American Healthcare: A Profile in Shortages

Abstract

Y ou are a physician, or maybe a nurse. Your aged mother, beloved by you, your spouse, and your children, who call her Muggie, has been taken by ambulance by the emergency medical technicians (EMTs) from her rural home to the only hospital within 50 miles. She was not conscious when she arrived there at midnight. The only emergency room physician had gone home with the flu, and only a physician's assistant was on duty. It is a pretty typical hospital. About 15 years ago, there were five emergency room docs, but three have gone on to other jobs.1 Now there are only two, and a part-time contractor who comes in occasionally; they cannot fill the posts. The physician assistant calls for help and an hour later a specialist arrives. He has driven in from his farm. He prescribes a drug, but the hospital pharmacy has had it on back order for weeks so he is forced to make a more problematic choice. You are on the phone with him, and based on what he is saying the diagnosis seems straightforward, one drug being clearly indicated. They have given her something else he says, an apology in his tone. They had no choice. Complications arise. Your mother dies. A story from a developing nation? No. An all too frequent occurrence in American hospitals, particularly rural hospitals, which are now experiencing a largely unremarked but astounding