Rural hospitals are closing. Family medicine in rural communities is disappearing. And the lack of accessible healthcare in any impoverished community is deplorable. Recently, I mentioned the proposal to begin reforming the ACA (Obamacare) with a buy-in option for people at age 55. I am becoming more convinced that a single-payer system, “medicare for all,” is the way to go.
Reforming the payment for services highlights the need to reform the delivery system. I’ve been thinking about our current training system of medical personnel. Is the possibility of being very rich the sole reason people endure med school and residencies and debt? I don’t believe so.
One solution is to create a fifth branch of service called the Civil Medical Corp. This is separate from the people who train to be military medics, nurses, and doctors trading military service for their education. This would be a civil service commitment.
In exchange for post-high school medical training focused solely on the medical requirements for the chosen course of professionalism, the graduates are deployed throughout this nation in every community.
Civil Medical Corp members fulfill a period of service commitments, receive pay through the single-payer system or salaries like any other medical office/hospitalist and are “stationed” according to needs of the people through a state-based assessment and application process.
These medical professionals would take only courses necessary to become degreed. Medical doctors and all levels of nursing as well as the technical specialties would each have tracks. Thus training and deployments include MDs, xray techs, CNAs, RNs, etc.
Training focuses solely on the knowledge required to become prodicient in the chosen track. Problem-solving, critical-thinking, psychology, and communication are part of the process throughout. Limited electives allow recruits to broaden their interests, thus reducing the education by 2, 3 or even 4 years depending on the initial concentration. Field training through Internships would be required before deployment.
All first level Civil Medical Corp practitioners remain in the “service” for 10 years. Thinking specifically about doctors, after 3 years as a family practice or pediatric generalist, a doctor may apply for a residency in a specialty and return to study for surgery, etc.
The major disruption to the educational process for MDs is the change in undergraduate degree elimination. So a qualifying process and 1 to 2 year program of basic requirements would have to be developed.
I envision a process that moves a doctor candidate into obtaining a Bachelor’s of General Medicine–then 3 year deployment. The Masters degree would be the specialties, such as Emergency and Trauma or General Surgery or Dermatology. And the Fellow and Diplomate would be in ever higher levels of specialized care.
Associates for non-doctor tracks and Bachelors degrees are paid like we do ROTC, Masters level would be jointly funded by the individual and the Medical Corp. And anything after that is paid by the individual. Educational partnerships with states, institutions, and private investors may provide subsidized funding through scholarships or internship/work-study programs.
The appeal for the CMC to potential students is debt-free training and guaranteed employment.
Every community would have local access to the foundations of good healthcare.
Sound impossible? Every day we take 18 year-olds and hand them multi-million dollar equipment, train them to make instantaneous decisions over life and death, require them to be killers in our name, then send them all over the world to do their job. Regularly conversations erupt about spending more for the improvement of our nation rather than sending money overseas. Given these two considerations, shouldn’t we compensate a little by turning some of our kids into life-givers here at home?
Run with it, you who are are smarter than me.