Doctors with Borders

Apr 1, 2011

I had an interesting conversation yesterday with Joe Schwarz, one of the best-informed, multi-talented men in public life in this state. After a stint as mayor of his native Battle Creek, Schwarz spent sixteen years in the state senate, where he was immensely knowledgeable on education policy and finance.

That was, of course, back in the era before term limits. Schwarz is also one of those people whose resume could fill a box. He’s also had a career in the U.S. Navy, and as a spy in Southeast Asia during the Vietnam War. He ran for governor once and congress twice, finally winning a single term in 2004.

Schwarz’s problem was never the general election. Every time he got to one of those, he won easily. But he had trouble in  Republican primaries. He is a fiscal conservative and a military hawk, but also believes in funding education, and that abortion should be “legal, safe and rare.” Nor does he always suffer fools gladly.

By the way, I didn’t mention his day job. He is an otolaryngologist, which we civilians call an ear, nose and throat surgeon, and is still happily practicing medicine. 

That is, when he isn’t teaching at the University of Michigan’s Gerald R. Ford School of Public Policy. Schwarz understands health care issues, and I was curious about our medical school explosion.

The U of M has a medical school; Wayne State has one; Michigan State has two; Oakland University and Beaumont Hospital have started one, and Western Michigan is now starting one.

Is that too many? Will we be producing too many doctors?

That’s a good question, the good doctor told me, but not the most important one. When all these medical schools are up and running, they’ll be producing something like six hundred and ninety doctors a year, trained largely at state expense.

If current trends continue, about half will eventually leave the state and practice elsewhere. My guess, given our situation, is that the real figure will be considerably higher.

There are areas of this state which are underserved by physicians; other places, like the rich sections of Oakland County, where doctors are thick on the ground. But the biggest problem is what the new doctors are specializing in. What’s needed most are family practitioners. These days, fewer than five percent of new doctors want to go into family practice, in large part because they make less than specialists.

Joe Schwarz has a solution for that: Michigan should offer full-ride scholarships to fifty students a year interested in family practice, or maybe pediatrics. In return, they’d agree to practice medicine in this state for at least eight years. Otherwise, they’d have to pay Michigan back the two hundred thousand or so it cost to train them.

That might cost the state five million or so a year. But it strikes me as excellent public policy, and virtually pocket change in a state that spends nearly two billion a year on prisons.

Reinventing Michigan means more than just cutting taxes; we also need to invest for the future. My guess is that Governor Snyder put some money aside for his kids’ education.

Investing in family doctors sounds to me like a good way to invest in our entire state.