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:”
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.
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?
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.