the type that Dr. Goodman advocates now, its purpose was to solve the perceived maldistribution of physicians in the province. It tied a new applicant physician’s ability to get an assigned billing number, necessary to be able to bill the single payer government system, to geographic locations. Simply put, if the government needed a doctor in a rural area and if you wanted to practice in British Columbia you went where you were told. Of course this was fraught with corruption and you could get around it by buying an outgoing physician’s practice who sat on one of the boards in the area you wanted to practice in. In place for years, Bill 41 was defeated in large part due to law suits brought on by the Professional Association of Residents and Interns of British Columbia (PAR-BC), a group greatly affected by it as they all had to apply for billing numbers once out of training. There is no way to measure how much liberty was lost during its grasp on these physicians. 

Undeterred by defeat and impervious to what is just the Ministry of Health now ties reimbursement to geographic location. All General Practitioners with a new billing number get 50% of the customary reimbursement for 5 years. Specialist can get 50%,75% or100% depending on the “need” in the area they choose to live in. They are subsidized by the government if they agree to go to “designated areas” with what are basically stipends. This was all done with the blessing of the traitors at the British Columbia Medical Association. PAR-BC challenged this legislation and lost.

Young men and women in this country considering medicine as a career need to be aware of their governments’ intentions on limiting their liberty in this and many other issues before us. Your labor and hard work are your property. Marx believed in the eventual abolition of private property. He would see the efforts of Dr. Goodman as a good start.