What is the main conflict in The House of God by Samuel Shem?

Roy G. Basch is a new intern in internal medicine at a hospital called the House of God. He begins his internship under the tutelage of the Fat Man, a second year resident who has some crazy ideas as to how to take care of patients. According to the Fat Man, there are two types of patients: the dying young and gomers. Gomers are elderly, demented patients from outside nursing homes who barely qualify as being human and who, the Fat Man says, never die. Only the young are sick enough to die at the House of God.