While listening to the radio about outsourcing American jobs to foreign countries so that corporations can get away with paying their employees less, I breathed a sigh of relief that my particular job (yes, I'm a real physician) would never suffer such a fate.

I was wrong.

There are a few trends in American medicine that may prove how wrong I was. First is the tendancy for many, if not most, of today's physicians to become employees, of hospitals or clinics, rather than operate their own practices. The voluminous paperwork and beaurocracy involved in a medical practice nowadays are something most doctors are ill prepared and ill disposed for, so being an employee has an appeal. Second, there is a growing use of the internet and webcams to practice what is called "telemedicine." This phenomenon has been widely used in remote places like Alaska, where the distances and weather involved in going to get medical care are formidable obstacles.

Let us now imagine a future in which you get sick, and you must boot up your computer, activate your webcam, and communicate with a physican in, say, India, which is where your medical insurance company has hired some practitioners and REQUIRES that you talk with them first. They then can treat you, remotely, or triage you to, if they see fit, to go to an actual human being near your location.

I do not wish to disparage the medical expertise of foreign medical graduates, although that expertise should, in my opinion, involve the wisdom of when to participate in telemedicine and when not to. I can, though, disparage the possible lack of understandable accents, the lack of knowledge of American colloquial English, and the lack of knowledge of American lifestyles. These problems may be more prominent in certain specialties, such as psychiatry, substance abuse, and geriatrics.

In the big picture, this scenario is a possible outcome when a country has a privatized health care system run by large corporations. And there is only one country in the world like that, isn't there.

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