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Cautious optimism for the future of medicine.

As we experience the rapid and systematic destruction of what was once a very good medical system, it is encouraging that there might be some hope for the future. Dr. Josef E. Fischer, MD, a former First Vice-President of the American College of Surgeons, Chairman of the Department of Surgery, and Associate Dean of Community Affairs at the University of Cincinnati Medical Center, suggests in his article, "Our health care system: Where are we going?" in the March 2000 Bulletin of the American College of Surgeons that the public is finally beginning to recognize that the Jackson Hole Group and their concept of managed care has been dreadfully wrong.

Dr. Fischer points out that the self-appointed seers of healthcare, theorists with no clinical experience, determined that there was enough waste, fraud, and inefficiency in the system that could be eliminated so that care could be "managed" and actually improved without increasing costs. There were five axioms: (1) There would be no decrease in quality. In fact, quality would be improved. (2) There would be no decrease in access. In fact, access would be improved. (3) There would be no change in the demographics or quality of students going into medicine and, therefore, quality of care would not diminish because of a constricted substrate for becoming physicians. (4) One could treat professionals as employees and still expect them to act as professionals. (5) Generalists could substitute for specialists, and physician extenders (nurse practitioners and physicians' assistants) could substitute for generalists without decreasing the quality of care.

Dr. Fischer points out that, in fact, what has happened is exactly the opposite. Each of these axioms has turned out to provide the reverse and deleterious effect. Of special interest is his observation that the public is learning that specialists provide better, more cost-effective care than generalists or physician extenders. (I noted this fact in an editorial in the August 1994 Ear, Nose & Throat Journal, "What Makes Specialists So Special?" Indeed!!)

Dr. Fischer notes that medical schools in New Mexico and Quebec have now turned from training generalists to training specialists. He urges surgical subspecialties, which have not always functioned together, to understand that "the public desires your services. It is time to get that message to the various leaders of this country, both legislative and corporate, who are controlling health care." He suggests that we might even join forces with some of the medical subspecialties, particularly the proceduralists. Hopefully, Dr. Fischer is in the position to know, and his prediction that the public understands that managed care is not good and that specialty care is desirable will happen within the next five years. Can the public and the profession of medicine hold out?



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Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:May 1, 2000
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