Health Care Catapulted to Forefront

A word to students, residents, fellows by Kavita Shah, MD

The last several months have been exciting for those of us in medical school and in training. As the medical system rapidly changes, the system we will enter in a few years will be profoundly different than what we know today. This shift was made evident by the passage of the Affordable Care Act, the growing acknowledgment that we are facing a physician shortage, and the push to bring politics into our exam rooms.

The landmark passage of health care reform in 2010 and the selection of Rep. Paul Ryan (R-WI) are sure to catapult health care into the upcoming November elections. While the passage of the ACA will improve health care access for millions of Americans and increase insurance coverage for preventative health services, the legislation did not touch on many issues central to us as students, residents, and fellows. For example, we still desperately need to reform the student debt program. Mounting evidence shows that our generation of trainees leaves school with far more debt, which in turn affects our choice of specialty and practice location. Still other problems— undergraduate medical education curriculum renewal, resident physician shortages, and lack of malpractice and tort reform, remain unaddressed.

A Great First Step

On a more positive note, HR 6352, “The Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act,” was recently introduced by Rep. Aaron Schock (R-IL) and Rep. Allyson Schwartz (D-PA). This bill acknowledges the shortages in graduate medical education and increases the number of residency slots nationally by 3,000 each year from 2013-2017, for a total of 15,000 additional slots. However, one-third of these new slots would only be available to training hospitals currently over their cap, so the actual number of new house staff eligible to train would still be less. This federal bill is a great first step in the right direction, acknowledging our growing physician shortage as well as constrained opportunities for further training of medical student graduates. However, the bill would require adjusting Medicare Indirect Medical Education (IME) payments by 2% based on a hospital’s quality and performance measures. Because two-thirds of graduate medical education is funded by IME, the bill proposes an interesting but potentially thorny method of addressing the physician shortage and quality and performance of our teaching hospitals.

Not the Role of Lawmakers

Finally, the past year has brought an unprecedented number of attacks on the patient-physician relationship. While many of these attacks have focused on reproductive care and, thankfully, have been unsuccessful, all trainees and physicians should be alarmed. We students and physicians must stand united. It is not the role of politicians to mandate what physicians must counsel their patients. In many cases, they mandate that we counsel them with medically inaccurate information. It is not the role of lawmakers to require us to perform medically inappropriate tests on patients; and it is not the role of politicians to intrude on our sacred patient-physician relationships and our autonomy within the confines of our exam rooms.

For all these reasons, it’s more important than ever for us to stay active and involved in organized medicine and continue to advocate for our patients and ourselves.  

Dr. Shah is co-chair of the Chicago Medical Society’s Resident District, and is also a CMS trustee from the District.