Heal for America

A modest proposal to improve our health-care system


America faces a growing shortage of primary care physicians, especially in chronically underserved inner-city and rural communities. By 2015, according to a recent report, the shortfall will amount to as many as 35,000 providers. Yet only about one-sixth of medical students intend to enter primary care. Deterred by poor reimbursement rates, low income relative to other specialties, and increasing patient loads—not to mention high levels of student debt—new MDs are opting instead for more lucrative fields.

I’d like to propose a solution. Every year, thousands of students graduate from America’s most prestigious colleges without a clear vocational direction. They are brilliant, hard-working, and eager to contribute to society. What better way to address our shortage of physicians than to organize these new graduates into a corps of energetic, idealistic young doctors and dispatch them to those same underserved areas? I envision a competitive application process, five-week summer training program, and two-year initial commitment. Sure, recruits are likely to feel overwhelmed at first, but what a life experience for them, out there on the front lines of the health-care crisis, making a real difference in people’s lives. More importantly, disadvantaged communities will begin to receive the medical attention they so desperately need.

I can already hear the objections. With little training and no experience, our new providers won’t be “real” doctors. What will they possibly have to contribute? But a lot of experts say that medical school is a waste of time. Poorly taught classes in tedious subjects like anatomy and biochemistry are no substitute for the enthusiasm, enterprise, and general awesomeness that our novice physicians will bring to the clinic. In medicine, knowledge and skill are less important than a can-do spirit. Besides, these kids are the best and the brightest, as their colleges are always telling them, quick studies in any subject to which they choose to turn their scintillating intellects. They’ll be up to speed in no time.

Will there be resentment from the other doctors—the ones who have been toiling in obscurity for years, unvalued, ignored, and underpaid—about having to work beside these Ivy League celebrities? Perhaps, but what matters here are the patients, not the sensitivities of a bunch of careerist hacks who have always been more interested, quite frankly, in protecting their professional prerogatives. If our new physicians help to break the power of the AMA, then so much the better. And if they accept the two years that society invests in them and then decide to take their talents to a different field, like finance or consulting—well, I’m sure they’ll be a friend to health care for the rest of their successful lives.

Besides, what is the alternative? Funding medical services for low-income communities at anything like adequate levels would take a lot of money. Not compared to what we give the Pentagon, but you know what I mean. America’s job creators aren’t going to stand for higher taxes, especially when incomes for the top one percent have gone up by only 11 percent since the start of the recovery. Our aggregate tax burden is already over 25 percent, more than half of what it is in Western Europe. We need to be realistic here.

Similar proposals have been made with respect to our educational system, but those, of course, are ridiculous. Everybody knows it takes years of training and experience to become a good teacher, and that students and schools need continuity, not a pack of self-congratulatory dilettantes who parachute in for a couple of years, then go off to Goldman or McKinsey with their newly burnished resumes. I could see it working for lawyers, though.

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William Deresiewicz is an essayist and critic. His book Excellent Sheep: The Miseducation of the American Elite and the Way to a Meaningful Life is based in part on his essays “The Disadvantages of an Elite Education” and “Solitude and Leadership.” To read all the posts from his weekly blog, “All Points,” click here. He is a contributing editor of the magazine.


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