June 2001

Pigeon a Fit

By Michael J. Katin, MD

It is obviously a sign of desperation for topics that would lead to reflection on the multiple similarities between physicians and pigeons. There is possibly only one new dissimilarity since, to paraphrase an old saying, with further cutbacks in reimbursement only a pigeon will be able to make a deposit on a BMW. Even the word "pigeon" is close to "physician" alphabetically, with "pig" being the only organism closer in the dictionary. Physicians are known to be pigeons when it comes to investments (stocks, restaurants, land), contracts with managed care companies, and second and third spouses. The analogy can even be made between the majority of physicians who have become dependent on the Medicare system and the passenger pigeons who rapidly became extinct once their habitat was altered.

But what about one of the great mysteries of modern society, specifically, why do we never see baby pigeons? Why are the only pigeons in the streets all full-grown? And what does this have to do with radiation oncology? Everything. We are now in the midst of a dramatic shortage of radiation oncologists. The ACR listings for jobs far outnumber the listings for people looking for jobs. It used to be explained that this was just because the residency requirement had increased to four years but this would only account for a temporary shortage.

It now turns out that other specialties are finding the same situation. Many of our urology colleagues have commented that there are not enough new urologists to go around. Even worse, apparently there is an acute shortage of entry-level general surgeons. Maybe mankind can go on without a full complement of radiation oncologists, but think about the problem the next time you have a kidney stone or appendicitis. We always used to claim that these graduates were going into family practice programs, but along with the deterioration of the family unit, there is also a deficiency of family practitioners. Maybe the specialty will have to change its name to "lifestyle unit" practitioners, but that would be a topic for somebody else's column

It has been theorized that Secretary of HEW Joseph Califano deliberately set out to increase the number of medical students in order to flood the market with physicians and make us more vulnerable to government efforts to control distribution and costs of medical services. In Spain, for example, there are so many physicians that most are happy to find work in goverment clinics at low salaries. So what went wrong? The number of positions in medical school hasn't gone down and even more medical schools are opening. The only explanations are that: 1. more physicians are graduating and never going into practice (e.g., Michael Crichton, Dr. Dre); 2. more physicians are going into complex multiple degree programs such as MD/PhD/MBA/DMD/JD/ASCAP and never coming out; and 3. they are living with the baby pigeons.

I dread this mostly for the adverse effects there could be on the pigeons, although, if true, it would mean there is a reservoir of talent out there waiting to be steered into different branches of medicine. Or at least to find themselves perched on them

email: mkatin@radiotherapy.com