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:

“Why not? The physician who has diagnosed the trouble and finds that an operation is necessary may have paid only two or three visits to the patient at $2 or $3 a visit. The result is that, honestly, he must give his patient over to a surgeon. ‘What surgeon?’ is asked most frequently by the patient. Honestly the doctor names a man who has taken many cases from him and most successfully. But where the physician gets $8 or $10, the surgeon may get $150, $300, or $500. And—except for the physician—the surgeon never would have heard of the patient.”

“It’s all fair enough if openly above board,” said Dr. Evans, in reply to the same question. “It would be a most logical thing in business, only that the public is not prepared to compare business with the professions of medicine and surgery. When it comes home that both doctor and surgeon must be assured of a living, however, the fact is a jar to the purely ethical.”

Another physician said: “I have just had an experience along the line of the split fee. An old doctor friend of mine discovered the presence of gall stones in his patient. It is a difficult thing to diagnose with certainty. My friend, however, made no mistake and received $25 from the wealthy patient. The surgeon who operated in the comparatively simple case got a fee of $500. It would have been only fair for the physician to have received part of that $500 fee, and I think he was a chump if he did not get it.”

“But you can’t put a profession on a business basis,” shriek the high moguls of ethics. Why not? On this subject Prof. George Burman Foster, of the University of Chicago, speaks plainly, as follows:

“What is the difference between a profession and a business? Is it, as was once thought, that the former is fulfilled by the mind and the latter by the body? But, for example, dentistry is quite manual and engineering or carpentry quite mental as well. Besides, the old idea of a dualism between mind and body is no longer held by the modern man. Then is the difference that the profession is ‘learned’ but the business is not?

“But we have men who are not college graduates entering the professions, while business of a higher order is clamoring for college graduates. Besides, we have changed our notion of what constitutes ‘learning’ and concluded that the man who by experience has learned ‘life’ may know quite as much as the man who has learned books in the school. But is the difference, then, that the professional man receives a special professional training, while the business man does not? But farmers are going to agricultural schools, while the majority of preachers still do not go to a theological school!

“Shall we say that the professional man is distinguished by eminent character and ability, while the business man is not? Hardly. We know that while the business principle is pagan and not Christian to-day, still the average business man is quite as good as the average professional man, no matter what the profession may be.

“Who deserves more honor—the farmer who provides us with our daily bread, or the dentist who keeps our teeth so that we can eat it, or the physician our stomach so that we can digest it?

“The best sign of our time is the growing sense of the worth of the profane, of the secular, and a growing depreciation of what once was called ‘sacred’ and ‘holy.’ To be sure, of the professions the ‘clerical’ is still regarded as ‘sacred;’ but since the religion of the future is to be a secular religion, the ‘sacredness’ of the ministerial office will in time pass away.

“The students in our schools to-day are taught this. They see that the distinction between profession and business is at last only traditional. They are bent on fulfilling the task which is in accord with the incentive and legislation of their special natures and characters. They know of something above the old honor of the profession and the new money of the business—namely: the unfolding of moral personality and the service of their brothers.

“They seek the calling, disregarding the old distinctions, which is adapted to the growth of their peculiar self and to the service of the brother. Hence, the wall of partition has been broken down by interests that are above profession and above business.”

● Transcriber’s Notes: ○ Missing or obscured punctuation was silently corrected. ○ Typographical errors were silently corrected. ○ Inconsistent spelling and hyphenation were made consistent only when a predominant form was found in this book. ○ Text that was in italics is enclosed by underscores (_italics_); text that was bold by “equal” signs (=bold=).