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Good, bad or indifferent, doctors are doing well financially. Their incomes have skyrocketed and approached escape velocity with the passage of Medicare and, for some states, Medicaid. In 1961, the average doctor, after office and other professional expenses, netted $25,000. By 1965, it was up to $28,000, and last year it reached $34,000. Dr. Martin Cherkasky, the crusading director of New York's Montefiore Hospital, says that doctors have the consumer over a barrel because they are in such short supply and such great demand. The shortage was sedulously fostered by the A.M.A. for 30 years, beginning in the Great Depression and ending only in 1967, when it conceded that something must be done to increase the medical schools' output. "This shortage," Cherkasky says, "makes it impossible for society to deal with the medical profession. You're at their mercy."
Gross Mismanagement
The patient is also at the mercy of the hospitals. Which are the good ones? The nearest thing to a criterion, except for university affiliation, is whether a hospital is accredited by the Joint Commission on Accreditation of Hospitals, set up by the A.M.A., the American College of Surgeons, the American College of Physicians and the American Hospital Association. The U.S. has 5,850 general-care hospitals,-with 645,000 beds for medical and surgical patients, 82,000 for maternity cases. Of the 5,850, only 3,914 have received the cachet of accreditation. Each year there are about 1.5 million admissions to the unaccredited remainder. Worse, in Cher-kasky's opinion, accreditation standards are so low as to be meaningless.
Hospitals are big business. Yet according to Jerome Pollack, professor of medical economics at Harvard Medical School, they are a prime example of gross mismanagement. Hospitals are run by boards of trustees, made up mostly of businessmen, who would never dream of running their own corporations the way they try to operate a hospital.
The first objective of most hospitals is to operate in the black. For generations, U.S. hospitals achieved this by paying little or nothing to interns, residents, student nurses and "nonprofessional" help. Social justice has caught up with the hospitals and found them totally unprepared. They have to pay interns and residents halfway decent salaries ($9,000 to $12,000 in some areas). What has hit them hardest is the demand of scrubwomen, kitchen help and janitors to be paid what is called a living wage. Most U.S. hospitals are grudgingly raising the pay of this nonprofessional help to $1.60 an hour, though in New York and California the rates are nudging $2.50 an hour.
With the reduction in shift hours and the demands of better care, the ratio of hospital personnel to patients has soared from about 145 employees per 100 patients to 260 per 100 in the past 20 years. With mounting labor costs, up go hospital room rates. Hospital administrators stand aghast at this; yet in all too many ways it is their own fault. Dr. Leona Baumgartner, a former health commissioner of New York City who is now at Harvard, can cite chapter and verse to show how hospitals have consistently lagged behind reality and then reacted in a "Who—me?" way. When the baby boom of the late 1940s was aborning, says Dr. Baumgartner, she got