microphone.
“Three nurses die in an accident and are spirited up to the pearly gates,” he began, without any introductory remarks. “Saint Peter is there and asks each one, ‘Who are you, and why should you be allowed to walk through these gates?’ ‘I was a nurse in a private doctor’s office for forty-five years,’ the first responds. ‘I instructed patients on how to take their medicines; I gave out lollipops to the children—sugar-free, of course.’ ‘Go right in,’ Saint Pete says.
“The second nurse walks up. Same question from Saint Pete. ‘I was a nurse in a hospice,’ she says, ‘and for many years I soothed dying people’s fears of crossing over to the other side, and made the transition a peaceful and enlightening one.’ ‘Please go right in,’ Pete says again. ‘Milk and cookies are on the right.’ The third nurse comes forward. Again, Pete asks about her qualifications for admission. ‘I did case reviews for a managed-care company,’ she says. Pete checks his massive golden book. ‘Ah yes,’ he says, ‘I have you right here.’ He swings open the gate, and as she starts in, he adds, ‘But we’ve only got you scheduled for a three-day stay.’ ”
Laughter from the assembled was enthusiastic, even though Will suspected that most had heard the joke before. Lemm was right. These men and women needed to laugh. Their profession, in many cases their dream, was under constant attack, and the AMA, the organization they had counted on to man the battlements, had mounted a feeble defense. The well-oiled machine of the managed-care industry had cut through the various medical specialties like a thresher.
It probably wasn’t totally fair to draw the analogy between the way managed care overwhelmed the practice of medicine one specialty at a time (giving concessions to the ophthalmologists at the expense of the GPs, then suddenly regulating the ophthalmologists) and the way Hitler swept through Europe a country at a time, but Will was hardly the first physician to see it that way. There was a remarkable, intensely moving Holocaust memorial near Quincy Market in Boston. At the entrance was a quote from a Lutheran pastor named Martin Niemöller.
In Germany they came first for the Communists, and I didn’t speak up—because I wasn’t a Communist.
Then they came for the Jews, and I didn’t speak up—because I wasn’t a Jew.
Then they came for the trade unionists, and I didn’t speak up—because I wasn’t a trade unionist.
Then they came for the Catholics, and I didn’t speak up—because I was a Protestant.
Then they came for me—and by this time there was no one left to speak up.
“Let’s begin this meeting as we do all our meetings with a reading of the roll—physicians who have notified us they are leaving patient care or retiring from medicine prematurely. Their specific reasons vary, but the themes behind them do not. These physicians can no longer handle the paperwork, frustration, and inconvenience to their patients, if not actual danger, of corporate medicine.”
The reading of the roll, consisting of as many as twenty names each month, was, as always, painful. Along with most of the names was a short statement of the reasons this fifty-one-year-old family practitioner or that forty-eight-year-old obstetrician decided to look elsewhere for the emotionally fulfilling, economically rewarding life that they at one time felt was worth the years of sacrifice, exhaustion, and escalating financial outlay demanded by medical school and residency.
This month, three of the nine names on the roll were well known to Will. One of them had been a clinical instructor of his in med school.
Half of all physicians recently polled
, he was thinking glumly and angrily,
had said that given the chance, they would not do it over. . . .
After the reading of the roll, Lemm called on the Society’s legal committee, which reviewed in detail the status of a class-action suit being
“Three nurses die in an accident and are spirited up to the pearly gates,” he began, without any introductory remarks. “Saint Peter is there and asks each one, ‘Who are you, and why should you be allowed to walk through these gates?’ ‘I was a nurse in a private doctor’s office for forty-five years,’ the first responds. ‘I instructed patients on how to take their medicines; I gave out lollipops to the children—sugar-free, of course.’ ‘Go right in,’ Saint Pete says.
“The second nurse walks up. Same question from Saint Pete. ‘I was a nurse in a hospice,’ she says, ‘and for many years I soothed dying people’s fears of crossing over to the other side, and made the transition a peaceful and enlightening one.’ ‘Please go right in,’ Pete says again. ‘Milk and cookies are on the right.’ The third nurse comes forward. Again, Pete asks about her qualifications for admission. ‘I did case reviews for a managed-care company,’ she says. Pete checks his massive golden book. ‘Ah yes,’ he says, ‘I have you right here.’ He swings open the gate, and as she starts in, he adds, ‘But we’ve only got you scheduled for a three-day stay.’ ”
Laughter from the assembled was enthusiastic, even though Will suspected that most had heard the joke before. Lemm was right. These men and women needed to laugh. Their profession, in many cases their dream, was under constant attack, and the AMA, the organization they had counted on to man the battlements, had mounted a feeble defense. The well-oiled machine of the managed-care industry had cut through the various medical specialties like a thresher.
It probably wasn’t totally fair to draw the analogy between the way managed care overwhelmed the practice of medicine one specialty at a time (giving concessions to the ophthalmologists at the expense of the GPs, then suddenly regulating the ophthalmologists) and the way Hitler swept through Europe a country at a time, but Will was hardly the first physician to see it that way. There was a remarkable, intensely moving Holocaust memorial near Quincy Market in Boston. At the entrance was a quote from a Lutheran pastor named Martin Niemöller.
In Germany they came first for the Communists, and I didn’t speak up—because I wasn’t a Communist.
Then they came for the Jews, and I didn’t speak up—because I wasn’t a Jew.
Then they came for the trade unionists, and I didn’t speak up—because I wasn’t a trade unionist.
Then they came for the Catholics, and I didn’t speak up—because I was a Protestant.
Then they came for me—and by this time there was no one left to speak up.
“Let’s begin this meeting as we do all our meetings with a reading of the roll—physicians who have notified us they are leaving patient care or retiring from medicine prematurely. Their specific reasons vary, but the themes behind them do not. These physicians can no longer handle the paperwork, frustration, and inconvenience to their patients, if not actual danger, of corporate medicine.”
The reading of the roll, consisting of as many as twenty names each month, was, as always, painful. Along with most of the names was a short statement of the reasons this fifty-one-year-old family practitioner or that forty-eight-year-old obstetrician decided to look elsewhere for the emotionally fulfilling, economically rewarding life that they at one time felt was worth the years of sacrifice, exhaustion, and escalating financial outlay demanded by medical school and residency.
This month, three of the nine names on the roll were well known to Will. One of them had been a clinical instructor of his in med school.
Half of all physicians recently polled
, he was thinking glumly and angrily,
had said that given the chance, they would not do it over. . . .
After the reading of the roll, Lemm called on the Society’s legal committee, which reviewed in detail the status of a class-action suit being
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