Writer-in-Training, Columnist and in-Training Staff Member
Philadelphia College of Osteopathic Medicine
Aishwarya is a second year medical student at the Philadelphia College of Osteopathic Medicine. She relishes any opportunity to talk policy, social determinants of health, mental health parity and inclusion topics. Outside of school, Aishwarya enjoys yoga, green tea with lemon and copious amounts of dark chocolate.
Doctor of Policy
Doctor of Policy is a column dedicated to exploring and challenging contemporary health policy issues, especially in the fields of behavioral health, health care access, and inclusion, all from the eyes of a public health girl in a basic sciences world
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.
How can doctors-in-training integrate policy change with patient care? Matt, a fourth-year medical student in Philadelphia deciding whether to pursue clinical medicine at all, shares his divergent path through medical school that involved taking two years off. He reflects how his work with the government on systemic health care issues and later in medical communications informed and reinvigorated his work on the wards.
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.
As health care reform begins to take hold in America, we are beginning to see some significant departures from our “ways of old.” The new forms of payment that are taking hold seem so foreign to us because they are in direct opposition to our past system. Our previous method, primarily fee-for-service, was one where there was an incredible amount of wiggle room for what payments should be. Individual hospitals or practitioners would negotiate with an insurance company as to what their reimbursement should be for a given service or procedure. This has led to enormous disparities in what individual hospitals may receive for the same procedure and the same outcome.
To begin our examination of doctors’ salaries, let us first look at the real cost of becoming one. According to Medical School Admission Requirements (MSAR), the data warehouse for medical school application services, less than 60 percent of all applicants to MD programs are accepted.
On November 22, several hundred premedical and medical students gathered at the Northwestern University Feinberg School of Medicine for the American Medical Student Association (AMSA) Training Grounds. It was the second Training Grounds sponsored by AMSA this fall, with the topic of “Leading the Change in the Culture of Medicine.” Although a popular topic being addressed throughout all of medical education, Dr. Jeff Koetje, AMSA’s Education and Research Director, clarified that AMSA Training Grounds is unique. “These conferences provide a safe place for students to learn about these topics away from their home institution,” Dr. Koetje said. “Students can come here and discover that they are not alone.”
“Which one of you idiots gave my patient a homosexual dose of diuretic?” Unbelievably, this is what the senior surgeon “growled” at Dr. Pauline Chen and her cohort during surgery training, according to her article in The New York Times entitled “Does Medicine Discourage Gay Doctors?”
With all the recent advancements in the field of technology, every major electronics company is eager to develop the “next best thing.” Currently near the front of the technology boom is Google with the development of Google Glass.
Contributing Writer
Drexel University College of Medicine
Branden is a Class of 2017 student at Drexel University College of Medicine.
