Those Were the Days

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Reflections on Medicine - July 2008


Tex Med. 2008;104(7):10.

By George H. Brandau, MD

The ranks of physicians serving before and during World War II have become very thin indeed. That shrinking number, however, possesses many medical and sociological facts not apparent in the current health care industry. A very superficial examination of health care delivery in the United States will reveal several areas of real concern that need to be addressed more thoroughly.

First, health care has become far more sophisticated and complex today. As a result of specialization, the training of physicians has become longer and more costly. Secondly, the changing population, both by growth and physician relocation, is a major factor in health care delivery. This is especially true in rural and thinly populated areas.

The declining number of generalists presents an ongoing problem that complicates the situation as an increasingly important factor in delivery of adequate care. The reasons for much of this change are obvious and tend to make a reversal or improvement more difficult.

The high cost of drugs and appliances in the medical industry needs to be addressed and revised to reach a larger segment of the population.

The economic impact on health care is a further concern, as escalating costs have become stumbling blocks to many changes affecting delivery. The pool of prime office personnel often is not open to the profession because of its odd hours and other factors, such as higher pay in other industries, which makes health care less attractive to potential employees.

Group practice, in one form or another, also contributes to shortages, especially in some areas. This issue is not a criticism of anyone or any group, but is a significant factor in some settings.

Combined, the above factors present reason for concern overall as current health care delivery in America faces a crisis. The government issue and hospital costs are very important, but will not be discussed at this time.

Dr. Brandau is a retired surgeon and lives in Houston. He was a member of the TMA House of Delegates for some 20 years. He is one of the founders of the Museum of Medical Science in Houston and served as its first operating president.

Editor's Note: This is the latest in a continuing series of essays by members of the TMA 50-Year Club .



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