We have already seen it happen in education. Republican governors have caused education professionals across the nation to rethink career choices. Add public servants. Next add medical professionals.
Recall in decades past when we had a nurses shortage? In large part many of those issues were resolved with union activity. Republicans are again attacking the unions. Trumpcare is attacking health coverage. Doctors are responding by refusing all insurance and working on a cash only or subscription basis.
At the heart is this one dilemma. If a person is in need of care and lacks coverage that person will still seek care. There are only so many individuals in healthcare who have the temperament to turn those people away.
I started my career in 1980 at an inpatient, adult, psychiatric unit within a private hospital. One day the head nurse came to me and said that since I was the Lead Social Worker it was up to me to go tell a particularly difficult patient that her eligibility to be on the unit had ended and that she would need to be transported to the county facility. Partly because I was a rookie but mostly because I wasn’t naive I went to her doctor and told him I was uncomfortable delivering this news myself and asked him, since it really was his responsibility anyway, to go with me. Fortunately he was a good, solid clinician and immediately accepted responsibility. We went to her room and he delivered the news in a kind manner with a reasonable plan for transfer of care.
The information was received stoically and we went back to the nurses station heaving sighs of relief as we had both expected a more negative response. Not two minutes later the patient calmly walked out to the nurses station where she announced, “I am not leaving”, took out a razor blade and cut a deep incision down the middle of the inside of her arm. So, my point here is that clinical staff have no business being guardians of the money nor gatekeepers of who gets in. The traits necessary to do those tasks are at odds with one another. There will be an exodus of the best professionals and it will take decades to rebuild the ruined system.
Afterword: This is not presented as an invitation to discuss the merits of how the information was delivered to the patient or of the nature of the patient’s behavior. The system then was operating the way it was because of prevailing conditions and that’s just what happened. Many young professionals left then because they got stuck in the financial disputes which then confused their clinical judgment. But no matter what the government says or what rules the insurances companies make every conceivable type of patient is going to walk through the doors and clinicians need to be armed with clinical skills to deal with them, not economic theories or moral philosophies. My point is to say that we should not again compel young professionals to abandon all the ideals that propelled them into a helping role in favor of becoming a guardian of the money.