The Next Generation of
Doctors and Presidents


Leonard Zwelling

         I was discussing a problem of recruiting with a physician friend
from an institution in a state other than Texas. This state, like Texas, has
significant barriers to medical licensure for those whose training occurred
offshore, let alone out of state. As any of you know who came to MD Anderson
from another one of the United States, a Texas license to practice medicine
does not come easily. It is acquired through a lengthy process. That process is
best done prior to starting a new job in Texas when that job involves caring
for patients and billing their insurers.

         The discussion with my out-of-state friend surrounded a
recent recruit in his department from
Europe who not only had to contend with the nuances of acquiring an American
license, but also learning the skills of dealing with American government
funding agencies, American drug companies, American IRBs, and the FDA as this
new hire was going to be doing experimental clinical investigations.

         While my friend explained what he had to do to help with the
process, my mind drifted to why his department chair could not recruit talent
from within the 50 United States. It also drifted to the same problem that is
facing the US Congress and those of us who care about the 2016 run for the
White House. Where the hell is the talent?

         This may seem like a bitter question from an old man, but is
it really?

         More and more of the young physicians I encounter are not
native-born Americans, nor even first generation Americans. They are foreign
born young people who came to the U.S. to train and then stayed by any number
of ways. It is not that they are not good docs. Some are, some are not. It is
that so many of the young people who were born here have elected a career path
other than the one that I held most dear when I was in their shoes.

         My hypothesis on this is that the lessening of the value of
a medical degree (especially in lifetime income), the lowering of likely
salaries, the need to pay back student loans, and the fact that the number of women now equal the number of men in medical school have devalued an MD as once occurred in law schools
and teaching. I understand this is a bitter pill, but tell me how I have it wrong. These changes have dropped the barriers to entry into medicine such that many
who were excluded before, like the Jews were in the 1940s and before, are now welcomed in. Plus, the smartest of the smart among the American born go to Wall
Street or Silicon Valley (this can be the first stop before jail, as well). Add to this the absence of a military draft and the
need for medical school deferments and you get a lowering of the IQ of
in-coming docs. I know this annoys one and all when I say it, but that is the
hypothesis. It remains to be tested and by the way Baby Boomers, we are the test dummies of this hypothesis for the most recent graduates with newly minted MDs.

         Unfortunately, the same seems to be true of Presidential
candidates. The barriers to entry have dropped and the quality of those running
has, too.

         On the Democratic side, Hillary is the presumptive nominee.
This is neither good nor bad on its surface. That her ideas will not be
meaningfully challenged from the left is a problem for many Democrats who want
Elizabeth Warren to get into the race, but Ms. Warren is way too smart for
that.  She will be happy to allow Hillary
to steal her populist message and run it up the nearest flagpole just in case
no one salutes.

is a deeply flawed candidate whose strongest asset, experience, is also her
greatest vulnerability if experience is perceived as fatigue by the American
public. It remains to be seen whether or not she can shake her reputation and
penchant for lying and secrecy.

         On the GOP side, the possible candidate list keeps growing
in length but not in stature. When MSNBC flashed a photo of Marco Rubio next to
one of Hillary Clinton, you had to wonder if this was Grandma and her Boy Scout
off-spring posing for his Bar Mitzvah picture. Where is the Republican with the
stature of Ronald Reagan, George H. W. Bush or even Barry Goldwater? It surely
is not Ted Cruz, Rand Paul, Marco or Scott Walker. Ou est le gravitas?

         I guess I am just an old man waiting to hand off the baton
to young people who I see as being imbued with the piss and vinegar I viewed in
myself 30 years ago and I cannot find in these young people. That’s probably because my
view of myself 30 years ago is completely wrong. Nonetheless, Americans have to
look at their doctors and have confidence that the man or woman in whose hands they are putting their lives has some idea of what the heck he or she is doing.
Ditto those running for President, but that doesn’t mean Grandma gets the
automatic nod. That she is getting it in her own party is not going to make her
a better candidate in the general and I think she knows it.

         Hillary ought to hope for a challenge from somewhere. Challenges for my
doctors I worry less about, for the chronic diseases of heart and back I throw
at them keeps them on their toes.

have found the solution with regard to my future medical care though. When my
current set of physicians, who are my age, retire, I am just going to die. It
seems less frustrating than having to text my doctors every time I need a
decision made. The nurses are too busy with the EMR to answer a call button (see op-ed link).

gets the final nod as the next President will need the wile of Kennedy, the
intelligence of Nixon and the amiability of Reagan.

a pretty good formula for any Presidency, of anything, don’t you think? And a formula whose specifics are as rarely known as those of Coca Cola.

Leonard Zwelling