Opinion: Say ahhh …

Cedar Rapids/Iowa City Gazette weekly column, “On Topic,” from 01-15-12
We keep hearing there is a shortage of doctors. I suspect that means not so much a shortage of all doctors, and not everywhere — in larger metro areas names of radiologists and anesthesiologists seem to crowd the directory boards of office complexes.
But in less-populated regions, fewer doctors of all kinds are practicing.

And no matter where you are, family physicians and, in particular, general practitioners — GPs — are thin on the ground.
When I took a job in Chicago a few years ago, I spent several days trying to locate a GP on my company plan who’d sign me up as a new patient. There was no room at just about every inn I telephoned.
This, mind you, in the third-largest city in America.
That challenge multiplies, or rather, intensifies, as the MSA shrinks — an inverse ratio. Open slots for doctors are projected to outnumber applicants in rural and low-income areas for the next several years, the College Board notes.
The GP is supposed to see the big picture. In movies and television, from Marcus Welby to Dr. Quinn Medicine Woman, it’s the care giver to whom we want to take all our problems. (In pop culture, it’s more often a man than a woman — don’t ask me why.)
On the screen, they can advise on birth, death and every catastrophe in between, including depression, family relationships and the odd bullet wound from a Colt 45.
In the real world, GPs do attempt to fulfill that Catcher-in-the-Rye function. They know when to prescribe and treat, and they’re smart enough to know when to refer a patient on to a specialist.
The need for these first-point-of-contact folk with such vast knowledge is simple: No matter how much time a patient spends consulting the oracle known as the Internet, you can’t always diagnose yourself. (“Honey, do these spots look reddish to you?”)
And, hey, I’ve heard rumors that some of the information found on the Internet might not be 100 percent reliable.
With GPs, it’s a matter of experience, breadth and objectivity.
And yet more health care professionals choose to specialize rather than be seen as that kind, lovable and resourceful stalwart of the community.
One reason is likely prestige. A heart specialist knows a lot more about that specific topic than any GP or family practitioner, right?
Plus, they needn’t be bothered with a waiting room stuffed with all sorts of coughing and sneezing patients bearing all manner of who-knows-what unidentified illnesses and aches.
GPs work a lot, too. The College Board contends 43 percent of such doctors work 50 hours or more a week.
And, of course, it is about money. An anesthesiologist, counting salary, bonuses and profit-sharing from a practice, can pull in some $372,000, according to PayScale.com.
A GP? Somewhere around $209,000 … and that assumes a big, healthy practice in a decent-sized metro area.
I for one have tended to have good luck with GPs. For the first couple decades of my life I saw the very same doctor who attended my delivery.
Dr. Sam, as he insisted he be called, had a deep, loud voice and a forceful presence. And always, always a cigar — unlit when making hospital rounds or house calls, but puffing thick, dark smoke in his office. (It was his office, after all.)
As a teenager, I’d walk into his inner-city office to find a waiting room as often as not jam-packed with patients, many of whom I later learned never paid. Sam Goldberg saw them gratis, and he’d zoom through their appointments faster than his receptionist/nurse could keep up.
He’d fling open the door to his examining rooms with a crash and shout the name of the next patient, starting his cross-examination before that person left her or his chair: “Come on, get in here. What’s wrong now?”
Every visit, whether for flu-like symptoms or an annual check-up, ended with a slap across the cheek, at least for me.
“There’s nothing wrong with you. Go on, get out of here. All right, who’s next, come on, come on!”
His faux-grumpiness fooled me for only the first 15 years of my life.
In eighth grade when I’d broken an ankle and landed in the emergency room, Dr. Sam got called in apparently right after a round of golf. As I sat on a hospital gurney out in the hallway, I could hear him coming from way off along the corridor — his booming voice as he greeted and/or yelled at hospital staff and, as he got closer, the clacking of his golf shoes, which he’d refused to remove.
“What’s wrong with you now?” he demanded, a recently ground-out cigar clamped between his back teeth. As he manhandled my ankle: “This is nothing, it’s just broken.”
After X-rays and then wrapping my ankle — which he did himself — he shouted: “OK, now get out of here.”
He stormed back out of the hospital, possibly to squeeze in another round.
Or possibly to make a house call.
The question I’d have for all health care professionals is this: Why wouldn’t you want to be this guy?