Medical Care: Myth of Specialization

In reference to “One Casualty of Clinton’s Health Plan: Freedom to Choose” (Sept. 22), I want to discuss reasons for specialization in medical practice and Park Nicollet cost saving and innovation.

I agree with the main premise of the article, that medical care rationing is most likely in our future. Columnist James Flanigan is, however, perpetuating a myth that has gained wide acceptance through repetition by policy wonks and the media: that “the vast majority of medical students have gone into specialized practice because that’s where the higher incomes have been.” I wonder if anyone has bothered to check with the specialists or, for that matter, the primary care physicians, as to the accuracy of this assumption.

In my own case and in the case of most of the other physicians I know, the relative monetary rewards were far down or nonexistent on the list of reasons for entering a specific area of medical practice. My reasons went something like this, 25 years ago:

* The amount of knowledge needed to do a good job is overwhelming. I need to find an area that I can get a handle on and do well.

* I am smart enough and honest enough to recognize and admit my own limitations.

* What can I do that is interesting enough that I will enjoy doing it for the rest of my professional life?

* What area of medicine fits my personality and physical abilities?

* What are my personal, social and societal goals?

* What sort of day-to-day work environment do I want?

* Medical school professors are often super sub-specialists by necessity and tend to encourage specialization from an intellectual and-or quality standpoint.

* What specialty program is available to me? Are my grades high enough?

Money was not even on the list, because I felt that whatever I chose would have adequate compensation. As you can see, doctors are not so different from other people in their needs for job and life satisfaction. It is quite unfair to simplify the present structure of medicine to purely financial motivations.

In fact, regarding those who have gone into primary care, has anyone actually studied the motivations of that group? Using my own medical school class as an example, the reasons for going into primary care were as varied and perhaps more financially oriented than is implied in Mr. Flanigan’s article. In addition to some of the same reasons listed above, I know of some others:

* Why spend two to seven more years in training, when I can go start earning an income now?

* My medical school debts are overwhelming. I must start paying them off soon.

* I really want to be a family doctor.

* My grades are not high enough to get into specialty training.

* What’s the big deal about specialization? I can do everything.

CHARLES J. AUCREMAN, M.D.

Simi Valley