World of medicine gets smaller, flatter

AMA Leader Commentary. By Edward L. Langston, MD, Dec. 3, 2007.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from Edward L. Langston, MD, chair of the AMA Board of Trustees.

I was raised on a farm in central Indiana. It was a typical farm in the 1950s and 1960s in rural Indiana. My father planted corn, soybeans, wheat and oats. He farrowed and raised hogs; we call them swine these days.

Dad also had a herd of registered Aberdeen-Angus cattle. The herd was mostly breeding stock for resale and, of course, competitive 4-H stock for showing in county and state fairs.

Back then, the world was pretty well defined for me. My hometown, Burlington, Ind., population 300, was where I went to school, met my future wife and grew up in a supportive and small community. Kokomo, Logansport and Lafayette were larger cities, all within 25 miles, which provided a venue for shopping and sporting events at Purdue University, for instance.

Looking back, that world seems very limited, but at that time, it seemed big enough to me. Indianapolis was 52 miles due south. That was a special trip in those days. Not only did it require a special reason to travel that far, such a long journey occurred very infrequently. The most frequent reason was to transport a truckload of hogs to the stockyards in Indianapolis.

My world has changed, and radically so. The entire United States now is just a flight away -- business, pleasure or education. I think nothing of driving 65 miles to Indianapolis, flying to Chicago for a meeting, then off to Washington, D.C., to meet with congressional leaders, followed by a stopover in Connecticut to speak with the Hartford County Medical Assn. and the Connecticut Academy of Family Physicians and finally back to Indianapolis -- all within three days!

Our medical world is international. Some say the world is essentially flat. It is not unusual to communicate by e-mail with colleagues around the world any day of the week. Many of my patients have x-rays interpreted by U.S.-trained radiologists in countries across the globe. Many medical business transactions are outsourced to communication centers located in Puerto Rico, India or somewhere in the Far East.

How can this be? Modern communication tools and transportation expansion have broken old barriers that previously limited opportunities. With the instantaneous and ultrafast technology that exits today, what used to be old barriers are now new opportunities and challenges.

Medical tourism also is increasing. Patients in the U.S. are traveling to countries around the world to receive medical care. These are small numbers, but they are increasing yearly.

There are ultramodern "centers of excellence" springing up in an increasing number of countries worldwide. Many are staffed by U.S.-trained physicians and support technicians.

What propels this emerging market for international medical care? Certainly the cost of care in the United States is a major factor. Daily one can read advertisements in journals and lay magazines marketing medical services along with the reduced costs associated with that care compared with the cost in the United States.

Business agencies are sprouting up all over this country and elsewhere to assist patients in exploring options for care internationally. Some insurance carriers and employers are exploring this international market as an option for certain high-cost services for their clients or employees.

What about quality? Good question. It is still buyer beware. But there is international interest in having the Joint Commission, for instance, evaluate and consider accreditation of hospitals and surgical centers to address the quality-of-care issues with the standards of an accepted and valued organization recognized by the U.S. market and decision-makers. The Joint Commission International has now accredited nearly 175 organizations using rigorous standards similar to those adhered to in the United States, and the requests for education and evaluation are increasing.

So much has happened since 1492 when the world was truly thought to be flat. Now it is again! With the burgeoning international growth of "centers of excellence," will it be long before many U.S.-trained graduates of our medical schools start flowing to these international centers and joining their international colleagues in the practice of their chosen specialty in those countries?

Why might they do this? Lifestyle issues? Medical opportunities? For the international experiences? Who knows? But I do know this -- my world has changed in ways never thought of 15 years ago. I bet yours has, too. The future looks exciting.

For me, this is hardy food for thought. I hope it is for you as well. Have a happy holiday season, and best wishes for a happy new year from my family to yours.

Dr. Langston , a family physician from Lafayette, Ind., was chair of the AMA Board of Trustees during 2007-08. Learn more about Dr. Langston at the AMA's bio page.

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