Two Roads Diverged
Doctors. They have existed since in the beginning of civilization in order to continue civilization. From herbal remedies to the first vaccinations and now laser surgery, where is medicine headed? That question can be answered in part by looking at those who are entering the field as future M.D.’s and D.O.’s. The cost of medical school and the approach the newest generation of doctors take toward medicine are two of the most discussed issues in medicine currently.
According to the American Association of Medical Colleges, there has been a steady increase in the number of total applications sent out to medical schools in 2010-2011 (43,919 applicants with an average of 14 applications per adult).This helps to satisfy the AAMC’s 2006 call for increasing enrollment in medical school to meet the needs to bypass the physician shortage predicted by 2020. A February 2014article by the AAMC reporter Alicia Gallegos describes the problem perfectly: “The AAMC’s Center for Workforce Studies estimates that by 2020, the United States will face a shortage of 45,000 primary care physicians and 46,100 surgeons and medical specialists. These estimates take into account an aging physician workforce, as well as the 15 million patients who will become eligible for Medicare and the 32 million younger patients who will become newly insured through the Affordable Care Act.”
Two of the specialist that are most needed right now are orthopedic surgeons and clinical oncologists. Orthopedic surgeons are the physicians that get people back on their feet and keep them active. It is also estimated that the current number of oncologists cannot meet the needs of the public since the number of cancer patients will increase with the aging of the population. Fortunately, cancer patients are also living longer due to amazing therapies, surgeries, and medicines. However, this also means longer periods of treatment.
Just like undergraduate colleges and universities, there are public private medical schools. Adults consider the impending student loans when they choose where to send out their applications to. Most aspiring doctors enter the field because they simply love to help people. While the future paycheck does seem rewarding, the debt terrifies people, especially those who wish to support family members. It is pure logic that specialists make more money: more years of training required and there is more value behind someone who can accomplish a task that few are capable of. Therefore, it does not come as a surprise that aspiring doctors find specialties more appealing. I am not suggesting that they are in the field for the money. (Unfortunately, some men and women only desire a title, money, and praise, but I am not considering them right now.) I am merely piecing together that people jump at the chance to provide for one’s family and get out of debt as quickly as possible with a lucrative job. Can you blame them?
According to a New York Times Wellness article, it is estimated that medical school could be made free for roughly $2.5 billion per year. This is an extremely small fraction of the current health care expense in the country. Is this at all possible? The article also suggests charging doctors for specialty training rather than taking government money. The current training system allows doctors to be paid salaries during their period of internship, along with receiving a stipend if one so chooses to enter a specialty field. Changing this would upset some groups for obvious reasons. However, the lucrative position of a specialist earns a median salary of $325,000, making it easier to pay off loans for the specialty training. (Remember, medical school itself would still be free.)
This sounds all good and wonderful. So why has it not been implemented? Some hospitals that provide training to specialists are not affiliated with medical schools. So now two organizations must somehow work together to send 1 doctor through specialty training. Also, it cannot be guaranteed that medical schools will not raise tuition since there is a new person cutting the check for it.
A 2004 American Medical News article discusses a survey that claims more than half of doctors ages 50 to 65 perceive the younger generation of doctors as being “less dedicated and hardworking.” Long hours and working above and beyond for a single patient was the staple of good medicine. However, the younger generation of doctors feels that turning the practice of medicine into a healthier career is of the utmost importance. Setting boundaries does not mean they are less committed to their career.
This change in mindset is largely contributed to the influx of women into the profession. 2003-2004 saw females making up the majority of medical school applications. Many of these women want it all: a career and a family. Meeting the needs of the community and one’s own children are highly important. More physician assistants are also entering the field. While they are not given as much clearance as doctors due to the extent of training, PA’s still provide a new and efficient way of seeing patients without reducing time with patient contact.
One of the biggest health care discussion is the transitioning from paper charts to electronic health records, which has received much praise and much negativity. On one hand, EHS creates more efficiency in the office by sending scripts faster and keeping patient history in an organized format with like information together under the same tabs. It also holds doctors accountable to check for certain things with their patient because there is discussion of making the EHS public. This could not be accomplished with paper charts.
The negativity lies in the hassle of EHS. For starters, like any computer system, glitches exist. Second, the older generation of doctors who were not taught to function a computer from an early age like younger generations are, the use of EHS actually reduced efficiency. Most of the doctors having trouble are the ones that are also traditionally minded in the practice of medicine. Therefore, they refuse to cut down time with the patient and instead work longer hours.
Over spring break, I had the opportunity to shadow two primary care doctors. One mentioned that an increasing number of residents he trains have been encouraged to focus on taking cost-effective measures rather than taking a holistic approach to practicing medicine. For example, the time slot is set for a reason. Even if the patient wants to discuss something just on their mind, the practice is losing money by the doctor remaining in the room longer. However, the doctor should be in charge of looking out for the entire person.
This is an extremely exciting time in medicine. All of the debates previously discussed have so much depth. Patient care will remain a civic issue as long as doctors remain in practice.
