Physicians Seek Care in Mexico

By Jay Stearns MD

“Earth provides enough to satisfy every man's needs but not every man's greed.”

Mahatma Ghandi

Wednesday, December 11, 2024

Burlington

Dear Mr. President, Honorable Members of Congress and Distinguished Staff and Fine Citizens,

When explaining why my wife and I, both physicians, choose to receive health care in Mexico, a developing country, a multitude of thoughts, reasons, and personal experiences come to mind.

As a physician with nearly 40 years of experience in the USA and abroad, I have witnessed unimaginable medical advances since I began my training. With this in mind, why would anyone, especially a physician, prefer to seek medical care in a country like Mexico?

It’s best to start from the beginning. Until the Reagan administration, all hospitals and health insurance companies in the USA were required to be nonprofit. In the 1970s, the average cost for an employer to insure a worker was about $35 per month. Notably, reasonably priced international health insurance policies are available for citizens living outside their home countries. However, these policies do not cover services within the American healthcare system.

Today, in the USA, large corporations control all aspects of the medical profession, prioritizing profits over patient care. These corporate leaders often lack an understanding of, or concern for, what it takes to provide quality health care. As a result, hospitals and outpatient clinics are understaffed to maximize profits. The so-called "physician and nursing shortage" stems from healthcare professionals refusing to work in unsafe conditions that put patients at risk and increase medical-legal liability. Those who remain are frequently disillusioned and frustrated, negatively impacting the quality of care they provide. Many healthcare workers also carry significant educational debt, making it challenging to advocate for reasonable patient loads without risking their employment. Job security in healthcare has become a relic of the past.

When higher-level hospitals cannot accept transfers from lower-level facilities, it is often due to staffing shortages rather than a lack of available beds. Overburdened healthcare professionals resort to unnecessary diagnostic tests or, at worst, commit malpractice. I have witnessed this all too often. For example, I recently declined an outpatient job opportunity near my home because it required seeing 30-40 patients in a ten-hour day. While it may seem impressive for a physician to see this many patient daily, the poor quality of care that results will not be. I could fill a book with the errors I’ve observed in American hospitals over the past 18 years since returning to the USA. Here are a few specific examples:

Example 1:

When working in a private hospital in Maine as a locums hospitalist, I was told that hospitalists are not to do procedures because there was a " procedure team" that is insured and could bill the insurance company more efficiently. Unfortunately, when faced with a 47-year-old man suffering from cirrhosis and massive ascites requiring urgent abdominal paracentesis due to severe abdominal pain and respiratory difficulty, I was informed by the procedure team as well as the head of the radiology department, that it would have to wait until noon the next day, due to understaffing. The gastroenterologist was also too busy. It was evident that the paracentesis could not be postponed for another 30 hours, so I did it myself even though I did not have procedure privileges at that hospital. Note that I do an average of 1-2 of these procedures per week where I usually work. The patient as well as the nursing staff were grateful but the pseudo-doctor that represented the administration objected due to the liability risk as well as billing issues. The fact that there was no other way to relieve this patient's pain or to eliminate the risk for other complications (abdominal compartment syndrome, which can lead to organ necrosis), was of no concern.

I also noted that overall patient care was poor due to the general understaffing of all hospital employees. During my 2-month work period at this hospital, I became aware of the act that the only way for the permanent hospitalist physicians, to complete their daily tasks in 12 hours was to spend a minimal amount of time wit patients and to consult already overworked subspecialists for even the most elemental decision making. This resulted in a great deal of animosity between departments which in turn reflected on patient care. I was offered a permanent position and hospital privileges. For obvious reasons, I declined both. Incidentally, according to my hospitalist colleagues, working conditions at this hospital were superior to most of the other local hospitals in the area.

Example 2:

The following is a contrast between 2 identical cases. One in Mexico another in the USA.

A Mexican surgeon while shopping in the border town of Brownsville Texas came down with appendicitis. Knowing about the outrageous expenses and the unnecessary delays that can occur at US hospitals, he crossed the border back to Mexico and went to a public hospital where he received immediate surgery without any delay or inappropriate imaging. His recovery was uneventful.

In contrast, I witnessed the case of an 11-year-old boy that presented to a Vermont hospital with a classic case of appendicitis at 9am. I informed the ER physician, who agreed, that this was appendicitis and required surgery. The surgeon ordered a CAT scan without even seeing the patient. The CAT scan, which was not needed in the first place, did not visualize the appendix but showed general inflammation in the area close to the appendix. The surgeon wanted to "observe " the boy overnight and would have done so if we had not insisted on an immediate operation. In all, it took 7 hours for this overworked, burnt-out, surgeon to take this boy to the operating room where he was found to have appendicitis which was on the verge of rupture. It turned out that the surgeon, even though he was on call, had to see an office full of patients as well as having to make rounds on hospital patients and in addition was required to perform urgent surgeries.

I worked at this hospital for two years and resigned after the accountant who ran the hospital decided to increase our workload to unsafe levels. I was the eighth "permanent " hospitalist to leave in 2 years. In the space of 3 years, 4 hospitalist directors had resigned.

Example 3:

When my wife and I required a colonoscopy for health maintenance, I called the office of a gastroenterologist that I had worked well with on a previous assignment. It was August. The receptionist informed me that there were no openings for this procedure until June. I am certain that the nurse did not inform the Physician that I was his former colleague. In fact, she probably would have been more efficient at guarding the gates of Hell than Cerberus, the 3 headed dog of Greek Mythology.

When we made a trip to visit family in Mexico a few weeks later, I contacted a local highly regarded Mexican gastroenterologist. She put us on the schedule the next week. The doctor had state-of-the-art equipment, and she did not seem to be as overworked as are most American doctors (thus, in my opinion, the risk for error was much less). The cost was 400 dollars compared to three to four thousand dollars in the USA.

Example 4:

While working at a private hospital in Vermont, I received a call from a vascular surgeon who worked at a referral hospital 90 minutes away. He stated that he had attempted to do an endovascular repair of a dissecting abdominal aneurism on a 92-year-old male 6 weeks earlier. The attempt was not successful and subsequently, the patient developed irreversible renal failure with fluid overload of the lungs. The surgeon had called both our medical director and the hospitalist director, and both refused to allow the patient to return to our local hospital due to financial concerns. The patient's only desire was to see his 92-year-old wife for the last time. She was too frail to be transported to see him. This obviously did not move these two pseudo-doctors. I accepted the patient as a direct admission. When he arrived, he was given a strong dose of a diuretic as a temporary measure to clear his lungs.

When his wife was brought in to see him, he gave one of the biggest smiles that I had ever seen. Later that night, his lungs began to fill up with fluid. He died peacefully in the arms of Morpheus (a large dose of morphine).

The refusal of the administrative physicians to allow a dying man to see his wife for the last time is an example of how corporate-driven medical practice often overrides basic human compassion.

In conclusion, my wife and I feel safer using Mexico’s private hospital system because care there relies more on clinical expertise and common sense, rather than fear of malpractice. Costs are also significantly lower — about 5-10 times less than in the USA. We dropped our American health insurance years ago due to the predatory practices of private insurers. Until the U.S. healthcare system is reformed and removed from the control of for-profit corporations, it will remain dysfunctional.

In contrast, Mexico’s private healthcare system allows skilled professionals to focus on patient care without treating them as mere cogs in a profit-driven machine. Note that care in Mexican private hospitals is excellent when provided by reputable physicians. However, the situation in Mexican public hospitals differs and does not apply to foreigners seeking care in the country.

Respectfully submitted,

Jay Stearns MD