Mixing and Matching the MDs

I've been considering the implications behind this one since my wife mentioned it.

The annual ritual of Match Day is anticipated with excitement and fear by 4th year medical students throughout America.  Medical school is only the beginning of a physician's training; there almost always is an internship and/or residency to be served.  How the newly-minted physician is matched to his or her post-graduate training program has a major impact on various life decisions, including but not limited to the nature of the physician's practice, the finances, and, quite often, geographical location.

If the 4th year medical student has a significant other, then the situation is complicated all the more; this I know firsthand, and, without getting too deeply into the specifics, will state that the geographical and financial issues of my then-fiancee's career impacted my own.  Our courtship and marriage continues to be a very viable item after thirty years, but not everyone is so lucky; the marriage between one of my law school classmates and one of my wife's med school classmates did not survive the medical residency period.

So looking at the numbers for this year's Match Day, we had 30,212  physicians competing for 41,334 residencies, a match rate of 73%.  Yes, it is true that some additional residencies will materialize, so the unsuccessful contenders are not yet totally out of luck (and some will go for a PhD or find some other gainful activity).  But let us look at what the numbers tell -- and do not tell.

Behind the official Match Day numbers are physicians who are saddled with debt for their educations.  Those physicians who matched will have some stream of income and will be able to at least make a small dent in their educational debts.  Those who did not match and who are unsuccessful in finding gainful employment, however, will find themselves in some very trying circumstances financially.

The foregoing verbiage is applicable today, was applicable when my wife did her residency match, and was applicable even a generation before, when my uncle did his residency match which sent him out of town.  Today, however, there is a new spin on the Match Day numbers, a spin that Uncle Leonard knows not from his own direct experience, but from the experience of his granddaughter, who this year was fortunate enough to get matched with the residency program that was her number two choice.

Not reflected in the numbers is the fact that the cost of a medical school education -- like any other collegiate educational program in America -- has been rising at a far, far faster rate than the consumer price index.  Not reflected in the numbers is the fact that more and more foreign-educated physicians are entering the game in America.

Not reflected in the numbers is the fact that hospitals and other health care facilities are under pressure to reduce their costs, and so, functions formerly performed by physicians are now being done by others, most notably Physician Assistants and Nurse Practitioners.  To be sure, there is much to be said for a competent PA or NP; my wife speaks quite highly of those in her own department at the hospital where she works.  But in too many instances, the PAs and NPs are being given too long a leash, and are making decisions without the benefit of a full medical perspective.

And, of course, there is the misnamed Affordable Care Act, which has created a demand for healthcare without actually increasing the supply.  If not before, then by the time a student has sat in the classroom for his or her Economics 101 course, then he or she should fully appreciate that as demand increases relative to supply, price increases.

I shall leave it to the economists and statisticians to give detailed analyses of the match numbers.  All I ask of you now, dear reader, is to remember that the Match Day statistics you read are all part of the big ObamaCare train wreck, and must accordingly be viewed in that context.

The Passover holiday will soon be upon us; wishing all a happy and meaningful one.

Independents and Big National Chains

Back before the big drug store chains became the norm, I had a job after school in a small town pharmacy.  The old man, in addition to being very highly reputed in the pharmacy profession, was also a shrewd business entrepreneur.  Shrewd enough to exploit a loophole in the mimimum wage laws, enabling him to pay full-time students such as myself and a few of my classmates less than the nominal minimum wage.

Years later, at a high school class reunion, I got into a conversation with a classmate.  We sized up those of us who were there, and those who weren't.  Though there were exceptions both ways, we came to the conclusion that those of us who had gainful employment in high school fared far better in life than those of us who did not, notwithstanding the impecuniousness of the emolument which some of us received.  And a third classmate put us in our place when we started pissing and moaning about our low wages from our respective after-school jobs; his "gainful employment" was helping out his parents with the family business, and, doing the arithmetic, his take-home pay on a per-hour basis was less than ours (though he did subsequently attain an ownership interest in the family business).

The proprietor of the drugstore where I worked after school may have been a miserly tightwad sonofabitch, but he was a good boss.  He knew how he wanted to run his business, he made the rules, he communicated the rules to his employees, and he basically left his employees alone to do what they were tasked to do when he wasn't chewing us out.  And he had a sign posted in the back room:  "Customers Pay Your Salaries!" On one occasion when he was dressing me down, two customers simultaneously walked up to two separate cash registers.  He cut off his tirade and said to me, "Go help that gentleman at the register, and I'll yell at you later."  (He did).

The old man's Rule Number One was that The Customer is Always Right.  He insisted that we never get into an argument with a customer, and any dissatisfied customers were to be referred to him (or to the pharmacist on duty if he was not available). 

My son's first remunerative job was gotten through the good offices of his maternal parent.  My wife arranged for him to volunteer during a summer at the hospital where she works, which gave him a preference for a remunerative position the next summer.  My wife told the chair of the department where he was working that she was to hold my son to the same standard as any other employee.  The next year, his senior year of high school, my son lined up his own after school job (or, rather, jobs, because he had two), which paid him more than the hospital could.

So I certainly can identify with working in a low paying job after school, and I certainly can respect those who do it.  Accordingly, I give benefit of the doubt to the young lady whom I encountered in the Big National Chain drugstore this evening.  It is entirely plausible that she did not have the benefit of proper training and direction.

I walked into the store and immediately noticed (could not help but notice) that the "background" music was not so background.  I would estimate it to exceed 70 dB (normal conversation is about 60 dB).  This young lady came up to me and asked me if she could be of help.  I told her that, first of all, the background music was too loud.  She told me that she has no control over it.  I said to her "Don't you have a manager here?"  She told me that her manager would tell me the same thing.  At that point, I was really, really uncomfortable, so I put down the item I had intended to take to checkout and walked out of the store.

A while later, I passed a Big National Chain drugstore at another location.  I went into there.  The same background music was playing, but it wasn't as loud.  I did my shopping there, and continued with my agenda this evening.

The independent pharmacies (or hardware stores or stationery stores or any other kind of store) were good because they were managed by people who had skin in the game.  At the Big National Chain drugstores I visit, they end up with a new manager every few months.  The small town independent pharmacy where I worked was one and the same as the financial security of its proprietor.  And so, the old man did his utmost to keep the customers satisfied; and while he couldn't always give them the lowest prices, he insisted that customers be given the most courteous, expeditious and competent service.  He knew that the most important person in the store was the customer.

Almost two years ago, I had occasion to walk by what had been the small town drugstore where I had been employed.  It is now a high-end bistro restaurant.  Two blocks away is a Big National Chain drugstore.  I went into there to get something for my Mom.  I cannot say that the personnel in that store gave me poor service, or had poor attitudes.  But somehow, I don't believe that the establishment would pass muster with the old man if he were still around.  And, given how this ObamaCare is perverting the healthcare system, I cannot imagine the Big National Chain drugstores emerging unscathed by it.

The Fiat Fix for Obamacare

"A large number of installed systems work by fiat. That is, they work by being declared to work."

–Anatol Holt

The biographical particulars for the late polymath Anatol Holt are well beyond the scope of this posting.  I now shall only say by way of understatement that his personal and professional life was interesting and accomplished, and by way of disclosure that a number of years ago I carried on a correspondence with him and was on various occasions a guest in his home.

I have not found the source for the quote set forth above that is so widely attributed to him, but there is absolutely no doubt in my mind that Tolly Holt in fact said and/or wrote it.

Tolly, you called that one correctly!  The Administration is now declaring its Obamacare website to be operational.  "[W]e believe we have met the goal of having a system that will work smoothly for the vast majority of users" is the quote now being bandied about the Internet.

And I have found the source for that one:  The final sentence of a Health & Human Services Report which seems to be missing a date.

The website is the least of the problems for Obamacare; it has just been fixed by fiat.  Obamacare has problems far, far more extensive than its website.  Money transfer, information security and availability will persist no matter how well the website works.  The problems ain't over yet, folks!

Politically Correct Documentation (or Lack Thereof)

            I am a 3rd generation American.  I believe that we need to have an intelligent, practical and properly enforced immigration policy.  I believe that those who wish to latch onto the American Dream need to follow the rules, just as my grandparents did.  And I believe that we need to send away, and keep away, those who have come here but who have not played by the rules.

            It is my policy to not make inquiry of my students regarding such personal matters as religion, ethnicity, gender preference, or immigration status, effectively a very effective "Don't Ask - Don't Tell policy.  Nevertheless, I do become cognizant of such particulars quite often.  This, of course, gives rise to an inherent conflict when it comes to having a student whose presence in these United States was not accomplished according to the rules.  The way I resolve that conflict is to embrace the fiction that the law enforcement personnel are doing their jobs, thereby allowing me to ignore the immigration status matters and conduct an unimpeded professor-student relationship.   My students need to be able to approach me freely if they are to truly learn the subjects I teach.  Unless a student whom I know to be here illegally commits some sort of violence or larceny or other infraction of the safety and security of real Americans, I do not get involved in the immigration issues.

            Yesterday, I was giving a presentation to a group of my fellow faculty members.  None of my students (nor anyone else's students) were present.  During the presentation, I had occasion to mention that the exemptions from the insurance requirements of this Barack Hussein ObamaCare naufragio include "jailbirds and illegal aliens." 

            Three in the room, myself included, espoused what is commonly called the right-wing sentiment.  The remaining two dozen or so were approximately equally divided between the leftists and the überleftists.  One of the more vocal (and more über) of the überleftists took great umbrage at my use of the term "illegal alien."  She indignantly interrupted my presentation:  "They are NOT "illegal aliens!  They are undocumented immigrants!"

            I don't know how I was able to muster up the presence of mind for my immediate response:  "Janetta, if they were legal then there would be documentation!"

            Some of the leftists gave me a look of grudging approval.  Political leanings notwithstanding, Janetta had been grating on them, and they were happy to see her get a comeuppance.

            After the meeting, one of the more rational of the leftists, who works with preparing female prison inmates for release and  reintegration into society, came up to me and said, "I wish that you wouldn't refer to prison inmates as 'jailbirds.'"

            Seems that the Political Correctness Police are on patrol!

Making the Mandate Mandatory

The two most notorious (though not necessarily the most nefarious) provisions of the Obamacare law are the Individual Mandate to be covered by healthcare insurance and the Employer Mandate to provide healthcare insurance to employees.  This posting shall not now delve into the exacting details, the rules, the exceptions to the rules, or the perversions of the rules by those who should be enforcing them (i.e., the Obama administration).

It suffices to say that the Obama Administration has unilaterally taken upon itself to delay enforcement of the Employer Mandate, and the Republicans in Congress now seek to impose a commensurate delay in the enforcement of the Individual Mandate.  Conspicuous by its absence is the critical spotlighting by the Republicans of the Obama Administration's double standard in the matter, a publicity campaign along the lines of "sauce for the goose is sauce for the gander."

Well now, Judicial Watch and Dr. Larry Kawa are doing what the Republicans should have been doing in that regard, except they are taking the opposite approach.  Instead of striving to delay the Individual Mandate, they have filed suit to enjoin the Administration from delaying the Employer Mandate.

The strategy is not only interesting, but also carries a level of integrity that has been missing from the whole process thus far.  Employers are, by and large, elated to have a one year's reprieve from the Employer Mandate.   Dr. Kawa is asking to be treated equitably, even if such equity means he will be deprived of his entitlement privilege.

We shall see how this one develops.  For the Congress.  For the Administration.  For the Employers.  For the Individual Mandate.

And, of course, for the Judiciary, whose integrity is being tested no less in the matter.