The Underrated Profession

 The collapse of a bridge in Washington, DC and the a condominium in Surfside, Florida offered me a new perspective in the importance of the engineering profession. As I begin to prepare for state licensure, I could not help but think about how people within the profession view this position of trust: "Always have a job"; "The headhunters will find you"; "The paper looks good on the wall". Now, engineering for some time has been regarded as the most "9-to-5" learned profession, not the type to throw lavish parties for clients, or work overtime. A select few study research and development from the laboratories of universities, and put it into their practice; continuous professional development is often overlooked. Most, though, prefer work-life balance.

Nor does industry wish for engineering to be a cohesive, comprehensive profession. Architectural and engineering review requirements are being waived on larger and larger building projects, and licensure is generally not required when working on industrial design projects. Builders and manufacturers, in theory, then take on extra responsibility and liability to increase their profit a tiny bit. Thus, everyone is an "engineer" until nobody knows who an engineer is. In contrast, the medical profession has taught the public how to differentiate between a "Medical Doctor" and a "Doctor of Nursing". As a major infrastructure renewal bill nears approval in Congress, it's time for engineers to remember what the profession is about: to ensure public safety in the built environment. 

A New Golden Age of Medicine

Imagine the 1950s in medicine. Within a generation, public health advances had eliminated communicable diseases; medical discovery brought antibiotics, vaccines, and new medicines; and surgeons performed daring operations to correct conditions of the heart and brain. The family doctor was an approachable, respected professional who often performed house calls. With memories of premature deaths and disability caused by now-treatable conditions, people were grateful for the work of medicine.

Ahead of the establishment of Medicare in 1965, the government discovered that some seniors and the chronically ill did face financial difficulty due to medical expenses. In general, though, medical care was affordable for the out-of-pocket payer: Walt Lillehei was the best in his field, and charged just $400 (or $4,000 today) for each cutting-edge heart surgery he performed in the 1950s, and often did not deposit the check, anyway (1). There were fewer healthcare administrators and managers to take a cut from the surgeon’s pocket; in contrast to today, hospitals were run by experienced physicians, not businessmen.

Things changed. Institutional Review Boards for medical research, informed consent for every procedure, the rights revolution of the 1970s (both on the new age left and the religious right), legalization of physician-assisted suicide, and widespread skepticism seemed to slow progress. Research doctors no longer worked in clinical practice. FDA regulations and the threat of massive lawsuits forced a risk-adverse approach to new medicines, devices, and treatments, to the detriment of patients waiting for a cure.

The convolutedness of medical billing forced a focus on quantity over quality, and closed many private practices: few new doctors today imagine opening their own office. Access to healthcare has improved marginally- many Americans remain uninsured and delay medical treatment due to cost. 1 million Americans declare bankruptcy each year due to medical expenses (2).

At some point, things have to get better. Recently, my friend quit his job in finance and went to medical school, following his old passion: he conducted small public-health research projects in high school, and his father is a physician. Operation Warp Speed, the American effort to discover and produce vaccines against COVID-19, was a demonstration of new prowess. The leading vaccines use mRNA research, which had been conducted behind the scenes for decades, and finally implemented for cancer treatment ten years ago. It is being released to the American public on Emergency Use Authorization: a breakthrough of red tape. Due to the costs of approval, promising treatments for small populations and the developing world had been left to wither, as there was no commercial viability. Hopefully, the new public focus on medical research and clinical trials will push government officials to do what is right for patients. This could be the herald of a new golden age in medicine.

 

(1) King of Hearts, book by G. Wayne Miller

(2) Medical Bankruptcy Statistics (thebalance.com)