The Cure: Remaking Health Care ™
Med students weigh in on health reform
The final health care reform bill will have a big impact on the doctors of tomorrow. What does the next generation of medical practitioners think about the proposed new rules? Joel Rose reports in the next installment of our series, "The Cure."
Medical student Nicklaus Atria at work at the University of Miami Pediatric Mobile Clinic (Joe Raedle/Getty Images)
TEXT OF STORY
Kai Ryssdal: There's word today that the Senate Finance Committee's going to vote on its health-care bill on Tuesday. That's clearly not going to be the end of the health-care debate but to paraphrase Winston Churchill, it could be the end of the beginning. A point of departure for yet more negotiations. Whatever the final bill does looks like, it's going to affect today's doctors quite a bit. Tomorrow's, too. As part of our continuing series, The Cure: Remaking Health Care in America, Joel Rose asked medical students what they think of all the proposals floating around.
JOEL ROSE: With her clipboard and long white coat, Manasa Ayyala could be auditioning for the cast of "Grey's Anatomy" as she examines her instructor's scalp in a classroom at Temple University School of Medicine in Philadelphia.
MANASA Ayyala: So now I'm going to palpate your skull, apparently. OK, so...
Ayyala is starting her second year of medical school. She plans to go into primary care. She recently talked about her choice with her own doctor. Now he thinks she's the one who should have her head examined.
Ayyala: I've always wanted to go into primary care, and just hearing that from my own physician -- don't go into primary care -- is really disheartening.
Primary care doctors earn a lot less than specialists like radiologists and cardiologists. That's a big reason they're in such short supply. The country will need 40,000 new primary care doctors by 2020. President Obama says he'd like to close that income gap. But whether he will is one of many uncertainties about the health-care overhaul.
ISMAR Dizdarevic: We're being asked to make a decision on what we want to do, what kind of career path we want to take, without really knowing where it's heading.
Ismar Dizdarevic is a third-year medical student across town at Thomas Jefferson University. He's wanted to be a doctor since he came to the U.S. with his parents during the Bosnian civil war.
Dizdarevic: I'd really like to be able to work with a refugee population myself. But at this point, it's kinda unrealistic that I'm going to be able to do that.
Unrealistic because Dizdarevic will graduate with more than $200,000 of student loan debt. So he's training to be an orthopedic surgeon. The White House wants to create more programs that forgive loans for primary care doctors. And the administration would like to boost their Medicare reimbursements. But that boost comes at the expense of specialists.
Gary Weissman isn't worried. He's a third-year medical student at Jefferson.
GARY Weissman: And I think in most other countries that specialists don't make nearly as much as they do in the United States. So I think it would be a more equitable system. There aren't any poor doctors anywhere.
There's another big question that divides medical students, and that's whether the health-care overhaul will include a government-run insurance plan, the so-called public option.
GREG Corcoran: It doesn't seem like they're considering much how this reform is going to affect doctors.
Greg Corcoran is a second-year medical student at Jefferson. He's planning to go into a specialty, though he hasn't decided which one. Corcoran opposes the public plan. His reasons may sound familiar.
Corcoran: They're trying to model if after Medicare. But I just think anything left up to the government is guaranteed to have some inefficiencies.
Corcoran also thinks a public plan would lead to lower salaries for doctors. But there are lots of medical students who support the idea, including Beth Hart, a second-year student at Temple.
BETH Hart: Cause that's the only chance of real reform happening. Everything else is just tweaking, and whatever. It's not reform.
Not all medical students have such strong opinions about the health-care overhaul. In fact, lots of the ones I talked to have no opinion at all. They're busy enough just trying to make it through their classes.
In Philadelphia, I'm Joel Rose for Marketplace.
Comments
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From Framingham, MA, 10/13/2009
"ISMAR Dizdarevic: We're being asked to make a decision on what we want to do, what kind of career path we want to take, without really knowing where it's heading."
Who the heck knows where their field is heading these days? I'm a software engineer, and I certainly don't. (Offshore outsourcing, anyone?)
From Framingham, MA, 10/13/2009
Anthony Nguyen, most of the information I've heard about Candians' opinions about the quality of their health care is that they wouldn't trade their system for ours. Also, how do you account for American "health care tourists" who are willing to travel to countries such as India for care? Lastly, whether America has the best high-tech procedures is pretty much irrelevant if we can't afford them because the costs have gone through the roof.
10/09/2009
The easy solution for the Obama administration is to reduce payments to specialists and reward PCPs. This does not correct the issue. Politicians need to address how health benefits are taxed. Subsides make more of an item, taxes reduce them. All government and state workers have premium health care benefits. So what this does is encourage more doctor visits, more treatments more cost, more doctors billing for procedures. If we taxed these benefits, gov't workers would use less (or demand lower coverage) health care. Then they would forgo non-medical emergencies and only go to doctor when they really needed to. In the end, all of us not working for Uncle Sam foot the bill for the premium health care benefits for state and gov't workers.
From Troy, MI, 10/08/2009
How long does it really take to become an attending, a doctor that practices on his/her own? 4 years of college, 4 years of medical school, and 3 to 8 years of residency and fellowship before physicians can earn their salaries. That means that it takes a MINIMUM of 11 years to become a primary care physician and even longer to become a specialist. That is a tremendous amount of training, time, and self-sacrifice that we as American physicians, must make in order to save people's lives. Many of us work 30 hours straight and sleep on hospital cots to take care of our patients (i.e. you and your family). We work as hard as the average working American, but we have much more at stake--human lives. Consider the average salaries of lawyers and investment bankers, who have far less education and training. Physicians tend to get singled out, especially during this current health care debate. Yes, our medical education and training is an investment. It is more than just about our loans...it is the amount of time and effort we spend preparing to take care of YOU. In America, you will get the most highly-trained physicians and the most advanced medical treatments available. Compare this with other countries that provide universal health care, such as the Canadian system. So many Canadians find that their system cannot provide timely treatments for their serious ailments—the line for procedures is just too long. American hospitals in states bordering Canada find themselves inundated with sick Canadian patients who would rather pay full price for their necessary procedures to be done immediately in America, instead of waiting an average of 6-12months to be treated in Canada. This why so many people around the world seek medical treatment in the States, journeying across the globe to be treated by the best doctors in the best facilities available. I ask you this: Are you willing to travel to hospitals across the world when our own country’s health care system is crippled? How long are you willing to wait to have open heart surgery, or a liver transplant, or some other live-saving procedure for you or any of your loved ones? How many lives are you willing to sacrifice?
From sacramento, CA, 10/08/2009
I'm really curious if anyone has run the numbers on how long it takes a MD to pay back their student loans versus other majors. For instance considering the economic rewards of and medical degree verus the pay scale of a teacher. Who really needs the assistance to pay back their loans?
From Pittsburgh, PA, 10/08/2009
Mr Rose never mentions how much primary care physicians make. Nor does he mention how much specialists make. If he were reporting about new autoworkers' or auto executives' reaction to legislation out of Washington, would he have failed to mention their salaries? In a sector of the economy less crucial to life and limb and more subject to substitution, we might conclude that insurance executives and doctors make enormous salaries. Mr Rose has sympathy for a Family Phys. struggling with $200 K debts and, by their 3rd year of practice, pulling down only $135K to $208K per year -- doubling during his or her career. Does his sympathy extend to average working Americans who earn $32K -- you know, the medical transcriptionist, the autmotive glass installers, the floor sanders, the semi-conductor processors etc, etc, etc. The later graduates with an Associates Degree and debts too. Mr Rose, is your classism showing?
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