This Guy Knows What’s Best For You by Pat Conrad MD

Everybody loves the story about NYU not charging new medial students any tuition.  I commented on it recently  and wondered which strings are attached, and where.  And while I am deeply skeptical of the motives and hidden mechanisms of the whole initiative, it’s not my money they’re spending.

Slate.com writer Jordan Weissmann seems to think it is his money, so helpful and ardent is the advice he gives for spending it.  Weissmann quickly mixes in concerns over class privilege and race into his criticism of the NYU policy, because ALL medical stories have to be about politics.  Which is not to say Weissmann doesn’t recognize a couple factual points:

  • Most medical students will graduate with a painful amount of educational debt.
  • There is a worsening primary care shortage.  And without a contractual obligation beforehand, the great majority of NYU graduates will go into specialties other than primary care (because they aren’t stupid).
  • Offering free tuition won’t guarantee more minority students.

And on this last point, Weissmann throws down the race card and veers off into a progressive hootenanny of self-righteousness.  He drips class-envy when he calls the no-tuition initiative “a well-intentioned waste – an expensive, unnecessary subsidy for elite medical grads who already stand to make a killing one day as anesthesiologists and orthopedic surgeons.”

In fairness, NYU opens itself up to this moralizing when they voice pro forma platitudes that their move “addresses both physician shortages and diversity.”  Oh brother.

The author is upset that the program does not guarantee “diversity” (whatever value that ensures), and that “Instead, NYU is going to offer free tuition to every upper-middle-class Caucasian student destined to make a killing as a urologist in Florida, and hope that a few more exceptional black students show up at its door as part of the bargain.”

My problem with Weissmann is that his rationale infers that medical education is solely in the public sphere, a favor to be conferred upon the right sort, to fulfill larger community goals.  “By covering every student’s tuition, without any conditions, NYU’s leaders are essentially crossing their fingers and praying a few more of their grads decide to do something public spirited with their lives.”  How lovely for a blog writer to dispense moral guidance as to the desires others should have, and the sacrifices they should make.  He scorns the “tax deductible donations from overwhelmingly wealthy men, like billionaire Home Depot founder Ken Langone, whose name adorns NYU’s medical center and who chipped in a cool $100 million to this effort.” Weissmann calls it “a donation from today’s rich to tomorrow’s rich, all at taxpayer’s expense.”  It seems to have escaped him that these evil rich nonetheless GAVE something.

The greatest value of this story is the object lesson it offers to would-be medical students.  If you enter this philosophically fractured profession, then everywhere you look will be those less talented, less determined, and less able complainers who believe that they have a purchase on you.  Weissmann writes for the great mob who believe – not think – that even the gift of free tuition should be subject to their wants and arbitrary moral weighing.

The sole of public medicine is ingratitude, as the writer beautifully demonstrates.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “This Guy Knows What’s Best For You by Pat Conrad MD

  1. Kurt
    September 8, 2018 at 4:27 pm

    I love your comment Doug:

    “There is a worsening primary care shortage. And without a contractual obligation beforehand, the great majority of NYU graduates will go into specialties other than primary care (because they aren’t stupid).”

    Especially the “Because they aren’t stupid.” part.

    Fix primary care?

    1. Initial certification by testing and 50 hours CME a year period! None of this paying the ABFM mafiosi protection money for once every 10 year testing. (Their CEO who gets ~$800,000 or more graft money a year) This is outrageous and I really have a tough time holding back on cuss words and vulgarity along with death wishes.

    2. Eliminate P4P, metrics, EHR requirement, meaningful use and any other nonsense that interferes with the Dr./Patient relationship and DOES not improve anything. Patients pay lip
    service, go out the door and continue to do what they’ve always done. They are their own worst
    enemy.

    3. Wanna pay someone? Give the patients (especially the younger ones) meaningful health premium cuts for meeting and maintaining health benchmarks. (ie. BMI, cholesterol, BP glycohb). I’m not talking piddles**t either. The diabetic who takes exquisite care of themselves like not being able to tell they are diabetic from their blood work, should have significant discounts on their premiums.

    End this current failing system as is and pursue along the lines as I outline above and perhaps students might pay more interest in primary care.

    DPC is fine but I think it will only benefit those that get in on the ground floor. Start a DPC in a rural area where I work and too many patients are used to sucking off the government teat and you’ll go bankrupt. We used to have something like that. That was called private practice and
    they all left 20 years ago.

    Out in rural land there aren’t hospitalists (yet) so an office only DPC is not viable as the other docs who work in the hospital and office will spit in your eye and not cover a DPC doc (who’s horning in on the “better” patients) if DPC docs patients get admitted.

    Again, I stand to dissuade students from primary care. It’s a losing battle UNLESS a radical change occurs. I don’t think that will ever happen as the ABFM will never let go of the cash cow diplomates they can milk all they want in the name of “quality care” (sic)!

    Quality Care, will NEVER be achieved in the USA until the patients are held accountable for their
    sh***y health behaviors. I don’t know what to do with Public Aid as they get everything for free.
    Very difficult to incentivize that group.

  2. A Lewis
    September 3, 2018 at 6:18 am

    So are you saying there is no value in diversity?

    • Pat
      September 3, 2018 at 1:12 pm

      I am asking what that value is. No one can quantify it, or even really define it beyond the exclusion of one particular skin tone-gender combo.

      “We need more (fill in the blank) in medicine!” Why? Isn’t it scientific to ask that question? Like “quality”, we are conditioned to embrace it but have no idea what it means, and the term’s favors get doled out as from a spoils system to which ever identity group makes the most racket.

      • A Lewis
        September 5, 2018 at 11:06 am

        Not everything can have it’s value quantified. Some things just come down to basic values and fairness. After generations of in which minoroties have been locked out of the prosperity of associated with becoming physician, to me it only makes sense that we do more to support those who have been historically disenfranchised in the US. If we are a country that is for justice and fairness, ensuring that there is equal opportunity should be a no-brainer.

        That being said, there have also been studies done showing that when patients from minority backgrounds are treated by minority physicians, their health outcomes are better. There have also been plenty of studies showing the continued implicit racial bias in medicine and its negative impacts on patients health outcomes (feel free to do a pubmed lit search if you want to review the studies yourself, one hot topic now is difference in birth outcomes for women of different ethnicities). So yes diversity in medicine does have value both for the people who have been historically locked out of the field and the patients who are served by those those diverse physicians. How to go about addressing that lack of diversity is debatable but I don’t think the inherent value of diversity is. Then again, as a female physician of color perhaps my experiences in the medical field are different than yours, hence the different perspective.

        Also the minimal initiative by those who have always been in power to ensure equal opportunities for future physicians of color and to address implicit bias for minority’s patients is the reason for all the “racket.” Sorry if it disturbs your morning tea but for some of us this is literally life or death.

  3. SP
    September 2, 2018 at 3:38 pm

    If you look at the comments on the article, you can see that most people see through the pettiness of this writer, who writes like a bored outsider who knows a lot about medicine because he’s seen a doctor occasionally and his mother “runs a program for minority students who want to go to medical school.” Notice he didn’t say his mother is a physician. And the underlying, unwarranted “shortcut” of referring to minority students as necessarily disadvantaged is pretty obnoxious. Racial diversity and economic diversity are not always the same thing and this guy is plain sloppy.

    Anyway, there has to be a long game to this strategy. Like most big academic centers, NYU is buying up and connecting to everything it can in NYC and the environs beyond. ( Including where I work). You need constant referrals to feed the academic beast if you want to survive. So why not train your future referral base for free? When they graduate, you can “employ” them at one of your gazillion office spaces or hospital locations and you will have doctors who will serve on bended knee. This is how you start a kingdom. Free education is the mighty scepter that will pay off handsomely. I wonder if there will be an incentive to stay for residency and fellowship. And they are planning on shortening the length of school to 3 years which will save them a substantial amount of money and bring in the $$ much faster…

  4. Mario
    September 1, 2018 at 3:32 pm

    I stand vindicated. I predicted this when it first came out. Can’t wait…… (more at eleven).
    I was thinking… would it not be better to spend all that money to increase the class size, attract the best academics; state of the art facility to teach future physician how to deal with growing technology. More seats would have certainly increased diversity. To bad we have to wait four years to see the results or projections of this grand “progressive” experiment.

  5. Terry Nugent
    September 1, 2018 at 12:16 pm

    No good deed goes unpunished

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