CHAPTER XVI
WHAT SHOULD THE PHYSICIAN DO?
All this leads up to the question “What is the young physician to do?” The majority of them can remain strictly ethical and drag out a miserable existence, so far as getting a livelihood from the practice of their profession is concerned, because they never should have studied medicine in the first place. Those who are equipped by nature and education for successful practice, may gain a competence by imitating some of their elders (those who howl the loudest about violation of ethics) and throw down the bars. Just how far they may graze in the non-ethical pasture is a matter for each practitioner to judge for himself.
According to the Journal of the American Medical Association, the organ of the strictly ethical cult, there are 140 “acceptable” medical colleges in the United States, turning out on an average of 5,000 young doctors annually, to say nothing of those graduated from other schools. The census of 1900 gave the number of physicians in the United States, including Alaska and Hawaii, as 132,439, an average of one to each 122.5 families. But these are not distributed pro rata. Naturally the doctors are most numerous in the thickly settled parts of the country. Hawaii has one physician to every 1,412 persons, and Utah one to every 907. The ratio in the entire United States is one to every 575.7 people. In the District of Columbia, however, which is virtually co-extensive with the limits of the city of Washington, so far as population is concerned, official figures show one doctor to every 297 residents. Chicago, with a population of 2,185,283 people, has 4,432 doctors, one to each 515 people.
The plain fact is that the medical schools are grinding out alleged “doctors” too fast, and without proper regard for individual qualifications. But there is some sign of improvement. The better class of colleges, notably Rush Medical and the College of Physicians and Surgeons, have called a halt, and are insisting upon a higher grade of attainments for admission, and upon a more thorough and searching examination at graduation time. Last year the College of Physicians and Surgeons alone turned away 150 applicants as not being fitted for a medical career. This new system has had the effect of greatly reducing the number of candidates for medical diplomas. In 1900–1901 Rush Medical had 1,055 students on its rolls; in 1909–1910 the number was only 584. The decrease at the College of Physicians and Surgeons, while not so marked, was still a healthy one. In 1900–1901 this college had 676 students; in 1909–1910 the number had dropped to 529.
But, despite this reduction, the number graduated every year is still much too large. There are at least 2,000 alleged “doctors” turned loose every year whose medical services could well be dispensed with—with profit to themselves, and more safety to the community. Taking the average of one physician to every 122.5 families it follows that, in order for each doctor to earn the modest income of $2,000 a year each family must contribute $16.31 in fees every year. This is preposterous.
Again we are brought face to face with the question, “What is the young physician going to do?” As said before, he can kick down the bars of the ethical field and emancipate himself, if he has brains, courage, and a winning address. Or, he may assist in the formation of a sort of labor union for the maintenance of fees and the black-listing of dead beats. This latter course, however, is not likely to prove effective, as there are too many needy ones in the profession ready to remain outside of such a union and grab what they can.
Dr. W. A. Evans, commissioner of health for the city of Chicago and for twenty years in touch with the medical profession, says that hundreds of physicians in Chicago are virtually without means to support their families. What a man situated like this often does do in the circumstances may work disaster even upon the general public. He may help put the records of the health department to the bad. Here is an example in point.
“A young doctor is called into a family which lives in the rear of a man’s place of business, above the store or next door to it. The competent young physician discovers a patient suffering from diphtheria, scarlet fever, maybe smallpox. The law requires the posting of placards and the isolation of these victims of contagious diseases. But at once the family in such close connection with the place of business recognizes what such a placard may mean to the business by which the family of the patient lives.
“Will you imagine the pressure that may be brought to bear on this physician whose own family is so dependent upon him? Isn’t it reasonable that with sufficient compensation offered him he is likely to cover up the infectious case? Or if the family has not thought of offering the inducement, the young doctor himself may propose it and ask the limit of compensation.”
Educated, brainy physicians of high standing, are beginning to balk at some of the ethical commandments which bar the way to a doctor’s increasing his income. When Dr. Oscar A. King was asked what he thought about the division of fees, he said: