Tuesday, June 24, 2014

Post-collapse professional credentials

[Guest post by Peter.]

At first sight you may think that this is a nonsensical topic. Is anyone really going to care about your professional credentials post-collapse? Unfortunately the answer may be “yes.” In order to illustrate the problems you may face, I am going to present you with a hypothetical scenario of a physician providing general medical services in an ongoing-collapse or post-collapse environment. The general principles are also applicable to other professions such as nursing, dentistry and pharmacy, civil engineering, etc.



Imagine that you are the sole physician in a large village or small town providing medical services to a few hundred people. You are going through a “slow collapse” scenario where there is no dramatic crash, but services are slowly deteriorating. The electricity supply is intermittent and the telephones, television, internet and banking ceased to function a while ago. The postal service is slow and unreliable but you can still tune in some radio stations. These tell you that there is fighting and civil disorder in some parts of the country, but your area has been relatively spared and remains peaceful.

You provide basic medical services to the community, doing the best you can with what you have. These include minor surgery, suturing wounds, setting broken bones, delivering babies, using herbal medicine and comforting the dying. You also provide the community with public health advice on clean water, sewage disposal and limiting the spread of infectious diseases. There is little paper money in circulation and you are mostly paid in kind with food, favors and maybe a little gold and silver. There are few supplies coming in from outside the area, and consequently consumable/disposable items like latex gloves, paper towels, plastic syringes and plastic speculum tips are in short supply. Because of the lack of writing paper, you make brief, if any, medical notes, and store most of the information in your head. You sterilize and re-use most of your surgical equipment. You haven’t been approached for annual subscriptions by your medical licensing board or malpractice insurers for a couple of years, so you have let those lapse, considering them no longer important. Nobody has the time, the money or the inclination to hire lawyers any more anyway. The community understands the limitations on what is available and is grateful for your services.

One day you receive an unexpected visit from representatives of the state medical licensing board. The board’s head office is in the state capital some 200 miles away. The representatives are touring the outlying areas ensuring that standards of medical services are being maintained even in these difficult times. They ask to inspect your premises and your charts, and you comply. At the end of their inspection they state that they are dissatisfied with many aspects of your care. You have not paid your malpractice or licensing board subscriptions. You are not using sterile disposable items. You are not keeping adequate records. You are setting fractures without taking x-rays. You are growing opium poppies and preparing opium for medical purposes but you do not have a license to do this.

The representatives of the board inform you that you have 14 days in which to remedy all of these deficiencies, failing which your medical license will be revoked and you will be required to close your practice.

What should you do? Here is a suggested 9-point plan.

1. DON’T PANIC. Similar scenarios have probably been played out many thousands of times during this and other collapses. There are multiple ways out of this dilemma. What you are observing here is the struggle between the dying old order and the emerging new order. Slow collapses are messy and confusing because people are unsure of who is in charge, what rules apply and what their roles should be. The old order is like a fatally wounded dinosaur: doomed, increasingly irrelevant, but still dangerous until it is completely dead.

2. Maintain the four C’s: stay cool, calm, collected and courteous. There is nothing to be gained by appearing angry, rude or flustered. Be cooperative. These people are here to do business with you and, like it or not, you will have to do business with them. Tell the board representatives that of course you understand their concerns, and any misunderstandings or defects in performance will soon be rectified. Offer them your hospitality. Smile a lot. (People rarely hit a man who is smiling: they might cut their knuckles on his teeth.) Tell them you need a little time to sort things out and to wait while you go and speak to some people.

3. Comply with their requests if it is possible to do so. In normal times the medical licensing boards do a reasonably good job of maintaining medical standards and protecting the public, and they deserve the cooperation of practitioners. However, these are not normal times, and in the scenario I have outlined, it is not possible to comply with the requests because there is neither the money nor the materials to do so.

4. Try to establish the facts. In times of slow collapse and increasing lawlessness, things (and people) may not always be what they seem. Your visitors may indeed be representatives of the medical licensing board, as they claim, and the board may just be out of touch with reality. Or they may be former employees of the board who have discovered a lucrative sideline in extracting money from physicians. Or they may be con artists with no connection to the board at all. Your response may have to be tailored depending on the reality of the situation. But you can’t rely on the facts being what your visitors say they are: try to verify them from third party sources (see Step 5, below).

5. Recognize that this is a situation you cannot handle on your own. You need the support of the community, both for information about the situation and, if necessary, for bodies on the ground. It helps if you already have the support of the community before trouble occurs; in other words, if you have been providing a good service to the community, and they are grateful for it and don’t want to see you go. If this is the case, then go and see whoever is in charge (village elders, mayor, chief of police, sheriff, chair of town council), explain the situation and see if they have any information which could shed light on it (see Step 4, above). Does anyone know these people? Are they who they say they are? Have they visited other physicians or communities in the area and what was the result?

6. If the visitors are genuinely from the medical licensing board, try to make a realistic assessment of what powers of enforcement they have. In normal times, if a physician continues to practice after his license is revoked, this becomes a criminal offence and enforcement is handed over to the police and the criminal justice system. However, if the police and the justice system are locally based and not willing to carry out enforcement, or absent altogether, the board has no power to enforce its orders. Explain the situation to the local sheriff or police chief if you haven’t already done so, and see what his view is. He may be quite happy to throw the visitors in the local jail, under a charge such as the all-purpose “Vagrancy with intent to commit a felony,” and release them once they come up with the requisite paperwork to certify your practice as fully compliant with their demands.

7. If collapse is quite far advanced in your area, the ultimate person in charge may be local representative of an organized crime syndicate, who has extensive (although informal) powers of persuasion, enforcement and protection. Let’s call him Mr. Big for short. His people may already have approached you and persuaded you to purchase an insurance policy of sorts; if not, it may be time to inquire about their services, because it may soon be the time to make a claim on that policy. If you feel squeamish about this, you need to overcome that squeamishness; these are different times and you need to adapt to the new ways of doing business, or perish. Go and see Mr. Big and explain the situation. He will probably be eager to help because, as a matter of principle, he can't allow outsiders coming onto his turf to interfere with his clients. Also, he won’t want to lose a paying customer, and he won’t want to lose a physician who is a useful resource to him and his men. Lastly, his men need something to do, to keep them in practice. However, having informed him of the situation, do not make any specific suggestions or requests. Instead, tell him that you still hope that the matter can be settled amicably. If he laughs in your face, don't argue.

8. Now report back to your visitors. The exact conversation you have with them will depend on the information you have been able to gather and the resources available to you, but it will probably be something like this. Tell them that although you would like very much to comply with their requests, unfortunately the lack of money and materials makes it very difficult to do so, and request their patience and understanding. Tell them that, even more unfortunately, their visit has come to the attention of some very influential locals, who are not happy about the situation. Tell them that you will do everything you can to ensure their safety, provided they leave, but if they choose to return, then all bets are off. Say that you would be very grateful if they would give you a good inspection report and recommend to the board that your license be renewed. Make it look like a win-win situation all round. Keep smiling (see Step 2, above).

9. Ideally, this business should be concluded with Step 8. There should be no need for any physical unpleasantness, which should be kept as an absolute last resort. However, if all else fails you may have to return to Mr. Big, explain that despite your best efforts, the business could not be concluded peaceably, and call in your insurance policy. It is then up to Mr. Big, as a matter of principle, to find and negotiate an equitable settlement with your visitors' “insurer,” provided they happen to have one. And, in case they do not, be sure say a prayer for them.

Although the discussion above used a medical practice as an example, the exact same principles apply in most other professional activities that currently require licenses, certificates, liability insurance and memberships in professional associations.

20 comments:

Samantha said...

An interesting mental exercise. It points out the need to be of use to someone in some way... the more people who see you as useful, the more support you will have dealing with problems of all sorts and the easier your life will be post-collapse.
I expect collapse will bring new meanings to the label 'useless eater'.

Eddie Tennison said...

Interesting scenario. Since the boards now are hardly able to police all manner of nefarious behavior that actually does go on in normal times, it's hard to see them cracking down effectively in a slow collapse.

But I can see it as an extortion racket. Just like I can see law enforcement turn into an extortion racket. In fact, we are affected by similar forms of extortion already, which under a slow collapse scenario can only get worse.

Right now we see all kinds of traffic violations that once carried minor fines resulting in huge wallet extractions. Traffic fines double in a work zone...and work zones are everywhere.

Car registration, once a small fee...now not so small, and bound to get bigger.

Any petty government bureaucracy will be increasingly under the gun to be self-financing. And just like letting law enforcement keep seized assets, which we already have had for some years, we will see all manner of trumped up fees, fines, taxes and harassment...mostly aimed at getting whatever money there is to get.

Cathode Ray said...

Thanks for the mention of opium poppies. They grow rampant in my area (inland Australia), and are utilised by the locals. Cutting and milking the poppy heads is quite labour intensive and must be done at just the right time. So the favoured local method is to wait until late summer when the heads are very dry. They are then picked and ground up. I wondered where they may have originated and found the answer here: "Under the direction of the Division of Plant Industry the opium poppy was cultivated with varying degrees of success in many parts of the Commonwealth, including Griffith, Bathurst and Wagga, Mildura and Gippsland, Lawes, Margate and Canberaa. Prisoner-of-War camps at Loveday and Hay also grew the poppy...." See page 628-630 of "The Role of Science and Industry" in the Australian Ware Memorial series "Australia in the War of 1939-1945" volume V by D.P.Mellor.

Stephen said...

Sounds like very practical advice. Since I'm not a 'credentialed' person, I don't foresee finding myself in quite this situation, but this advice may be useful in other situations as well.

michigan native said...

Finally someone has posted a thought process that I have been trying to figure out since late 2008, when I suggested to my co-workers of an impending scale back in the healthcare industry

For many years now, ads on the media have been blabbing on about critical shortages of healthcare personnel in this or that field, and so a rash of crank em out quick schools have popped up like acne of a pubescent teenager, turning the shortage into a surplus in a very short time.

As a result of chronic budget shortfalls, a situation will arise whereby management will want to save money and find ways to get rid of us seasoned veterans and hire in fresh green grads for their new reduced pay scale because the state parasites will be feasting on the owners obscene profits trying to stay alive

6 years later, of that staff, only 5 remain. Of the 5, two are presently out on medical leave, both with stress related illnesses. One of them supposedly had a nervous breakdown. The other is seen crying in the bathroom, she has kids and a mortgage to pay, so she has to endure the daily bullwhipping. The other 2 have kissed the attack dogs asses by licking their boots and/or snitching on people the attack dogs want to harass and so are untouchable....for the time being.


Basically, anyone from any department or agency that can find any way to fine, fee, ticket, tax, or otherwise steal money from people and institutions are doing so because they are all broke or strapped for money.

You think the cops on the freeways were on steroids, the state inspectors/regulators are both on speed and steroids. Whereas we would see state inspectors once or twice a year, now we see them once or twice a week. They are mandating that we switch to computerized charting, which is more time consuming, not because it is more efficient but because it makes it easier for them to dig and pry and find issues or problems and fine the places. Looking through charts and hand written documents is tedious and more time consuming for them.

That is exactly what is going on in the healthcare industry right now. Scaling back, more stress, more nursing homes closing and hospitals closing and /or consolidating, with more lay offs and lesser wages for the people who have to put up with being tortured by the plantation owners who are upset because they can't afford their exotic vacations every month or buying yet another Italian sports car for their fleet or the box seats for all the local, pro sporting events, etc. Non stop threats, intimidations, write ups, suspensions, and terminations. The plan of choice is to get the person to quit by switching his or her floor to a new one, with never ending threats, write ups, and harassment. If you quit, they don't have to pay you unemployment.

So I have wondered how they will get any of us to put up with this in a post collapse US? Money will be worthless and they can't pay us, yet I am sure the "you can't pay, so you go without" mentality will continue. The creditors will still demand their pound of flesh. Nobody in their sane mind, no matter how altruistic or kind hearted they may be, will put up with this sadistic game perpetrated by these assholes any longer. The state and governmental agencies had better back off and go away, because nobody is going to get tortured by them and the planation owners for free.

I see a return to folk medicine, herbal remedies, and a vastly reduced life expectancy in a post collapse USA. It doesn't stand a chance of taking off if they don't get the "government knows best" out of the picture (I smiled when the blog suggested they get tossed in jail, although accidentally tripping down the stairs or deciding to see if they can fly out of the windows of the upper floors seems yet more appealing).

donalfagan said...

People Will Talk is a classic film in which a holistic doctor once opened a butcher shop from which he dispensed medical advice to people that didn't trust doctors. The joke was that he preferred to be a doctor pretending to be a butcher than the other way around.

http://peakoil.com/generalideas/how-a-country-dies

I just read an article on Peakoil.com called How a Country Dies. The author expects that our government will expand before it shrinks, and I suspect that all these military vehicles that are being purchased by local police will keep that going for a while. I worry most about losing my house after not being able to pay insanely high tax and utility bills.

Taraxacum said...

@MichiganNative: I am seeing the exact same phenomena in the LTC nursing center I work at in another region of the country, coming out of the higher administration. It's been ramping up for the past year and a half, but really took off about six months ago. One of these days I'm going to walk out of there. I keep thinking the day has come, but just as I start making serious noises about leaving my immediate supervisors on the floor scramble and find some way to keep me satisfied enough to stay, for a little longer.

michigan native said...

I read the "5 stages of collapse" from the energy bulletin in late 08 and now have read everything by Dmitry, James Howard Kunstler, Richard Heinberg, and the late Michael Ruppert.

I started trying to project how this would affect health care workers in 08 and told my colleagues who thought I was nuts that there would be a scale back as a prelude to the collapse of the healthcare industry.

When the state budgets go bust, Medicaid and medicare slashed before they are reduced to nothing, they will close down the nursing homes (which I will admit, is probably a good idea) and have direct care workers take care of them in group homes, the incentive being that they get to live at the place where they work rent free and have access to food and water. That is my prediction for the nursing home industry. It will cease to be. Meanwhile the people that own them don't realize the party is over, and the state trying to steal money in any and every way they can. The victims of this are the care givers and the patients. The government makes it impossible to get all your work done, and the owners will terminate you if you did something that the state parasites cited them for. Bringing in fresh grads for less doesn't always work. The other day, this newbie gave a patient a shot of 100 of fast acting insulin instead of the blood thinner heparin. We had to pump 4 IVs of dextrose and endless tubes of instant glucose to for 2 days to prevent the patient from going into a diabetic coma. Many other horror stories, it amazes me that some of these kids made it through high school, let alone college.

As far as hospitals, that will be one of the institutions that they will have to keep going. How that will play out when there is no money to be exchanged, I still can't figure out. They will have to treat people for free, but offer some incentive to get skilled people to work other than their altruism. Perhaps a generous chunk of food and gasoline stamps, or they will set up living quarters for the workers right next to the hospital when the car culture is eviscerated by the US getting locked out of the international oil trade. This is already gaining momentum and some bill they passed in 2010 goes into effect July 1st this year that many are saying will be the ultimate end for the US dollar.
The insanity of US foreign and domestic policy proves that we are close. Warfare abroad and preparations for warfare at home, as martial law will be implemented.

Tis reassuring in some strange way that someone else confirmed what is going on here in MI, which is one of a growing number of states that are close to bankrupting. It is indicative of the larger collapse that is gaining momentum nationwide, which will likely claim the system of public education and certainly the college rackets and the retirement system. If anyone else told me these things and I didn't work in the field, I would think they were exaggerating or lying. This is clearly not the case.

Your managers scramble to keep you there because if they are short, than they themselves have to work the floor. God forbid the attack dogs should come out of their air conditioned cubicles where they watch tv, go online, or play video games and actually do some hard work.

One of the advantages of walking away is an almost immediate reduction in your stress and misery. You don't realize how much that place takes out of you until you step away from it. Your chronic back pain goes away. your blood pressure goes down to normal from the stroke level it was at when you worked your five 8 hour shifts (but in reality, to get your work done, you forgo your lunch break and stay over an hour or two on your free time to avoid getting written up or fired). If you had gastro-intestinal reflux, the heart burn goes away. Not even the sound of your cell phone ringing off the hook bothers you from creditors if you file for bankruptcy. You can't put a price tag on your state of mental and physical health.

k-dog said...

An interesting vignette but if a really legit inspector saw your doc's practice they'd not be so critical. I've had to go through the American health care system this week and in any collapse scenario fast slow or in between; half the workers would soon be gone. Those who would be gone are those not native born. In collapse scenarios jet-liners wont be flying in new health care workers. We will appreciate all the competent talent we can get.

Real inspectors in a collapse scenario might actually be dedicated to doing 'the peoples work'. A concept which for the time being in America is an anachronism.

Your inspector was sent by a Mr. Big but not the local Mr. Big. And despite a warm handshake and the good wishes of your physician in the conclusion of step eight your inspector might find himself swinging from a tree down by the river road when he leaves town.

But that would depend on how your local Mr. Big is feeling that day.

Blissex said...

«Basically, anyone from any department or agency that can find any way to fine, fee, ticket, tax, or otherwise steal money from people and institutions are doing so because they are all broke or strapped for money.»

In many places, starting with private businesses like banks, employees get a nice commission on every penalty or fee that they can find a reason to put on a customer or license holder.

«You think the cops on the freeways were on steroids, the state inspectors/regulators are both on speed and steroids. [ ... ] it makes it easier for them to dig and pry and find issues or problems and fine the places.»

It is a hard competition:

http://www.rollingstone.com/politics/blogs/taibblog/owss-beef-wall-street-isnt-winning-its-cheating-20111025
«That means that every single time a bank kicked someone out of his home, a local police department got a cut. Local sheriff's offices also get cuts of almost all credit card judgments, and other bank settlements.»

http://www.cnbc.com/id/101342970
«In Stockton,when then city manager Bob Deis warned in 2011 that police layoffs might benecessary, the police union bought the house next to his and immediately began noisy renovations.»
«The police union had also erected a giant billboard welcoming visitors to the ``2nd most dangerous city in California'' with Deis's phone number on it.»

http://autos.aol.com/article/police-usa-traffic-ticket-quotas-budgets/
«The TV news team obtained an email sent from the police union chief Ken Allen to his members in the Atlanta Police Department explaining that future raises will be funded through ticket revenue based on the most recent city budget.»
«In Bethel Heights, Ark., last month, Officer Timothy Brasuell recorded his police chief pushing him to manufacture reasons to make more traffic stops and get his ticket numbers up. Brasuell, reported NBC TV affiliate KNWA, played the recording for the county prosecutor and mayor who dismissed the officer's concerns "as an internal matter."»

Blissex said...

http://www.newyorker.com/reporting/2013/08/12/130812fa_fact_stillman
«Under civil forfeiture, Americans who haven’t been charged with wrongdoing can be stripped of their cash, cars, and even homes.»
«“We all know the way things are right now—budgets are tight,” Steve Westbrook, the executive director of the Sheriffs’ Association of Texas, says. “It’s definitely a valuable asset to law enforcement, for purchasing equipment and getting things you normally wouldn’t be able to get to fight crime.” Many officers contend that their departments would collapse if the practice were too heavily regulated, and that a valuable public-safety measure would be lost.»
«In 2011, he reports, fifty-eight local, county, and statewide police forces in Georgia brought in $2.76 million in forfeitures; more than half the items taken were worth less than six hundred and fifty dollars. With minimal oversight, police can then spend nearly all those proceeds, often without reporting where the money has gone.»
«In Oklahoma, a Caddo County district attorney hired a private company, Desert Snow L.L.C., to train a local drug-interdiction task force. Although the company’s contractors were not certified law officers, they reportedly interrogated drivers and took up to twenty-five per cent of the seized cash, even in cases where no contraband was present.»
«In Hunt County, Texas, I found officers scoring personal bonuses of up to twenty-six thousand dollars a year, straight from the forfeiture fund. In Titus County, forfeiture pays the assistant district attorney’s entire salary.»

The common feature is that the victims usually are poor brown or dark skinned working class nobodies (white skinned middle class people are almost never touched) and that fines, fees, forfeitures are almost always used to boost police budgets and to fund cutting taxes on white property owners.

michigan native said...

Food, water, and shelter as an incentive. Think that is far fetched? They are turning off the water supply to poor people in Detroit trapped in these bombed out neighborhoods with the weeds, rats, and trash infected neighborhoods riddled with scabies and bed bugs and the constant firing of bullets at night.

No money for water, the mean spirited target food assistance programs, and they have money now to build "homeless spikes" to keep homeless people from sleeping in certain "problem areas". A 73 year old Vietnam vet who was working at a Cracker Barrel in TN was fired because he gave supposedly gave a homeless, starving person some token of food. If this becomes the norm, the US will turn into a nightmare beyond anyone's wildest imagination.

No money for health and human services but 5 billion for this pro western maniac in the Ukraine who seems quite willing to sell his people down the drain or put us at risk for WWIII in a vain and stupid, futile attempt to save the US petrodollar. Your tax dollars at work. https://www.youtube.com/watch?v=RzHliHKIULs I am told that poor women in the red was saying something about a cell phone and asked the guy filming the scene to call an ambulance. She dies before help arrives. And then I see John killer Kerry and that despicable wench Hitlery Clinton get on tv and lie about "Russian acts of aggression" and the whores in the US media tow that line and call these people "insurgents". Compassion and honesty are clearly not high on the priority list of most americans.

Getting back directly to the original topic, the government or the local Mafioso, aka "Mr Big". I fail to see any distinction between the two. Both lie, steal, cheat, extort, and don't give a damn about other people. A reference was made about a legitimate state inspector. I was reminded of a joke I saw in Hustler magazine, this guy is walking with a knife in his chest and telling this other guy "He's an honest lawyer. He stabs in in the chest rather than in the back"

Whatever their original mission or purpose was, they have taken on a life of their own and with all these never ending rules, regulations, and paper work, are not in my humble opinion to better care for the patients, but to find ways to fine the facilities. Then management gets on the war path and the victims are the patients and the care givers. Notice the one person who confirmed this stated she was from a different region. We are so terrified of the state, we dare not use our names or locations out of fear that they will try and track us down and take away our licenses for having an opinion or telling the truth.

Credentials in the future. We have to pay to get our licenses renewed as well as take so many units of "continuing education". Now you can do it online for around 20 bucks, in the older days I am told you had to pay hundreds of dollars out of your own pocket to sit at these long seminars listening to some retard tell you things you already knew.

I am reading blogs by Gerald Celente and others which insist all of the gold in the US is accounted for, that the gold Germans entrusted to the fed has been stolen from them. (let us see how eager they are to keep NATO and the EU intact when they find out, along with the extensive spying by the NSA) So what will they charge us for if we have to keep our credentials? What will be the new medium of exchange when the dollar has long since collapsed? Again, I can assure you, no sane person is going to put up with the abuses being perpetrated on us now. The state/government, their fines, foolish regulations that are actually detrimental to the patients, the slave driving managers and attack dogs, and their system of credentialing will have to change radically if they hope to have any healthcare workers left.

Now let's see how quickly FACTA drives the final nails in the coffin of the US petrodollar. It goes into effect 2 days from now.

James Newlin said...

Civil Engineer here. If collapse happens, I don't see that our services will be needed. At least not services we were trained to perform. Houses can be built by amateurs. Civil Engineers are needed for large projects requiring large machines and steel beams & concrete from factories. Everyone today uses manuals & computer programs. Nothing is really done by hand, and people are only trained in industrial processes.

I think there will be a demand for people who can actually build things, not people who have spent a career picking industrial things out of a catalog. I don't see how our training or experience would apply to a world that is not industrialized. I think contractors and home builders will be more useful.

fadingpinko said...

The conjectured narrative is possible , though for physicians , at least in my province ( Ontario ) the governing body would be unlikely to field anybody .
Not that they wouldn't want to , but they are a turgid bureaurocracy and would be knee deep in paper before they got to the door .
One comment above darkly refers to medical malfeasance that escapes review by authority - but what , and how would he know . If they are missing real bad actors it might be because they expend limitless effort on the most pettifogging , legalistic ,public relations driven investigation of trivial crap - no complaint against a physician however meaningless or patently vindictive goes without an essentially unappealable protracted and minute tribunal process .

donalfagan said...

James Newlin, I just wrote about how today we assemble rather than build in an answer to the NYT OpEd about inferior construction:

http://donalfagan.wordpress.com/2014/06/27/inferiastructure/

I suspect that in a collapse scenario, architects will also be supplanted by builders. With CMs, we're almost there now.

James Truong said...

Yes, interesting thought exercise. But, within the "collapse parameters" that Peter describes above, I feel that the idea of governmental inspectors randomly arriving and trying to red-tape the local practitioner's "medical practice" out of existence would be anachronistic and unlikely for two reasons:

1) home-brew opium and no access to radiology suggests severe collapse. Like, REALLY severe...beyond our abilities to scavenge alternatives from the skeletons of the former system. In this distant and unlikely scenario, said "inspectors" would be too busy trying to keep their own families healthy and safe. Professional organizations and licensing, by that point, would be about as common as executive producers for travelling minstrels.

2) In the case where such a scenario of inappropriate licensure requirements are asked of said medical practitioner, given the scenario where an entire community was being usefully served...the appropriate response is...NO response.

a) the Powers That Be wouldn't be in any position to enforce their rules anyways. They wouldn't dare play chicken with the barefoot doctor and risk leaving an entire community without ANY healthcare

b) the Powers That Be wouldn't be able to bypass the army of pitchfork wielding citizens forming a human ring around their village healer



So...given the scenario Peter proposes, I wouldn't be particularly concerned.

James Newlin said...

donalfagan -

I just read your blog post. Not sure where you work, but I'm in DC where construction is booming and you see lots of fly-by-night contractors doing very shoddy work. Things are done to make money as quickly as possible, and quality always suffers. The materials we use today are junk and so much is built for the short-term. We are renovating buildings w/old solid masonry walls, and adding junk engineered wood products with other cheap materials covering over.

About professional credentials -- some of this is very new. Professional engineering only came about after the New London explosion in 1937 where hundreds of children were killed. The oldest engineers today were grandfathered in to get their license.

In a world of collapse where these dangerous industrial products have gone away (assuming the extreme collapse scenario), there will no longer be need for licenses. I think we're still too far away to make guesses about what will happen to licenses. For now, you still need a license to be a professional (doctor, lawyer, engineer).

Eddie Tennison said...

"One comment above darkly refers to medical malfeasance that escapes review by authority - but what , and how would he know?"

Oh, please. In this country, the US of A?

The answer is that it does eventually come to light, but often after the damage is done.

And in a scenario of declining reimbursement and an oversupply of providers, which is common today in areas where folks still have employment, overaggressive diagnosis and over-treatment is a real issue.

I'm a dentist, and it isn't at all unusual to see patients come in for a second opinion, carrying a laundry list of recommended procedures, none of which are necessary.

donalfagan said...

James,

I'm in Baltimore now, but I worked in DC suburbs back in the 70s and 80s. That's when I learned the expression, "Strictly from hunger."

D. Mitchell said...

I have done similar before. Mr. Big usually laughs, because he knows he's got you by the balls or else you wouldn't be coming to see him. Being a doctor wouldn't be so bad, you are more valuable alive than dead...a plus.