By Herbert Keyser, M.D.
San Antonio Express News, May 5, 2018
About 20 years ago, I accepted a position to be the backup obstetrician for nine well-trained midwives in a large medical center.
The institution had decided that all deliveries would be done by them unless complications ensued. Under those circumstances I would be called upon to either assist in the management or take over the case.
It was a wonderful and gratifying experience. I learned a new way of looking at normal birth, based on constant supportive care during labor and delivery. The results were more than phenomenal. A national publication wrote an article describing our results as some of the best in the country.
I wanted to understand why that should be.
It wasn’t that we were smarter than all the physicians in facilities where all the babies were delivered by obstetricians. We were doing the same proportion of complicated cases as seen elsewhere. There had to be another answer.
Soon it became apparent to me.
When cases became complicated, I did the interventionist procedures that were required. But without complications the midwives spent long hours with these patients. That allowed these mothers to accomplish normal uncomplicated vaginal deliveries.
In the world of physician-delivered newborns, other factors intervened. Rarely did an obstetrician sit for hours with a patient in labor. Office hours and surgery all took time.
Commonly, physicians do not appear until the point of delivery. The earlier stages are managed by a labor room nurse who frequently has multiple patients in labor.
The explanation was simple.
The presence, uninterrupted, of a supporting person made all the difference. Without pressures to end the labor, do an unnecessary cesarean section, or intervene in any way, women had their babies with fewer complications and better results.
This year, my wife had a serious medical problem. I decided to seek help from the famed Mayo Clinic. Their national statistics are the top in American medicine. However, the reason for this superiority is a conundrum. There are great physicians all over this country.
So, why is the Mayo Clinic overwhelmingly evaluated as being at the top?
From the moment we arrived, I was impressed by the efficiency of this organization. It took several days to understand what made the difference. It was not dissimilar from my experience with the midwives.
Today’s private-practicing, fee-for-service physician knows that to make the practice work, it is necessary to turn over a great number of patients. Expenses have soared, with malpractice, office rental and labor costs constantly increasing, only a large volume of patients can sustain the economic forces.
That is not the world of the Mayo Clinic.
Every physician spent a great deal of time with us, frequently over an hour.
The answer was quite simple. There is no fee for service. There is no bonus system for productivity. Everyone is on a fixed salary, which varies by specialty and longevity. The average salary is less than in some parts of the country, but is not terrible — at just under $300,000 per year.
Every physician can refer any patient to another physician in every area of medicine to rule out other possible causes of an illness, with no pressure to produce, just the need to care for patients.
If Mayo can do that, why can’t everyone?
We are told “we can’t afford a single-payer system.” The real truth is that we spend so much per person for health care, that just spending the same amount in a single-payer system we can provide better care than any of the other countries of the world and care for everyone, not just three-fourths of our population.
Some will be unhappy.
The insurance industry will not be pleased.
The pharmaceutical industry will have to be content with reasonable rather than exorbitant profits.
The physicians who charge huge fees will have to be paid less, although physicians in general will be quite well compensated.
Then the Mayo Clinic will be just one of many places providing the highest quality care.
Spending quality time with each and every patient can be a wonderful benefit in finding our way out of the disgraceful health care system that this country maintains.
The political pressure exerted by all the forces previously mentioned that profit from our present system must somehow be overcome.
Americans really can have the kind of health care they pay for and deserve.
Dr. Herbert H. Keyser of San Antonio was the co-director of the Department of Obstetrics and Gynecology for one of the largest hospitals in Long Island, New York, for eight years, served as a lieutenant colonel in the United States Army Medical Corps, and for the last 25 years delivered babies primarily in poverty areas, Indian reservations and in locations of migrant workers.
