In an unprecedented editorial published simultaneously by their leading professional journals, the nation's doctors and lawyers have been urged to honor historic ethics tenets and greatly increase the amount of free services they provide to the poor.
The editorial, appearing today in the Journal of the American Medical Assn. and American Bar Assn. Journal, urges each of the nation's 497,000 physicians and 675,000 attorneys to spend at least 50 hours a year providing uncompensated services to poor people.
The proposal represented the first time both prestigious journals had ever addressed together the issue of charity services. And the two top editors agreed the collaboration may be more significant as a first step in a new initiative to resolve the estrangement between medicine and law that has kept the two professions at loggerheads.
No Official Policy
The collaborative call for more free help for the poor--which doesn't, however, represent the official policy of either the AMA or ABA since editorials in the journals do not reflect the position of the publisher--was issued by Dr. George Lundberg, editor of the Journal of the AMA, and Laurence Bodine, the lawyer who edits the ABA Journal.
"The privilege to practice law or medicine has carried with it the obligation to serve the poor without pay," the editorial said. "Doctors and lawyers today have tended to become overly concerned with their professional incomes and practice efficiencies, but they must not forget their higher duties." The editorial--and law and medicine experts, as well--stipulated that little is known about the amount of time the average physician or attorney spends providing uncompensated care. An AMA study this year estimated that 17.6% of the doctors in the United States provide at least some uncompensated care--averaging 4.4 hours a week. A questionnaire survey by the San Francisco Medical Society found that 7% of patient visits were considered free of charge by 309 physicians who saw an average of 57 patients a week. The group concluded that charity care was worth an estimated $19,000 per doctor per year--though officials conceded the figures may be inflated.
Bodine said 90,000 of the nation's lawyers are known to be enrolled in organized, bar association-connected free services programs, called pro bono work in legal parlance. But though the number of attorneys may be significant, Bodine said the need for legal services among the poor is so great that "even if every lawyer were to work 50 hours for the poor (a year), it would really only cover a small fraction." Bodine estimated that 70% to 80% of the legal needs of the poor go completely unmet.
Both Bodine and Lundberg--whose offices are about eight blocks apart in Chicago--emphasized that their joint editorial views are nothing more than their own. "This is just Larry Bodine and George Lundberg talking," Bodine said. "There may be some people who wonder, 'Who in the hell is Larry Bodine?' But that's fine. I'm trying to get some discussion going. If people join the ABA because of this, that's fine. If they phone up and demand my resignation, that's fine, too."
Lundberg said he was attracted to the collaborative proposal because the majority of the nation's physicians have come into practice since enactment of Medicare and Medicaid and have come to think of care for poor patients as a compensable commodity. "The tradition of physicians giving charity care as a normal behavior has been here," he said, "but the average physician today just hasn't been exposed to it.
Catch Eyes, Tweak Interest
"We think we will catch the eye and tweak the interest and conscience of a large number of physicians who have not historically been involved."
Lundberg said he will begin a regular column of essays on issues directly related to charity care--the first installment was published today.
The collaboration began several months ago when Lundberg called Bodine to suggest a lunch to discuss possible ways in which two of law and medicine's most influential publications could cooperate. Both editors acknowledged that doctors and lawyers have been increasingly estranged in recent years--probably because of growing litigiousness in American society, with enormous growth in medical malpractice court action.
The interaction between Lundberg and Bodine will continue, both men said, with future collaborations likely between the two publications.
"This is a deliberate effort to get the two great old professions of law and medicine to start to work together again in the public interest," Lundberg said. "I came up with this (services for the poor) as a reasonable idea as to something the best instincts of members of each profession should support easily and honestly."