As I reach the conclusion of an over decade-long training process to become an internal medicine physician I find myself facing a dilemma I really did not expect. Yet while my training has prepared me to care for the sickest patients, I really don’t understand how to get paid for my work. The long and complicated medical training process does little to prepare young physicians for real world practice where a plethora of insurance, billing, documentation, and pharmaceutical companies prey on naive young physicians.
In the UK, there is currently a dispute over the new junior doctor contract. “Junior doctors” are defined as anyone in training and who is not a consultant. Many have deemed the new contract neither safe nor fair, and despite doctors striking, the Department of Health are intending to impose this contract in August 2016. On April 26, there will be a 48-hour full strike including emergency care — the first of its kind in the history of the National Health Services (NHS) — in the hope that the government will change their mind.
The Ontario government is cutting physician services. Two rounds of unilateral fee cuts, with the most recent on October 1, saw physician fees cut by 1.3 percent. Different from other public sector employees, physicians have a commitment to patient care, limiting their legal and ethical ability to take job action. As a medical student not currently earning a salary — but rather paying $24,000 a year in tuition — and junior member of the Ontario Medical Association (OMA), I can only passively observe the reaction of many doctors in Ontario to these cuts, and the accompanying provincial government’s almost apathetic response.
Recently, Congress passed the so called “Doc-Fix” bill bringing about changes to the Medicare reimbursement structure. Understandably, there has been great confusion about what the implications of these changes are, particularly for future and current physicians. Here are some of the key changes taking place as a result of the bill’s passage.
Whether you’re a first-year trying to survive the last few hours, days or weeks of school, or you’re a seasoned third-year ready to start applying for residency programs, a crucial piece of legislation was just brought to Congress and it’s time to talk about it. As you may know, funding for residency programs has remained virtually stagnant since 1997. While the funding has remained consistent, enrollment in medical schools has increased nearly 30% since 2002. How have we accommodated the increased number of entering medical students in residency training programs?
Vanilla Ice famously once said “Stop, Collaborate and Listen” in his 1989 song “Ice Ice Baby.” To the same token, we all can agree that we do not do enough of collaborating and listening when it comes to the issue of health care reform: it is a complex topic with no easy fix and one which has become divided on party lines.
In the past few weeks, there has been considerable press surrounding needle exchanges and the recently declared HIV epidemic in Indiana.
The first time I talked with my friends about needle exchanges, I had a visceral reaction. “Why would you give people new needles?” I asked, completely outraged. “Isn’t that enabling and therefore doing a disservice to the very people you’re trying to help?”
For patients struggling to stay alive, organ donation serves as a new lease on life. According to the U.S. Department of Health and Human Services, there are 123,358 people waiting for life-saving organ transplantation, yet there are only 13,125 organ donors. While subtle, nominal changes such as changing the U.S. organ donor program from an opt-in to an opt-out program have been proven to increase rates of organ donation, the rising levels of organ demand and stagnating levels of donors indicate that the only way to completely bridge the gap is through tangible and pervasive policy change.
In recent weeks, President Obama signed the Clay Hunt Suicide Prevention for American Veterans Act, a landmark step in promoting access to services and in supporting efforts to reduce deaths by suicide among veterans. Nearly 20 percent of deaths by suicide in the United States each year are by veterans, particularly veterans who served in active duty and combat.
What I have learned along the way is that many people find policy boring. Maybe they associate it with clips of C-SPAN they watched in middle school civics class, or perhaps it evokes the frustration felt when yet another health policy dies a silent death on a Congressional floor, but whatever the reason, policy is ascribed as a responsibility solely for politicians. This presents a massive conundrum because our interests as future clinicians cannot be represented if we are not the ones speaking to policymakers.
No one can deny the heavy price tag of health care in the United States — in fact, we have the priciest health care in the world. Some might jump to the conclusion that this would mean we also have the best health care, since increased spending means increased capacity to provide a higher quality of care, right? But according to the World Health Organization (WHO), we consistently fall short when compared to other nations in areas like life expectancy or speed of health services.
Congress can be frustrating. Beyond political affiliations and tactical alliances, navigating the actual policies created by Congress can be challenging. This causes many people, medical students included, to write off policy as “boring” or “irrelevant” to their careers. For medical students, nothing could be further from the truth. Everything from services covered by Medicare and Medicaid insurance policies to the types of research funded at the NIH are influenced in one way or another by policy. Inevitably, policy does not always reflect the realities of practice. One of the factors contributing to this disparity may be privilege.