Hello again! So here is my next posting on my series in healthcare politics. I wanted to get this up sooner, but my time for thoughtful reflection has been limited these past two weeks. J It’s an exciting time in my practice. I had two new employees start last week who I think are great, and with whom I know my patients will enjoy working. Kristina is my new medical assistant who in addition to her friendly personality and strong medical knowledge, also carries with her experience from two different electronic medical record systems. She is learning eClinicalWorks like a champ, and we are excited to re-establish an osteoporosis center over the coming year because she has experience with bone densitometry from a prior practice. Kristina will continue to work towards a degree in nursing while she works for me. Maggie is going to be taking over a large part of the administrative role in my practice. Maggie has an associate’s degree in accounting and finance, and is going to help manage my practice while she continues to finish her four year degree.
So back to healthcare politics….
The Patient Protection and Accountable Care Act (ACA) is a very complex piece of legislation that President Obama managed to get passed last year. It has been disparagingly referred to as “Obamacare” by many, and has been attacked for certain provisions such as mandating health insurance coverage and encouraging discussions on end-of-life issues (death panels). Now although there is still significant room for improvement within the law, there are some pretty groundbreaking advances that have the potential to dramatically improve the way healthcare is delivered in this country. Unfortunately, our country is very politically divided at this point in time. Certain issues which really should be non-partisan, have been assigned to one political party or another. This often causes legislators from the opposing party to avoid these issues like the plague out of fear of committing political suicide. So we are left with a situation where the Republicans want to repeal ACA, which the Democrats won’t let happen. As a result, the House of Representatives is exerting their power by not funding the programs that were put in place by the ACA. Basically, this leaves our country in political gridlock with a whole lot of nothing happening.
I travelled to Washington DC in May with the American College of Physicians (ACP). This is the primary internal medicine organization in the country, and after 9 years of membership and participation, I was appointed a fellow earlier this year. The ACP is made up of internists from all over the country, and is a group of doctors that practice medicine for very altruistic reasons. One of their primary stances is that healthcare should be a basic right in this country. They are very committed to seeing that the current system changes into one that is not only sustainable, but also provides a rewarding healthcare experience for both the patient and the provider. The platform for any healthcare reform always has to start with primary care.
Some of you may not be aware that there is a primary care shortage in this country that is starting to hit a crisis level. Internal medicine, family practice, and pediatrics are considered the primary care specialties. One could argue that primary care is the hardest field within medicine to do well. This is because of the enormous volume of information your primary care doctor has to manage. At the end of the day, it’s your primary care doctor’s job to know about everything related to your health. We are the “moms” or “air traffic controllers” in the world of the patient. We do all the referrals, field the vast majority of questions, and do most of the patient’s refills. Add on top of these already challenging tasks all the documentation that’s now required by the government and the insurance companies, and it’s easy to see that this job is not meant for the weak of heart.
A bigger reason for the critical shortage of primary care doctors, though, is the fact that they are the lowest paid doctors in the medical world. All doctors pay the same amount for school, but how much they make out in practice is very different. The average medical student is graduating with $160,000 of medical school debt at the age of 30. Given the big income discrepancy amongst primary care doctors and specialists, it’s not surprising that students are choosing to specialize instead of stay in primary care. Today only 2% of medical school graduates are choosing to work in primary care. This is a scary statistic given that 100% of the population needs a primary care doctor. Those of us in Chicago with private insurance may not notice the shortage since we live in an area that attracts primary care doctors instead of a rural area or undesirable part of the city. So we need more primary care doctors, and the Accountable Care Act addresses this issue both on the supply side and the retention side. I’m going to address the supply side in this posting, and we’ll get back to the retention issues in my next posting.
1. The ACA includes a provision for increased funding for the National Health Service Corps. This is a program that repays part of the medical school debt in exchange for working in an underserved area. For every 2 year commitment, doctors can get about $40,000 of loan forgiveness. Note this still means that a young doctor has to live and work in an undesirable area for 8 years on average to pay off their debt. This translates to now having to wait until their late-30’s to live where they may want to, but at least it’s an option for loan repayment which also helps to meet the primary care need in areas of the country with the least amount of access. Currently there are about 7 applicants for every National Health Service Corps grant available. Increasing the number of grants will increase access in the areas of the country that most need it by encouraging medical residents to pursue primary care in underserved areas to pay off their debt.
2. Section 747 of the ACA would increase funding for training in primary care medicine across the country. Obviously we need to make this investment if we want to be turning out enough well trained primary care doctors.
3. The ACA also provides funding for a team of 15 experts who would determine whether the demand for health care workers is being met, and then identify and fix barriers which keep physicians from entering and staying in careers in primary care.
So those are the provisions that will help us to encourage more medical students and residents to pursue careers in primary care. It may not be the most glamorous of the medical specialties, but it is probably the most needed role. As a member of the American College of Physicians and as an advocate for those who do not have access to care, I support funding these provisions of the ACA to ensure that everyone has the opportunity to improve their health and wellbeing through primary care.