19 August 2013

The Future Of Medicine

Recently, Scott and I have been discussing the family doctor conundrum. There is an obvious shortage of family doctors in the United States. Many osteopathic medical schools have, as part of their mission, a goal to help breach the primary care physician gap. Yet, medical students are exiting with an average of $166,750 in loans with up to $300,000 in interest costs and a pay back period of 10-30 years. Not exactly incentive to start a career in family medicine, sending some of the best future doctors on the path to higher paying specialties.

From my perspective Scott has been open to considering all of the specialties he encounters as potential careers; but he has received feedback from too many residents and physicians that he should stray from family practice, as it can't possibly provide a living for families.

Dr. Edwin Leap, an emergency room physician and writer, summarizes this conundrum that medical students are feeling in his address to Clemson University, "The future of medicine for aspiring young doctors":

"With young physicians exiting medical school with debt burdens in the range of $160-180,000, and with reimbursements for their care dwindling below the cost of running a practice, we are fast approaching a breaking point. Physicians with that kind of debt cannot buy houses, cannot easily have children or even automobiles. And opening innovative practices, in which they are business owners, is nearly out of the question. Into that mix, the likelihood that they will have either inclination or capacity to see the poor at a reduced rate (or for free), is next to zero.

It also makes the lower paying primary care positions nearly impossible, unless those positions are supplemented through loan repayment or scholarships."

Sounds like a gloom and doom situation to me.

One of the most frequently asked questions Scott receives when he meets someone new is "Do you know what specialty you want to pursue?" It seems funny that society is also driving students, with their small talk, to aim for a specialty. In these first two years of school, I haven't heard one student mention that they are hoping for a career in family medicine (though, Scott reassures me that there are at LEAST two). I, for one, am disheartened that my future pool of family doctors may not include the most creative and ambitious doctors.

Things may turn around in the next decade. According to recent studies, there is hope that the average salary of family physicians will continue to rise. Dr. Edwin also made a suggestion in his speech that would incentivize a career in family medicine and help with health care costs:

"What can we do? Among other things, we could structure loans to allow physicians to get credit towards those loans at a Medicare rate for each non-paying patient they see. Over a few years, they could work off that student loan debt. The same applies to other physicians in practice, but perhaps without student loans. We could allow them to receive tax deductions based on the same formula for caring for the indigent. A simple solution. It would provide care. It would build good feelings and rapport. And many of those cared for would one day have jobs, and insurance, and become paying patients of those physicians who saw them in their time of medical, and financial need.

This has been suggested by many legislators, but never enacted. It appears to reward the rich. Pity. Doctors, and especially primary care providers, are fast losing their financial power, even as they are considered wealthy. For future physicians to thrive, this perception has to be addressed."

The pressure is mounting. I think I can speak for Scott, though, when I say we're giving all of our possibilities, including family medicine, a fair chance. Starting today Scott is on rotation with a fantastic family medicine physician. We will see how our debate changes.