We live in a world of hyper-progress. I exist in a country that has turned the idea of “planned obsolescence” into an art form. As a glaring example, it was only 26 months ago that Apple’s first version of the iPad went on sale in the United States. Chances are, if you still own an inaugural version of this device, there are many things that it can’t do in today’s data infrastructure, leaving you frustrated. With each passing day, things that surrounded me have disappeared completely, never to return. Some things I miss, but I chalk up not seeing them as the price of progress. I also accept it as an inevitable cloud that grows ever larger over the aging process.
The human being, as it relates to the idea of obsolescence, is another matter entirely. In a famous episode of The Twilight Zone, Rod Serling provided a coda that said “any state, any entity, any ideology that fails to recognize the worth, the dignity, the rights of man, that state is obsolete”. Coming as it did in the days of the Cold War, this could be translated as an attempt by one political side to point out the anachronistic approach of their main political antagonist, in this case the Soviet Union. Yet the aging of any organism, at some point, will reach such a point that normal function and evolution, for all intents and purposes, stops.
In human beings, life itself is not the only thing that slams on the brakes. Every one of us who is employed hopefully goes forth with the realization that the skills and tools that we have used as part of our working lives will someday become obsolete. Because I am surrounded by the world of medicine, I think about the evolution of procedures and diagnostic tools, as well as treatment methods. Technology and intensive study have broadened the horizons of medicine at a faster rate than ever before. Consider for a moment that the 1926 Nobel Prize for Medicine went to Johannes Fibiger, who believed that parasitic worms were a direct cause of cancer. It took only a few years to determine that his theory was incorrect, and looking back on it 86 years later, knowing what we now know about cancer, the thesis seems particularly outdated.
Harboring all of these thoughts in my mind on a daily basis (along with sports statistics, band lineups from the 1960’s and other random bar trivia facts), it was with particular interest that I read a piece of proposed legislation from the House of Representatives. Last Friday, the Physician Reentry Demonstration Program Act was introduced by suburban Baltimore congressman John Sarbanes. If enacted, the law would establish a demonstration project for retired physicians to re-enter the working world as primary care providers. Specifically, the law would issue grants to encourage the creation of programs that assist physicians in transitioning back into clinical practice. Databases would then be created for the programs. In addition, assistance would be offered to granted entities for assessment and credentialing of physicians reentering the patient care world. The bill focuses on physicians who have been out of their area of specialty for two years or more.
Because the country is facing a critical shortage of primary care physicians, particularly as the Baby Boom population ages, Sarbanes’ legislation can be viewed as an honest attempt to address the problem, but knowing what I know about the world of physicians, I have a couple of questions. First, after one full year of inactivity, any Medicare provider is automatically terminated from the program. If that provider wants to resume billing the Medicare program, he or she must begin the credentialing process again, with new numerical identifiers being issued to that provider. Anyone who has dealt with the wonder and the majesty of the latest version of the Medicare credentialing process can tell you that it is anything but succinct. Additionally, with identity theft being at the root of many Medicare fraud cases, what controls would need to be put in place to ensure that the retired physician coming back into the clinic isn’t actually an elaborate front for criminal activity?
Second, in a world of hyper-progress, when merged with the inevitable truths related to the passage of time and its unavoidable effects on an organism, how quickly can a reentering physician be trained and brought back up to speed with present-day clinical protocols? Suppose for a moment that a paradigm shift occurs for primary clinical practice in the interim time between retirement and rehiring. This isn’t as difficult to imagine as you may think. Prescription drugs appear and disappear with increasing rapidity and genetic testing holds the promise of fundamentally changing existing treatments for long-established conditions. The suddenly-reintroduced clinical physician may find himself or herself at a critical disadvantage at a time in his or her life that is not particularly conducive to change. Suddenly, liniments, leeches and carbolic smoke balls aren’t going to cut it.
Sarbanes’ bill is very much a first draft, and his party affiliation, as it applies to the current political makeup of the House of Representatives, promises a rocky road for the proposed legislation. Yet even in the absence of CAS (Congressional arteriosclerosis; I just thought that up; evolution!), the realities behind Sarbanes’ modest proposal may sentence it to an eternity in the starting gate. Chalk another one up to progress.