A very large percentage of those abortions are in the context of diagnosed chromosomal or developmental abnormalities. With the advent of new technologies to facilitate tissue sampling for genotype and FISH analysis at earlier time points the frequency of the 16-20 week abortions will decline. Amniocentesis has to be performed after 16 weeks.

Very, very few women who decide not to carry to term make this decision past the first trimester-- unless of course, they have trouble finding a provider? Sounds like a strategy.

Honestly, this is a pretty shallow rendition of a complex problem.

You're giving short shrift to the debt issue. With the escalating costs of undergraduate + medical school it is not uncommon for newly minted MDs to start their internships with $200,000 in debt. No one makes any headway on that debt as a house officer so basically a new GP at the age of 30 is still carrying $200,000 -- just when they are starting out as the low man in a practice. Maybe they married a med school classmate -- tack on a few more $100,000 dollars. This is an enormous debt load and starting salaries for GPs are not particularly high.

Yes, they made choices -- expensive ones, but when you are a second year resident and you start "doing the math" -- doubling your starting pay with the possibility of achieving a much higher ceiling by extending your training by a few years becomes more enticing. When I was finishing my specialty training about 10 years ago many of my colleagues were still actively moonlighting and *hoping* to pay off their debts by the time they were 40.

Many of the complaints of today's practicing physicians (GP and specialist alike) are the same -- pressure to see many more patients combined with endless paperwork and at least 1 hour a day (if lucky) arguing on the phone with HMO/insurance representatives. For many older MDs, their day-to-day lives changed drastically -- these are the folks discouraging younger people from pursuing medicine.

Compounding these issues is the frustrating complexity of today's medicine. Patients are sicker at a younger age with chronic ailments that either could have been avoided with better (or any) preventative care -- problems that snowball and start affecting multiple organ systems requiring frequent hospital stays. Being a GP in any undeserved region is like spending your day shoring up leaking dams.

Any approach to "raise respect" has to be coupled to changing the nature of medicine to help make it rewarding again (not necessarily from the monetary standpoint)-- starting with 100% medical coverage for 0-18 year olds to start decreasing the incidence of early-onset obesity, diabetes, etc. Followed by the availability of step-wise graded coverage for folks who don't have insurance via employment. Even if these problems cannot be fully circumvented, it is far better to manage patients before they become ER "frequent flyers".

When coupled to a real streamlining of the payment bureaucracy and yes, debt reduction -- general practice will become more viable.

It's a multi-tiered problem that will require creativity and resolve to fix.

Oh and the MD on Park Ave -- he's busy drag racing with one of Ronald Reagan's welfare queens in her Cadillac. Be serious...

JT

Since one of the arguments here is that Viagra is designed to treat a medical condition. Of course, in the vast majority of cases it is simply allowing the patient to have sex in the context of neurovascular disease, overwhelmingly caused by diabetes in this country-- it isn't "treating" anything in most cases, it's facilitating what are considered part of "activities of daily living" by some people. Interestingly, Viagra was "discovered" in the course of studying a new drug for heart failure --- for some reason the study patients didn't want to give their extras back at the end of the trial.

So, exactly how many of these prescriptions are written by urologists following an appropriate diagnostic workup for erectile dysfunction? As opposed to, I don't know, a patient telling his MD (non-urologist) that he was having a bit of trouble "getting it up"? Want to venture a guess? I won't report my anecdotal evidence from my clinic but not an evening goes by without a request for the blue pill.

I would have less of a problem with this situation if insurance only covered Viagra in the context of an appropriate workup for ED. Otherwise it surely does come off as an unfair decision as to what constitutes a lifestyle choice.

JT

So let me get this straight, this is a "private family matter" yet the GOP is flying this guy in to trot out as some sort of tribute to the deeply held family values of the right wing?

Yup, wouldn't want to pry or focus on the kids now, would you? This is deeply cynical.

And I'm sorry, while I respect whatever decisions that were made here once the pregnancy was discovered (as long as they didn't involve any "shotgun" coercion) -- unplanned teenage pregnancies are often tragedies on many levels. I think this is heading towards glorification and boy, *now* who's the celebrity?

Ridiculous.

C'mon this is the same group of people that are claiming that Palin is perfectly qualified to be the President "on Day 1" and Obama isn't.

But I agree, this is really over the top, even for them.

And what are the odds that anyone will ask?