Med Insurance Covers Only 5 in Every 9 Distribution Troubles in Texas Medicin only doctor moved away. Recently a replacement arrived, and Schleicher residents could go back to having babies and broken arms again. The replacement, Dr. M. D. Faul, 41, illustrates the fact that the community must it the man which is why so many way-off communities are without medical help. Small town “type” doctors are getting scarcer. Pushing Human Nature Fortunately, Faul and Eldorado suit each other. He grew up in South Dakota towns just about He told the Observer: “The basic reasons for my corning to Eldorado are complex and personal, but unquestionably I was influenced by the type of people you find out here: friendly, they take you right in. “The social life centers around the high school, but I don’t have time for social life anyway. I’m always on the go.” Eldorado has a three-bed clinic. For real hospital work, Paul must travel 20 miles to Sonora. There has been some talk of building a hospital for him in Eldorado. Such communities as Eldorado, because of their isolation, are fortunate to have even one doctor; but it is large enough to support three, and to limit a community of that size to one doctor is to push human nature too far: that is, the law of averages will perversely determine that some of the people in the town won’t like him, will think he is too young or too old or too flirty, and will simply refuse to go to him for care. It is easy enough to shrug these people off as “‘making their own beds,” but the fact remains that_ a second doctor makes incalculably smoother the gears of social interrelationship in towns large enough to support as many as two doctors. When a community’s purse keeps pace, or surpasses, the per capita growth rate, there seems to be little difficulty getting more doctors to move there. Midland, for example, had 10 doctors in 1947. Since then the community’s size has multiplied about three and a half timesmost of the newcomers being well-heeled professional people linked to the oil industryand the city’s medical staff has grown proportionately, at last count being 35 doctors. On the other hand, Sweetwater in Nolan County, less than 100 miles to the east of Midland, has no more doctors today than it had 30 years ago, although the population has increased nearly fourfold, and despite the presence of an excellent municipal hospital. Sweetwater’s economic growth has been unspectacular, and new doctors have passed it by. One of the most dramatic solutions to the no-doctor problem ‘ came this week in Wells, deep East Texas near Lufkin. Wells, a community of 700, has been without a doctor for three years, though constantly trying to get one. Now Dr. William E. Watson, a native of Carlisle in Northeast Texas, has promised to move to Wells in February. To lure him there the community offered a new clinic, rent free, and with even the utilities paid for the first six months. \(Next Week: Hospitals, medical Over $133 Million Insurance In Force Girl anefiattie4 INSURANCE COMPANY P. 0. Box 8098 Houston, Texas HAROLD E. RILEY Vice-President and Director of Agencies and the specialist usually knocks down the best income. Somewhere between 34 and 42 per cent of Texas doctors, Williston says, are general practitioners. The second reason for a lower over-all income among Texas doctors is that they devote 11 to 12 per cent of their time to indigent patients and an “appreciable” amount of their time to patients whose fees must be reduced. Williston says the call for such service in Texas is higher than in the nation generally but he does not know exactly haw much higher. This benevolence, forced or otherwise, at the same time often stimulates the temptation to “stick the rich,” to balance things out, with “rich” often equated with those simply able to stand the gaff. That some doctors do succumb to this temptation is made plain enough by a recent survey which showed families earning $2,000 to $5,000 a year visit the doctor more often than families earning $9,000 up \(11 visits compared to 9.7 visits less per visit \($4.48 comparied to But Williston argues that in few other states does the public have more legal weapons with which to defend itself from the unscrupu California for the holidays and would be talking to students and grotips there. Another of the leaders has been Chandler Davidson, a senior philosophy student and recipient of a University hilosophy scholarship. Davidson is chairman of Students for Direct Action, the group which formed independent of University auspices to carry out direct action against segregation practices. , Faculty Letters The faculty endorsements began Dec. 9 with a letter in The Daily Texan from 12 members of the classical languages faculty endorsing the stand-ins. Then, on Dec. 20, there appeared letters from 180 other faculty members,. including 66 from the English Department led off by Dr. Mody Boatright, the departmental chairman. Many of the signatories were prominent members of the faculty. The letter from the English faculty said segregation is ” a fundamental violation of human dignity” and “a denial of intellectual freedom: When we recommend a film or a play by Shakespeare or Shaw, for example, or the work of a distinguished foreign producer, we want to be sure that such important experiences are open to all our students.” It is understood the writer of the statement was Professor Oscar Maurer. The history teachers’ statement said segregation is morally indefensible and that the nation cannot afford it. The statement from Germanic languages said: “Busi THE TEXAS OBSERVER Page 2 Dec. 30, 1960 lous doctor, whether his lack of scrupulosity reveals itself in his fees or in his medical techniques. Most easily available is the public grievance committee, operated by each of the 115 Texas county medical societies. The highest tribunal in such matters, however, and the one most feared and respected by doctors, is the Texas State Board of Medical Examiners, which usually meets once a month and, according to Williston, rarely meets without suspending at least one license to practice medicine. Its hearings are open to the public. The tendency to balance the paying patient with the non-paying presents a temptation from another quarter: medical insurance. If the insurance company is footing the bill, why not heap on all the expenses that come to mind? After all, the individual isn’t being put to a hardship when this isdone. Such reasoning can’t be as common in Texas as in the nation generally, however, for the reason that Texas doctor’s don’t deal with as many patients covered by health insurance. Of 9,700,000 Texans, only 5,300,000 are covered. In the nation as a whole, 72 per cent of the people are covered. When insurance companies feel they have been gouged by sharp ness enterprises which expressly cater to the University community should not fail to contemlate the actual composition of this community, and should not single out members of’ it for treatment which is insulting to intelligence and dignity.” Alongside these statements in the letters column appeared a statement signed “Students for Direct Action” asserting that “a person’s race is a totally invalid criterion of his worth.” “We believe that total integration should be accomplishea as soon as possible,” the statement said, “both for humanitarian reasons, and in order to gain the respect of other nations \(many of which are predominantly nonsegregation policies as hypocritical and atavistic .. . “Social injustice never ‘takes care of itself.’ It is corrected only by concerned, active citizens,” the statement -said, continuing that the group opposed emotionalism or poorly-planned demonstrations and bargained about and discussed their ideas with businessmen concerned. The FACT newsletter’s comments about the demonstrations: “When a person embarks upon a business career, he generally makes substantial investments.. .. When he makes a decision concerning his business such as who to serve he is motivated by busMess considerations . . . Forced integration of one’s private business is only one step removed from forced integration of one’s private home.” The newsletter said the demonstrators had adopted their standing-in method because they had practices, they can take their complaint to the specially-ap; pointed hospital-insurance-physicins joint advisory committee. Williston says the committee does not receive many complaints. Distribution Troubles A few statesMinnesota, Connecticut, Massachusetts, Vermont, North Carolina, Louisiana among themhave enjoyed a drop in the last 20 years in the ratio of potential patients to doctors, but Texas has ‘been with the majority, watching its ratio expand from 930 person’s per doctor in the late 1930s to about 1100 per doctor today. \(This is the current figure given by Bureau of Census; but Williston says the figure is more nearly This compares favorably with the national ratio, but it shows the inability of statistics to isolate Texas’ problem, which lies not in the number of doctors serving the state but in their distribution. After seven years of surveying the ‘situation, the Texas Medical Association finds no great and present need for more doctors, but an acute need to scatter them over the state in a way that will best utilize them. All the smart planning in the world won’t bring the distribution about, however; only lack of bus found that the student body did not agree with their views. Mrs. FDR Writes Mrs. Roosevelt, in a column in the New York Post, wrote of the stand-ins: “It is interesting to note that it is the white students in many of the Southern universities who are really carrying the fight for integration. Students from the University of Texas, for instance, have set themselves the task of picketing the Austin theaters, which are not integrated, in an effort to bring before the public in spite of a news blackoutthe fact that the city’s theaters are segregated.” \(\(The stand-ins have been publicized, to various extents, by the local dailies, The Daily Texan, the wire services and the ObMrs. Roosevelt continued: “At times class assignments require that students report on certain films, and such assignments cannot be carried out by Negro students. In this effort the students have had wide faculty support. . . What particularly saddens me about segregation at this \(Varrise at Campobello’ recently began a run there. I cannot help but think that the particular film should be available for every citizen of the U.S. to see, regardless of race or creed or color. “Therefore, I am personally grateful to the Texas students for making the effort to bring about the end of this kind of segregation in their state. But I wonder why students have to be without the help of the community in general . . . “I hope this action . . . will have some effect on the theaters in their area,” Mrs. Roosevelt concluded. “Over 2,000 students and faculty members signed an anti-segregation petition, and certanly this should serve to point up the fact for our older generation that times are Changing and that the young are closer to the futurebecause this will be their time and not the time of their elders.” iness, or the whimsical desire for a change of social scenery can be counted on to push a doctor out of a community where he isn’t needed into a community where he is needed. Some communities have struck it rich in medical care. Little Marlin, for example, has a doctorpopulation ratio of one-to-350. Doing even better is Galveston, with a ratio of one-to-315. Dallas has an extremely fortunate ratio, for a big city, of one-to-504. And Austin has a much better than average ratio of one-to-751. \(These figures are only approximate because they do not take into consideration those doctors who do not belong to the TMA; 67 per cent of all interns and resident physicians in hospitals do not belong. Neither do the ratios conHouston, El Paso, and Dallas are among cities in which doctors have increased by more than 50 per cent since 1950. Outside the big cities, doctors have increased by five per cent, as against a 23 per cent jump in population. Influential Wives Most men who undergo the lengthy rigors of a medical education are reluctant to reward themselves with banishment to the sticks, which is why most Texas cities are plentifully supplied with doctors and the boondocks are crying for them. But doctors’ wives are also influential in this regard, says Williston: They like to see their husbands once in a while, and the small town doctor is frequently on a seven-day, 18-hour schedule. The wives also are apt to take a squinty view of the type of schooling their children will get in the. small community. And occasionally a wife will demure on the grounds that the small town does not have a church of her denomination \(at least that is her exBut one of the foremost reasons for small towns being without doctors is lack of facilities. Typical is Hooks, Tex., a town of 2,700 and thereby able theoretically to support three doctors. It has none. It has not had a doctor for several years, and largely because it has no hospital. But recently it obtained hospital privileges at nearby Texarkana, and Williston is convinced that now the TMA can obtain a couple of doctors for Hooks. Deep East Texas and the sandscratchy areas of West Texas are most .critically in need of better Looking to the West for examples: There is no doctor in Mertzon, the county seat and only town in Irion County, and the chances are slim of a doctor setting up practice there, again because the town has no hospital. Young doctorsthe only age that will venture into such a set updo not have the money to establish their own clinics, and without clinics any doctor is largely incapable of giving more than high class first aid. Then there are towns of mar
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