One of life's most important duties is made in the choosing of people. Choosing the right person for the job, our friendship, and our other associates is so crucial, yet so often it is done with less deliberation than it requires. Sometimes, the choosing is done carelessly or even randomly. Choosing the leaders of our country is so important that the consequences of choosing poorly can be catastrophic for our nation; we have seen in recent weeks the results of choosing Supreme Court justices who do not much believe in the Constitution.
Other than choosing to follow Christ, there is no more important choice to be made in this earthly existence than the person we marry. A key choice to be made is where to worship, and under whose direction. Many people, especially young people, would be much better served if they chose their friends carefully, for often times our close associates have more influence on us than we would like to admit.
In the Bible, there are several instances where people were carefully chosen for their duties. In Judges chapter 7, we are told of instructions God gave to Gideon as he prepared his army to attack the Midianites. God felt that it was important to demonstrate His divine providence by having Gideon obtain victory in circumstances that would be otherwise impossible. He did not want Gideon winning the battle with a large number of men. In verse 2, "The Lord said to Gideon, 'The people with you are too many for me to give the Midianites into their hand, lest Israel boast over me, saying "'My own hand has saved me.'" First, God told Gideon to dismiss anyone who was afraid, and promptly 22,000 up and left, leaving 10,00 behind. Then He told Gideon to send his men down by the water, and told him to separate the men by the way that they drank the water, and he retained only the 300 men that brought the water to their mouths by their hands. And with only those 300 carefully chosen men, Gideon and his small army defeated the Midianites.
In Luke chapter 6, verse 12, we hear about Christ praying all night before a decision about choosing people: "In those days He went out to the mountain to pray, and all night He continued in prayer to God. And when day came, He called His disciples, and chose from them twelve, whom He named apostles." We can see by studying our Savior how important it is to choose people carefully, and consult God when we do so.
As a physician, I can assure you that it is extremely important when you need treatment to choose your doctor carefully. Likewise, it is critical that we choose the correct people to become doctors and train in the art and science of medicine. There are many who resent physicians, claiming they are paid too much and have undeserved prestige. However, the fundamental laws of economics, rewards and penalties, costs and benefits, play a role in who becomes a physician. When a profession becomes unattractive financially or burdened by regulation, fewer people desire to expend the costs to enter that profession. We have seen an unbelievable decline in people who want to train in my own specialty, Cardiac Surgery, over the last few decades.
When I applied for a residency in heart surgery, it was a highly sought after specialty, and you pretty much needed to be near the top of your class to get a training spot. Shortly after I entered private practice, and Medicare reimbursement began to be cut drastically, we began to see a sharp fall in the people who would be willing to spend four years in college, four years in medical school, and eight years in residency to be an open heart surgeon. In 1997, the number of applicants still exceeded the number of training positions, although the number of those positions had been reduced. At that time, there were 176 people in America who wanted to train in the 143 slots available. Currently, because so few people want to be a heart surgeon nowadays, the number of training slots has been reduced to 102, but only 80 people applied for those positions in 2012; only 80 people in a country of 300 million wanted to be a heart surgeon. As the residency programs still need to fill their positions in a time of declining demand, the quality of the trainees declines. Last year saw the highest failure rate on the Thoracic Surgery Board Examinations ever.
Likewise, we see entire medical school classes graduating where no one wants to go into General Surgery. It has become obvious to the residency programs that the quality of those entering such training has also diminished. Up to one-third of doctors graduating from General Surgery training are felt to need remedial training. When the number of people applying to train in General or Cardiac Surgery plummets, the residency directors can 't be picky about who they let in any more.
Even if you think that health care is a right and there should be a nationalized health care system providing care to Americans that they do not individually have to pay for, and that physicians should be paid much less because they are over-valued, you cannot force people at gunpoint to exchange valuable years of their lives and hundreds of thousands of dollars in educational debt to become doctors and not see commensurate rewards. And this leads to a severe shortage in qualified applicants.
I am not writing this to whine or to seek pity. I have had a good career that is clearly over half-way over; I am trying to address the problems the patients of the future will face with their doctors. You may feel that doctors are overpaid and over-valued by society. But with increasing regulations, paperwork and other governmental burdens, compounded by declining reimbursements, we see that the number and quality of physicians in some specialties is falling off a cliff. You may want to pick your doctor carefully, but you need to be aware of the "pool" of applicants from whence he came.
Now we come to the real tectonic shift in the grounds for choosing who will be a doctor. When I applied for medical school, only one in seven applicants was accepted, and at my particular medical school, it was one in twelve. One of the tests we all had to take was the MCAT, Medical Colleges Admissions Test, sort of like an SAT for aspiring physicians. Not only did we have to have decent grades, we had to score well on this test. We were tested on the knowledge we had acquired as undergraduates that we would need to succeed in medical school and as practicing doctors. We were tested on biology, anatomy, chemistry, physics, and biochemistry. It was an exceedingly rigorous examination, designed to select only those with an aptitude for learning the intricacies of the human body and its diseases. In medical school, we would later learn every muscle, tendon, nerve and bone in the body. We would learn every single chemical reaction and hormone, and the derangements of these functions as they caused illness.
The powers that be have now decided that a new test is needed to choose the doctors of tomorrow. The new MCAT will test medical school applicants with questions designed to test their knowledge of "psychology, sociology, and the biological foundations of behavior." There will be a review of "social inequality, class consciousness, racial and ethnic identity, 'institutional racism and discrimination', and 'power, privilege, and prestige'".
The MCAT's are going to qualify these people to become doctors not on their knowledge of all things medical, but by testing for their comprehension of "social inequality", "class consciousness", and so forth. I don't know about you, but when I go to the doctor, I could not care less about their views on such matters. I want them to have a deep and full understanding of how my illness needs to be diagnosed and treated. I really am not interested in how much you know about "institutional racism and discrimination", I want to know how much you know about curing my thyroid problem or my cancer. If I am seeing you as a patient and you are a surgeon, when you walk into the examining room I will wonder if you were one of the one in three who had to do remedial training before you were released to perform surgery without supervision, and who cares what your views are on "power, privilege, and prestige"?
God is sovereign over all, and yet we are allowed to make choices. He has shown us in His Bible the importance of picking and choosing wisely. Ironically, those who choose who will be a doctor today will likely one day in advancing age be patients who will need the utmost of skill and knowledge to diagnose and treat their illnesses, and will they then regret their choices? Those who vote for leaders that create the unwelcome environment in which physicians practice will also be receiving care from doctors that were poorly qualified applicants who were some of the few available for positions where there was not much competition. Unfortunately, almost all of us at one time will need healing services delivered by those chosen not for their aptitude for medicine but for their politically correct social beliefs. As a physician and Christian, my counsel to you would to be to pray to never get sick.
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