The NY Times has just published a fairly fluffy Q and A with Surgeon General Dr. Regina Benjamin. She’s an accomplished physician and leader, but she’s in a virtually meaningless job. The governmental parallel to Paris Hilton and other second-rate celebrities who are “famous for being famous” are Surgeons General, who are “respected for being respected”. Many people will assert that the Surgeon General job is terribly important but then be unable to explain why.
In reality, the Surgeon General is a low-ranking official whose office does not even appear on the main Department of Health and Human Services organizational chart. The SG is not “the nation’s top doctor”, s/he is not even close to being the top doctor in the building where s/he works. The Assistant Secretary of Health position, which is usually filled by a physician, dwarfs the power of the SG in every respect.
When I point this out to public health advocates, they usually become indignant and huff “But Dr. Koop…”. Dr. Koop was and is flat out a remarkable person (and a newlywed at 93!) but he would have been a great public health leader whether he took the SG job or not. And in any event, he came into office three decades ago. Challenge even a political junkie to come up with another important or even memorable SG since and they will usually say “Well, that one who said schools should teach masturbation” and, if they are total political junkies, will also remember “that one who had civil servants do her shopping for her”.
When I heard that Sanjay Gupta was being considered for SG, I thought that made sense, as the job’s only important public function is communicating health information and he is masterful at that. But then again — why become an SG to do that? Someone like Gupta has more freedom and more ability to reach people (and no political constraints and a higher salary) on CNN. He doesn’t need the SG post to do that and society doesn’t need an SG post to get that.
A small but useful reform for this job would be to remove the need for Senate confirmation, which it does not warrant. Make the job a career capstone for a long-term public health corps member who knows the bureaucracy and can make the trains run on time. And let them wear a business suit — everyone since Koop looks like they are about to offer us peanuts, Diet Coke and an inflight pillow.