December 2003 Bulletin

From our readers

Write to The Editor, AAOS Bulletin, 6300 North River Road, Rosemont, Ill. 60018-4262

Specialty Hospitals

I love to see this war on the so-called specialty hospitals (October 2003). Let’s understand what is happening. Currently in large metropolitan hospitals, hospitals depend on cost shifting to the types of patients who are now going to specialty hospitals. Medicare is not paying adequately for their sick patients. In turn, the hospitals have to bump up the bills sent to private insurers and to the non-Medicare patients to cover for this deficit.

By using specialty, hospitals we get to pull this healthier group away from the metropolitan hospitals. In my opinion, taking care of these patients in a specialized arena allows for quicker care and less morbidity. Patients also avoid getting their bills trumped up to help compensate for the shortfall that the metropolitan hospitals currently have.

As long as the government keeps under-funding hospitals for Medicare patients, the hospitals are going to be part of the action to stop subspecialty hospitals. In the long run our patients will then have to go back to these large metropolitan hospitals for special procedures and pay higher costs than they should because of the cost shifting. As many of you know, as the costs go up, patients’ medical premiums will reflect this. And, with medical premiums going up, there will be more uninsured.

Peter F. Holmes, MD
San Antonio, Tex.

I applaud the AAOS for being in the forefront on the issues of affirmative action and diversity as they apply to health care. I especially appreciate the efforts of Vernon Tolo, MD, who made these issues a priority. More importantly, the Academy pursued the issues with concrete actions, i.e., the diversity committee, diversity award, and amicus curiae brief in support of affirmative action in the recent U.S. Supreme Court case involving the University of Michigan.

Several letters to the Bulletin (February, June and October of 2003) have implied that the authors agreed with the concept of diversity but disagreed with affirmative action. At this point in America, we cannot have diversity without affirmative action. We need affirmative action now such that when we recite the Declaration of Independence, the ‘We’ means every American. I pray in the near future affirmative action will be obsolete and unnecessary.

There is a widely held belief that affirmative action does not work and students drop out because they cannot compete in the academic environment. This could not be further from the truth. Anybody who disagrees should read The Shape of the River: Long-term Consequences of Considering Race in College and University Admissions by William Bowen, former president of Princeton, and Derek Bok, former president of Harvard University and dean of the Harvard Law School. U.S. Supreme Court Justice Sandra Day O’Connor stated in the U of M Supreme Court decision (June 23, 2003), “In order to cultivate a set of leaders with legitimacy in the eyes of the citizenry, it is necessary that the path to leadership be visibly open to talented and qualified individuals of every race and ethnicity. All members of our heterogeneous society must have confidence in the openness and integrity of the educational institutions that provide this training.”

I am glad I am a member of an organization that feels it is part of the greater society. And more importantly, an organization that wants to and does the right thing despite not always being with the mainstream.

James A. Hill, MD
Chicago, Ill.

Affirmative Action
Congratulation to the Leadership of the Academy for signing the Association of American Medical College’s amicus curiae legal brief in support of affirmative action in the recent U.S. Supreme Court case, The University of Michigan v. Grutter. The Academy was one of 60 briefs representing more than 300 organizations supporting the University’s policy, compared to 15 briefs for the opposition.

Just mentioning the term ‘affirmative action’ brings about a very emotional response. Those in favor see the need to increase the number of minority physicians as a moral issue, and those who oppose believe that it is immoral to consider an applicant’s race or ethnicity, and the schools should only admit the best qualified. As late as 1968, there were only 130 blacks nationwide enrolled in predominantly white medical schools. Under affirmative action, there are now 5,000 black students enrolled in medical schools around the country. This does not imply that all blacks and other minorities were admitted under this policy. Opponents frequently overlook the contributions that these students make following graduation.

James L. Curtis, MD, recently reported on a group of 4,134 students who entered medical school between the years of 1969 to 1973. Of this group, 1,552 were black and 85 percent of them graduated from predominately white medical schools. He looked at the location of their practices after training and found that 36 percent of the blacks were in inner city urban areas compared with only 6 percent of the white students. He concluded that these young black physicians were meeting the urgent unmet needs of underserved urban communities. Another scholarly discussion by Lakhan of Harvard on the diversification of U.S. medical schools noted that in addition to the diversity, affirmative action programs also sustained the progression of biomedical advancement through systemic research; bridged the language and cultural gaps that prevent individuals from seeking medical attention; and inhibited discrimination while promoting tolerance within medical student bodies.

After reviewing studies such as these, I think that most would agree that affirmative action is not only the right thing to do, but also the smart thing to do.

Raymond O. Pierce Jr., MD
Indianapolis, Ind.

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