ARI SHAPIRO, HOST:
Let’s talk about a job posting for a doctor to work at an immigrant detention facility in rural Louisiana. This opening has caught people’s attention for a few reasons. First of all, the job pays $400,000 for a doctor with just two years’ experience. And the company doing the hiring, GEO Group, wants someone who is, quote, “philosophically committed to the objectives of this facility.” The facility has a thousand beds for immigrant detainees.
Dr. Ranit Mishori noticed this listing on the Journal of the American Medical Association Career Center. She’s a professor of family medicine at Georgetown and a member of Physicians for Human Rights.
Welcome to the studio.
RANIT MISHORI: Thank you so much, Ari.
SHAPIRO: How unusual would it be for a doctor with two years’ experience to make $400,000 a year?
MISHORI: Well, it’s very unusual, especially for somebody who is a general practitioner. This is way more than I’m making, so the job really caught my attention for a variety of reasons.
SHAPIRO: And you’re living in D.C., a city with a cost of living much higher than rural Louisiana.
The other thing is they’re not asking for a board certification, which usually is a marker for competency of some sort.
SHAPIRO: Explain what a board certification represents.
MISHORI: Board certification are additional exams that people who graduate from residency programs have to take to show that they can deliver the best high-quality care. They’re not asking for that.
SHAPIRO: And then there’s that line – philosophically committed to the objectives of this facility. How do you interpret that?
MISHORI: Well, to me, when I read that ad after the initial surprise about the experience necessary and the salary, this was really very concerning – even chilling – to think about what I interpret to be a loyalty test. This, to me, was a very, very specific example of what we call in medical ethics dual loyalty.
SHAPIRO: Explain that concept of dual loyalty.
MISHORI: Dual loyalty is something that relates to the potential conflict between clinicians’ duties to their patients and their obligations to their employers. When these organizations have sometimes questionable tasks to fulfill, that becomes a very, very serious almost ethical minefield, I would say.
MISHORI: Well, I think when you talk about any correctional facility, especially immigration detention centers, there are a couple of hats that one has to wear. One is to take care of routine medical issues – so somebody has a headache, somebody has an infection, is vomiting. But also, we’re talking about people who are coming with immense trauma, people who may have injuries, people who have suffered from violence. You need to address that in some ways. There’s also making sure that there’s no spread of contagious diseases, that people are being nourished well. So it’s a very big job.
SHAPIRO: Isn’t it important to have the best medical personnel possible in those facilities? Wouldn’t you want somebody extremely qualified to be hired for a job like this?
MISHORI: Absolutely. You would want the most competent, the most compassionate physician that you can find. But those are not necessarily the physicians that they’re trying to hire based on the ad that I was looking at.
SHAPIRO: As you were talking about dual loyalty….
SHAPIRO: …Is there a specific example you can give us to help listeners understand how this plays out in the real world?
MISHORI: So it can start from you being a sports physician, and your star forward is injured, but you want to get her back in play because you want the team to win. So that’s one end. But it goes all the way to facilities where you are withholding treatment as a means of punishment, to giving people medications against their consent and without giving them the right to refuse.
SHAPIRO: We heard some of this at Guantanamo Bay, for example.
MISHORI: Exactly. So Guantanamo Bay is a really good example – also, force-feeding of hunger strikers.
SHAPIRO: And I guess the point is that while there may be black-and-white scenarios, there are a whole lot of gray scenarios, too. And when you’re in the middle of one, it can be hard to tell.
MISHORI: Right. And one of the grayest scenarios is you’re in a facility where you are the doctor. The person comes in for a headache, and you notice that they have scars on their back from being beaten. And you’re not doing anything. You’re not asking questions about it. You’re not documenting it in a chart, or you’re not reporting it to anybody. One of the things we try to teach in medicine is, really, the foundational idea that we need to always act in the best interest of the patient. And oftentimes, these scenarios do not lend themselves to doing that.
SHAPIRO: You can’t just keep your blinders on is what you’re saying.
MISHORI: You should not. People do, but you shouldn’t.
SHAPIRO: Dr. Ranit Mishori, thank you very much.
MISHORI: Thank you.
SHAPIRO: She’s a family physician and member of Physicians for Human Rights. We also asked GEO Group for comment about the amount of experience required and the philosophical commitment noted in the job listing. A spokesperson did not answer those questions but wrote in a statement, in part, (reading) we are deeply committed to delivering high-quality, culturally responsive services in safe and humane environments.
(SOUNDBITE OF LAMBERT’S “MANDAL”)
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