A FEW months ago there was a list of forty-three calls for physicians needed to fill current overseas mission assignments. In order to meet these urgent needs the General Conference utilizes the regular recruitment services of its secretarial department, but in addition it employs two physicians as associate medical secretaries who devote their full time to searching out potential missionary appointees from among their fellow physicians.
Despite this considerable effort, the General Conference at its 1965 Autumn Council voted to appeal to the local and union conferences in North America to render every possible assistance in recruiting medical personnel from their respective fields for overseas service. This action was preceded by a preamble which stated that "the Seventh-day Adventist medical work overseas is at the present time facing personnel shortages of critical proportions, causing the actual closing of medical institutions and the threatened closure of others."
An alarming situation, and a puzzling one as well, especially for a church in which the medical missionary work is to be "a great entering wedge," "the pioneer work of the gospel," and "the right arm of the third angel's message"!
How can there be so many unanswered calls for doctors? What about the graduates of our own medical school at Loma Linda? Why aren't they going out to foreign mission service? These are questions that our leaders and our lay members alike are asking, and they are particularly pertinent questions in view of the large denominational investment currently being made in Loma Linda University. We might answer that some of the graduates of our medical college are responding to the call but in inadequate numbers. We might point out too that the needs are so great because so many of those who do go out to foreign mission posts return to the homeland too soon. In recent years, because of the desperate physician shortage, there has been a trend to accept physician appointees for less than a full term of service. Some have gone out to the field for only a few months to relieve a critical situation and they have been followed by a succession of other physicians who stay for similar short periods. This stopgap emergency solution to the chronic physician shortage has not only created problems in the field such as inefficiency of operation, lack of effective continuity in service, and excessive expense, but has also imposed upon the denomination a great burden to attempt to supply all the physicians needed to keep up with this rapid turnover.
The problem as here presented is an exceedingly complex one that defies any easy solution, but an answer to the dilemma must be sought. I would like to suggest that an important approach to a solution might be found in a reassessment of the physician's role in the organizational structure of the church and a reappraisal of the fundamental objectives of the medical missionary work.
"Spiritual Esprit de Corps"
One of the towering strengths of the Seventh-day Adventist Church has always been its remarkable organizational and fiscal structure, which has been a marvel to other religious bodies around the world. In many denominations the minister has an unusual degree of independence not only in the scope of his theological beliefs but also in his economic opportunities. A seminary graduate may begin his ministry in a small-town parish that is barely able to provide him with a subsistence salary. Should the young man excel in his calling, he may look forward to larger and more prosperous churches and may finally be called to accept the pastorate of a large metropolitan congregation that offers him a handsome salary with generous extra benefits.
In our organization, however, there is a more centralized authority that coordinates the appointment and distribution of workers on a more equitable basis of need and disburses salaries according to certain fixed standards that lie within relatively narrow limits. This type of central control has had a leveling and unifying influence upon the church and has given it a stability and strength that have enabled its relatively small staff of workers to carry on an enormous world program of evangelism.
Because of this closely-knit organizational structure, the individual worker necessarily loses a certain degree of independence. This loss, however, is more than compensated for by a distinct gain in economic security for the worker and (which is more important to our present study) by his involvement in an emotionally satisfying spiritual esprit de corps. The worker is not committed to personal position and monetary rewards or even to a local congregation of his choice but to a higher loyalty, the remnant church, the organization of God's own devising with its great world view and mission.
Furthermore, this well-integrated organizational plan provides the church with a high degree of controlled mobility in the deploying of its working force. In other words, the system gives the church a large personnel pool, a reservoir of workers from which it can draw to establish pioneer work, to strengthen existing programs, or to reinforce a deteriorating situation. For example, if an evangelist is needed in Venezuela, a successful soul-winning minister in Kentucky may be sent to take the position. A science teacher is needed for Sierra Leone? A New England academy has just the man. A business manager for a mission hospital? A Colorado sanitarium supplies the need. In each of these examples the worker was already a salaried denominational employee with established tenure and service record as well as a career-commitment to the denominational organization. He was free to change his geographical location without significantly altering his previous or future worker status. He is still a part of the worker pool in his new overseas position, and should he be required to leave that post of duty because of sickness, educational problems, or an international emergency, he may confidently expect that the denominational organization will relocate him in another overseas or homeland position. His salaried status, his service record, and his personal commitment to the organized work of the church are still unchanged.
Now, what of the physician? Where does he appear in the organizational scheme? Clearly the pattern changes. Where is our ready pool of denominational physicians? Unfortunately, we must look in vain.
In order to understand the physician's position more clearly let us take a hypothetical medical student at Loma Linda University. Throughout his twenty-five years of denominational education and indoctrination in the home, in the church, and in the school he has had a goal of dedicated service to the church kept ever before him. Now in the midst of his medical course he takes stock of his situation in order to lay specific plans for his future. As he makes his decisions what are the possibilities open before him? What are the factors he must consider? What examples and influences mold his decision?
It quickly becomes evident to him after a little observation and inquiry that there are basically only two possible job opportunities for physicians in the denominational organization. The first is a position on the medical school faculty. Clearly this is a door open only to a select few, those whose abilities and interests qualify them for the rigorous discipline of academic medicine, teaching, and research. If our student does not find such a future attractive to him, he can consider the other alternative, foreign mission service.
Before our young doctor-to-be has reached this point, however, he has been repeatedly impressed with one obvious fact. Most of the medical graduates of Loma Linda University go into the private practice of medicine, and the pressures brought to bear upon him to follow in the footsteps of his predecessors are well-nigh irresistible. Consider the facts:
I. The Influence of Faculty Members
Most of the instructors that the student meets during the impressionable last two years of his formal medical education are in private practice. Even the great majority of the "full-time" faculty members have part-time practices that bring them additional income from patient fees or from percentage-based commissions. The knowledge that the salary of the teacher-physician (particularly in the clinical sciences) is considerably in excess of denominational wage standards, the student sets the stage of his mind for the developing concept that the physician is different from the "regular" denominational employees. He apparently is not subject to the usual policies that govern other workers. The student observes, too, that even a physician's personal deportment and his attitudes toward Christian standards are not critical factors in maintaining his faculty position provided he is professionally and academically competent. Such observations portray to our student the denominational image of the physician and help to shape his own image of himself as a physician.
2. The Physician and the Adventist Medical Institution in the United States
Not every physician is suited for or interested in foreign medical work, even though he sincerely desires to be connected with the denominational medical program in a very real way. There was a time when such physicians could join the staff of one of our sanitariums as a salaried denominational worker but this opportunity is now in the past. Our institutions today are essentially community hospitals (and sizable ones at that) where private practitioners, Adventist and non-Adventist alike, can admit their patients for hospital care. Under this new arrangement the Adventist doctor is not a bona fide denominational worker like the nurse, the accountant, the chaplain, or the physiotherapist. Again our student sees the difference. The physician does not belong in just the same way as the other workers do. Limitations of space do not permit us to enlarge here upon this subject of denominational medical institutions. The writer has treated this subject in more detail in another paper, "Hospitals Versus Sanitariums," published in THE MINISTRY in June, 1966.
3. The Appeal of Denominational
Not only do our present Adventist medical institutions offer few if any full-time denominationally salaried positions for physicians but there is no appeal to join the local conferences in any position other than as an independent practicing physician. The student can only wonder, too, at the type of inducement not infrequently held out to him to join a certain conference—"Ideal practice location. Good church school. Excellent recreational area with good hunting and fishing. Previous doctor netted $25,000 a year." Is it any surprise that our student asks, "Is that what they think of me? Is that what they believe my objectives and motives are?"
With all these facts seething in ferment in his mind, our student returns to the subject of mission medicine, which he has all along considered as his real goal in life. These other unpleasant and somewhat incongruous ideas had only intruded themselves upon his consciousness momentarily because of the forcefulness of the observed facts. Now that they have come, however, they have a way of persisting. They are not easily dismissed but keep coming back to haunt him in his decision making.
"Why," our student asks, "are so few going into mission service? Can it be because they feel they do not really belong to the denomination? The opportunities are so few, the future so narrowly circumscribed. . . . And if I do go into foreign service, what then? Suppose I have to return to the States to take care of mother, or to educate our children. Where shall I go?"
Practical questions, these! After ten or fifteen years of denominational service overseas where does a physician go when he returns to the homeland? There are virtually no denominational positions for him to fill. His service record is broken or ended, his intimate association with the denominational organization is over, and his denominationally-based financial security is gone. Obviously he must go into private practice. He must virtually start at the bottom again and start a new life independent of his former employing organization and do so at the age of forty-five or fifty years of age. Ironically, this situation even holds true for missionary physicians who were ordained to the ministry overseas. They too have been dropped from the organization simply because there were no positions available to them!
This is the dilemma that faces the medical student and graduate physicians too. Perhaps the student has not consciously thought through all these points to arrive at this logical but enigmatic conclusion, but the result is the same as if he had. The physician's vital role in the denominational organization has never been clearly and fully defined for him, and thus by slow attrition, doubts and uncertainties erode away his commitment to the work of the church. Because of this uncertainty many who might otherwise happily accept a denominational career go into the well-trodden way of private practice, choosing to make their contribution to the church from outside the denominational framework. Having taken this step they become so deeply involved in personal, financial, and community obligations that it is extremely difficult to get them to break away and enter foreign mission service. They are effectively lost to the church's organized medical program. Many of those who are persuaded to go do so with reservations saying, "I can give a few years, perhaps even one term, but that is all." They are willing to make a time contribution to the church just as they give their tithe and offerings. Never very far removed from their practical judgment, however, is the disturbing realization that they are just temporary workers, who must ultimately get back to their own jobs.
This, then, is an analysis of the problem of physician recruitment for overseas service. Admittedly our search for clarity and understanding of the issues involved has given us at least some sidelong glimpses into some other aspects of our medical program that might profitably benefit from closer scrutiny in the light of our denominational objectives. Indeed, unless the problem of physician recruitment is studied in the full context of our distinctive Adventist objectives and principles there can be little hope that it can ever be solved.
(To be continued)