Rationed Health

A disjointed procurement policy . . . has resulted in hoarding and freezing unused doctors in the American armed forces. . . . This uneven procurement threatens doctor famines in vast rural areas with the probability of a general epidemic similar to the influenza conditions of 1918.

With these ominous words Senator Claude Pepper's Subcommittee on Manpower brought into the open the hush hush question of a doctor shortage.

There were many sides to this undeniable truth of a doctor shortage in certain areas. Some of them: Doctors are distributed in the U.S. by the laws of economics rather than medical need. The ratio of doctors per 1,000 population varies directly with the concentration of people and money (Alabama, one doctor to 2,022 people; New York, one to 656).

> Although State quotas of doctors needed for war were set on a flat population ratio so as to leave one physician for every 1,500 civilians, it has been easier to recruit doctors in the low-income areas than in the States where a captaincy is a painful financial comedown for a successful medico.

> On Aug. 1, recruiting was halted in 43 of the States which had met or passed their quotas. No State has exceeded its quota by more than New Mexico's 224% of expected enlistments. The five States which have not met their quotas are those with the highest concentration of doctors and patients--New York, Pennsylvania, Massachusetts, Illinois, California.

> Whatever the truth of its other charges, the Pepper committee has small cause for alarm about epidemics. Said famed Public-Health Authority Haven Emerson, M.D., to the American Medical Association at its annual session last June: "There are only two epidemic diseases against which we have neither warning of a calculable approach nor means for prevention and control. . . . These are influenza and poliomyelitis. Neither of these diseases is necessarily or otherwise than accidentally related, and certainly not causally, to wars."

Etiology of Shortage: There are 180,496 doctors listed by the A.M.A. as licensed to practice, but only about 155,000 are active. This gives peacetime medicine something more than the theoretically adequate coverage of one doctor to 1,000 people. Armed service needs are obviously higher--how much higher is a matter for argument. The British are said to count 4.75 doctors per 1,000 men under arms. The U.S. figure is 6.5 per 1,000, based on World War I experience when there were 31,501 medical officers in an army of 4,500,000.

Before Pearl Harbor there were only about 2,500 doctors in uniform. Since then probably one out of three U.S. physicians has joined the colors. The Army's adjutant general has banned the release of specific figures, but last week the Procurement & Assignment Service of WMC (which recruits the doctors) said it was a safe assumption that the entire 1942 quota of 42,000 doctors had been filled.

Treatment for Civilians: The third of the nation's doctors taken by the Army & Navy is actually about half the younger, most active men. Hardest hit have been the bigger hospitals and clinics which attract most of the younger M.D.s. Also hard hit are rural areas, always starved by the exodus of graduates to big-city medical markets.

In theory the Procurement & Assignment Service was set up to assure adequate civilian as well as military medical care. But the P&AS "as now constituted, is not in a position to deal with the financial and administrative problems involved in the provision of [civilian] medical care," according to the A.M.A. Journal. "As far as possible these problems should be met at the State level."

Ailing civilians can gain little comfort from this, or from the hope that the U.S. Public Health Service can somehow alleviate the doctor shortage by redistribution of available doctors. The Public Health Service is concerned mainly with preventive medicine, not the practice of medicine. The Public Health Service can do little except in local emergencies so serious that local authorities ask for help.

By harsh reality, if not by coupon, rationing of doctors may be forced upon civilians. The peacetime luxury of wide choice of family physicians or specialists may soon give way to taking and liking the doctor on duty. The midnight emergency call may bring an ambulance or a lecture. House visits will be reduced to the minimum of the bedridden; the office call without appointment will be standard practice. The luxury of casual illness is out for the duration.

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