Shifting resources could aid uninsured

There is something about medical school and residency that trains physicians to place an extremely high priority on free food. Perhaps it relates to being so busy that breakfast is often just a cup of coffee, lunch is often a soft drink or is missed entirely, and late work hours mean that we are famished by the time we get dinner.

Whatever the reason, the solution to improving physician attendance at medical staff meetings, quality assurance committees, and grand rounds so often seems to involve coffee and bagels, turkey sandwiches, and chicken caesar salads. In other words, if you want a physician's attention, offer him or her food.

This phenomenon, it appears, has not been lost on the pharmaceutical and medical device manufacturers. Showing up with doughnuts or other food items, while also being available to discuss new products, seems to be a common scenario in hospitals, ambulatory surgery centers, and clinics.

A seemingly distinct topic is the plight of the uninsured. The Wilmer Eye Institute is fortunate to have part of its endowment, representing the combined generosity of many people, allocated to subsidize the eye surgery of indigent patients who qualify for no insurance coverage whatsoever, not even the ridiculously low coverage provided by Medicaid. Ophthalmologists and anesthesiologists waive their professional fees entirely, companies donate some of the materials, and the endowment income is used to cover the remaining hospital costs. Unfortunately, as is true in many parts of our country, the number of uninsured exceeds the available funds.

How do these two topics relate? A while ago my residents came to me with an idea; they wanted to ask manufacturers no longer to offer Wilmer residents and fellows fancy dinners while listening to speakers. Rather, they proposed a "bare bones" alternative of pizza and soda. The funds that would have been used for the fancy dinner would instead be used to fund needed eye surgery for the poor of Baltimore. My residents are making this proposal to our local industry representatives.

I have not attempted to quantify accurately the money spent annually by industry on food and doughnuts for physicians, but I suspect it exceeds the gross domestic product of many medium-sized nations. I also do not know whether my residents' proposal to their industry representatives will bear fruit. But I do know that my residents' priorities are the right ones, and we should be proud of the coming young generation of physicians.

Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 North Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu