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Doctoring the CIA

One of the biggest attractions at medical meetings is the exhibition space, where publishers and companies peddle their wares and outfits looking to hire doctors sing what they hope will be a siren’s song.

The Exhibitors’ Hall at the annual American College of Physicians meeting is certainly among the most grandiose medical marketplace, if not the world’s largest. When I approach the hall, I’m always reminded of Louis Winthorp’s description of the NY Commodities Exchange to Billy Ray Valentine in the 1983 film Trading Places:

“This is it. The last bastion of pure capitalism left on earth.”

At ACP 2019 there were dozens and dozens of exhibitors, ranging from tech startups to health insurance providers. Digital stethoscopes? Check. Work for the newest telemedicine outfit? You bet. There were also journal and textbook publishers and purveyors of online medical information..

But by number, no category is larger than the recruiters — health enterprises all looking for medical personnel. Passersby definitely are made to feel needed in such a milieu.

Recruiting at ACP 2019 were hospitals, ambulatory groups, and academic practices all looking for help. There were also state, county and correctional facilities on the market for docs.

But I was surprised to see a recruiting booth from the CIA: America’s Central Intelligence Agency. It was one of the smaller booths, with but a flag, some brochures, and a lone recruiter, who by Agency policy couldn’t officially speak to me or be quoted.

So who is the Agency looking for? Primary care doctors and psychiatrists.

What does the job entail? Working abroad in embassies caring for CIA staff and their families.

Why, I wondered, if the job involves serving at U.S. embassies abroad, does the State Department not handle the recruiting?

Turns out that CIA doctors must be eligible for and able to obtain security clearances. In order to be considered, you must be physically and mentally fit, and able to pass both a background check and a polygraph test. You need to be a U.S. citizen, too.

The best of the brochures on the table dispelled 12 of the most common myths about working for the CIA: essentially, it ain’t what you see in the movies. Forget about car chases or secret gadgets.

Other brochures led with catchy slogans like, “Everything you do here matters,” or “Utilize your medical skills on the world stage.”

The CIA is not just interested in doctors. Like the real world around us, the CIA is looking for nurses (particularly with experience in occupational health), physician assistants, nurse practitioners, and clinical and research psychologists.

I asked the recruiter what a primary care doctor like me would do in the CIA. I’d once read about the CIA hiring doctors as medical analysts to render opinions on the health of world leaders. The recruiter told me that she was not charged with finding medical analysts at the ACP or her other recruiting stops–only doctors to work as medical professionals. Though with adequate experience and interest, changing roles while in the Agency is considered.

Through the conversation I learned that the CIA operates in five “directorates:”

  1. Analysis (think information gathering and synthesis);
  2. Digital Innovation (think cybersecurity and warfare);
  3. Operations (think spies–these are the folks in the famous clandestine service who handle missions and collect human intelligence);
  4. Science and Technology (think ‘tradecraft’) and lastly;
  5. the humble Directorate of Support (‘delivers everything the CIA needs to accomplish its critical mission of defending our nation.’)

Would-be CIA physicians apply for jobs in the Directorate of Support.

How much does a CIA doc earn? According to their website, the salary range is $157,000 to $164,000 per year, with ‘a progressive physician comparability allowance up to $30K per year.’

This might be the kicker, though. How young does one have to be to join up?

It might surprise you like it did me, but the recruiter said the Agency considers hiring doctors up to 60 years old!

So should you tire of domestic life and the day-to-day of clinical care here in the U.S., the CIA is an unusual way you can serve your country.


“Public Charge” is a Public Health Disaster in the Making

The following post was written by Sam Aptekar and Dr. Phuoc Le, Associate Professor of Medicine and Pediatrics at the University of California – San Francisco and Co-Founder of Arc Health.

I was born in a rural village outside of Hue, Vietnam in 1976, a year after Saigon fell and the war ended. My family of four struggled to survive in the post-war shambles, and in 1981, my mother had no choice but to flee Vietnam by boat with my older sister and myself. Through the support of the refugee resettlement program, we began our lives in the United States in 1982, wearing all of our belongings on our backs and not knowing a word of English.


Though we struggled for years to make ends meet, we sustained ourselves through public benefit programs: food stamps, Medicaid, Section 8 Housing, and cash aid. These programs were lifelines that enabled me to focus on my education, and they allowed me to be the physician and public health expert that I am today. Looking back, I firmly believe that the more we invest in the lives and livelihoods of immigrants, the more we invest in the United States, its ideals, and its future.

So, when I first learned of the current administration’s plan to make it harder for immigrants with lower socioeconomic statuses to gain permanent U.S. residence, the so-called changes to the “Public Charge” rule, I felt outraged and baffled by its short-sightedness.

Chart courtesy of www.cgdev.org

If this proposal comes into effect, government officials would be forced to consider whether an applicant has used, or is deemed likely to use, public benefit programs like Section 8 Housing, Medicaid, the Supplemental Nutrition Program (SNAP), and Temporary Assistance for Needy Families (TANF).  Additionally, applicants with pre-existing health conditions could be rejected purely on these bases.[1]

The implications of this rule are not hard to predict (and have already been observed throughout the country)[2]: noncitizen parents who are hoping to get green cards will not enroll their citizen children in government healthcare, which they have a legal right to obtain, out of fear that harnessing public benefits will prevent them from gaining legal permanent residence. According to the Kaiser Family Foundation, President Trump’s proposal could lead to a decrease in Medicaid and CHIP enrollment by a minimum of 15% and as much as 35%.[3]  Any proposal that decreases the number of insured American citizens, as this measure surely would, would increasethe financial strain on taxpayers who will be forced to compensate for unpaid coverage. Furthermore, Forbes estimates that Trump’s proposal would decrease legal immigration to the United States by more than 200,000 people a year and therefore “would have a negative impact on the Social Security System”- a deficit that American taxpayers would have to help cover.[4]

If the moral argument that every human being deserves the pursuit of a better life doesn’t work for you, then let the economic one suffice. A 2016 study by the National Academies of Science, Engineering, and Medicine concluded “immigration has an overall positive impact on long-run economic growth in the United States” and “immigration is integral to the nation’s economic growth.”[5]

Whether you are an immigrant or were born in the US, we all have a responsibility to vocalize dissent against the Department of Homeland Security’s morally and fiscally-flawed anti-immigrant proposal. Vote, attend town-hall meetings, write to your representatives, conduct personal research, engage in constructive dialogue, and comment below to get the conversation started. Remember, the Statue of Liberty reads: “give me your poor, your tired, your huddled masses.” If we match xenophobia and ignorance with empathy and facts, we can ensure that America remains a beacon of hope for future immigrants, just as it was for me in 1982.

[1] http://apps.washingtonpost.com/g/documents/world/read-the-trump-administrations-draft-proposal-penalizing-immigrants-who-accept-almost-any-public-benefit/2841/

[2] https://www.washingtonpost.com/outlook/2018/12/18/proposed-new-public-charge-rule-puts-childrens-health-insurance-risk/?utm_term=.82971bc137f9

[3] https://www.washingtonpost.com/outlook/2018/12/18/proposed-new-public-charge-rule-puts-childrens-health-insurance-risk/?utm_term=.0ac0803db1a9

[4] https://www.forbes.com/sites/stuartanderson/2018/12/14/these-flaws-may-kill-the-public-charge-rule/#17d961c72884

[5] http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=23550

Wallet X-Ray

Have you ever heard the term ‘wallet biopsy?’

A wallet biopsy is what occurs in U.S. health care when you or a loved one show up with a medical complaint to seek treatment.

From the emergency department to the inpatient hospital, to the doctor’s office or the procedure suite—at any location where an American might receive health care, you’re subject to a wallet biopsy.

Health care is a business. An expensive one. And the beast has to be fed—not only to keep the lights on, but also to buy the latest equipment and pay the folks that provide the care.

In a recent piece for Kaiser Health News, journalist Phil Galewitz updates us on how the U.S. practice of wallet biopsy has morphed into wallet x-ray.

The idea is longstanding: grateful patients (with financial means) have always looked for ways to share their good fortune with the medical establishments (and professionals) that have treated them.

Galewitz’ piece suggests that the practice of seeking out potential donors has ramped up in intensity: large health care enterprises (often university-based or affiliated) are performing financial background checks on patients they deem to be potential donors—and then aggressively wooing them.

There’s nothing necessarily wrong with this—it just smells a bit fishy. And it implies that if you’re not a grateful patient, or in financial position to be one, that you may wind up getting a bit less…er, attention? Fewer amenities? Less TLC?

Check out the article, which also ran in the NY Times, and let us know what you think of the specialty of wallet radiology.

Biggest Health Stories of 2018

Happy New Year, GlassHospital readers.

The year’s end provides the opportunity to reflect on the year that was.

These few stories stuck out as some of the most impactful of the year–and what they portend for the future:

1. Gene editing: In November, at the International Summit on Human Genome Editing in Hong Kong, Chinese biologist He Jiankui shocked the world with his announcement that he had manipulated at least two embryos to change a trait (or more??) in twin baby girls. The reaction was mostly critical, including calls for a moratorium on the use of CRISPR gene-editing in humans.

The upshot: stories like this will be with us for the foreseeable future. While the power of CRISPR to remedy harmful genetic conditions seems hopeful and fantastic, there’s a whole history of eugenics movements that should guide us to avoid the hubris of selecting for ‘desirable’ traits in humans.

2. #ThisisOurLane: Also in November, an NRA staffer (to this point unknown) tweeted a response to an article in the Annals of Internal Medicine recommending that doctors ask patients about gun use and safety as a health measure. The tweet infamously suggested, “someone should tell self-important anti-gun doctors to stay in their lane.” This was met with a firestorm of response from doctors across the spectrum, particularly those that care for gunshot victims (ER docs, surgeons, etc.) who tweeted under the hashtag #ThisIsOurLane.

The upshot: It’s hard to quantify the cumulative impact of the conflict, which is sure to go on, but the Justice Department did just ban bump stocks.

3. Bill of the Month: NPR, in conjunction with Kaiser Health News, started a monthly series examining outrageous and inexplicable health care bills. It’s been one of their (repeatedly) biggest stories of the year, as exemplified by the (insured!) Texas teacher who faced a $108,951 hospital bill after treatment for a heart attack (he was taken by ambulance to an out-of-network hospital–hardly the time, it seems, to price compare).

The good news: His bill was lowered to $332 after the glare of national media attention.

Alex says, “I ALWAYS look to GlassHospital for keen insights.”

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