“When you are really sick where do you go for medical care in Florida?” a friendly Bostonian asked me with a wink when I first moved back to my home state. I looked at him blankly as he delivered the punch line I am now all too familiar with — “The airport!”
Florida, with our wacky politics, extreme weather and quirky characters may be fun to joke about, but illness and death are no laughing matter. Palm Beach County is full of very good doctors, but there has been no solid anchor — no academic medical center of excellence. Nearly daily, I insist to patients that if anything were to happen, we would be able to take very good care of them here. But if things were to go seriously wrong and patients had the means, I’m pretty sure many would (and do) head for the airport.
Courtesy of Dr. Dawn Sherling
And yet, it doesn’t have to be this way. About 100 years ago, an endowment from a successful Boston entrepreneur, Peter Bent Brigham, established a small community hospital to care for the indigent. From very modest beginnings, the Brigham and Women’s Hospital has become one of the world’s leading research institutions and a medical mecca where people from throughout New England and the world go for lifesaving care. In fact, much of the Brigham and Women’s current endowment comes from donations originating from donors who claim a home in Palm Beach County. And yet, our local hospitals struggle.
“No one roots for the home team in Florida,” a local entrepreneur and philanthropist told me, lamenting the lack of funding for our science museum. “Their loyalties are to the museums ‘back home’ where they spend the summer.”
Perhaps one can decide to forego trips to the museum in favor of other diversions when in Florida, but a person gets ill at unexpected moments, often without warning. Flying “back home” isn’t always possible.
When I was in training at Brigham and Women’s, the internal medicine residency program director emeritus was fond of saying: “We can attract all the smart people we want. We are looking for nice people.”
And smart, nice people do flock to Boston to train to become world-class physicians. Because at the Brigham and other Boston-area hospitals there is money for whatever a budding physician might want to study, from primary care to interventional cardiology.
And lots of those doctors, from all over the world, who train in Boston, stay in Boston or its surrounding areas. Medical school and residency is an intense period, usually in one’s 20s, when careers and sometimes families are started. It is hard to pick up and move. This isn’t just a phenomenon common in New England. According to data from the Association of American Medical Colleges, around 50 percent of trainees settle in the states in which they did their training.
Consider that Florida ranks 42 out of 50 states in number of residency training spots. We rank third in population, with one of the country’s most aged population concentrations in South Florida, producing a terrible mismatch of doctors-in-training to people who will need them.
But this is slowly changing. Florida Atlantic University is soon to graduate its first class of medical students and has recently been granted nearly 100 spots to train internal medicine doctors. Its first residency class has already started training at Boca Regional Medical Center, Delray Medical Center and Bethesda Medical Center, and it will welcome its second class in July.
How well these future South Florida doctors are trained will, in large part, be up to the doctors already in practice here as well as local philanthropists. Dozens of doctors have stepped up to help train and guide these budding internists. But training doctors is expensive and anything but easy. There needs to be time and teachers set aside to make sure trainees get the skills they will need to soon care for patients of their own. There needs to be enough supervising physicians to ensure that patients are safely cared for during training. All of this costs a lot of money — $100,000 per resident trained by some estimates.
Great doctors are not born, they are made. And increasingly they will be made in Palm Beach County. How well they turn out will be up to us. And perhaps in a few years that airport joke, which is usually guaranteed at least a smile when told, just won’t be funny anymore.