Why medical students should be passionate about health reform

by Chris Chen

Recently, I stood in the back of a boisterous, packed auditorium as each of our school’s fourth-years received their match letters and proudly announced in front of friends, family, and classmates where they would be headed for residency.

As peers enthusiastically cheered each other, significant others breathed sighs of relief and little kids looked around wide-eyed, awed at the spectacle. As the fourth-years celebrated their initiation into a brave new world, I was struck by how much of medicine is a strict and hierarchical system.  These students were being sent off based on a computer algorithm that had mandatorily assigned them to their residency programs.  The reward for a (young) lifetime of hard work for these medical students was the next step on the long ladder: having gone from pre-medical student to medical student, there was internship, residency, fellowship, and board certification—many more rungs to go.

This strict system of medical education is largely comforting for us medical students. We are scientists, and by personality we like certainty.  By studying and learning in system in which the rules and steps are clearly drawn—in which we know which steps we have to climb on our way to being certified for clinical competency— we can prepare ourselves to succeed within the confines of this structure.

A medical student myself, I sometimes wonder whether our focus and drive to succeed within this strict system undermines our curiosity about wanting to change the world in which we will one day work.  Chatting with fellow medical students at a wide range of schools, I’ve found many people strangely uncurious about the delivery and payment systems that will control our professional lives.  Perhaps we’re just too consumed right now with our medical studies to learn about policy issues not directly related to our current focus; a recent survey of deans found wide variation in the extent of health policy education across medical schools.   Perhaps as scientifically oriented people, we’re just not interested in the complex economics of health policy.  Our perhaps as aspiring healers, we thrive in fighting for clean moral goals—like improving the health of our patients—and don’t like the messy world of politics.  Whatever the reason, the central truth is that we work so hard to become good doctors but don’t work nearly as hard to shape the system in which we are the central players.

Our collective lack of passion is especially critical in this moment.  The dirty little secret of the massive health reform bill is that its failure or success will be largely determined not by the specific regulations contained within but by how well they are executed.  State insurance exchanges can either be powerful tools for individuals and small businesses or they can be gutted structures with little practical utility.  The same goes for ACOs, comparative effectiveness research, and the CMS Innovation Center.  Our willingness to take charge in implementing, in good faith, the ACA’s payment and delivery reforms will shape the future of medicine.

One of the phrases I hate most is “ObamaCare” / “RomneyCare” / “<insert a politician’s last name here>Care.”

Our health care system isn’t our politicians’.  It’s ours, to make or break.

Chris Chen is a medical student who blogs at Progress Notes.

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  • doc99

    The ACA is neither about patient protection nor affordable care. The 16,000 new IRS hires and the IPAB speak volumes. Please D/C the Kool Aid before it’s too late. “To Serve Man” – It’s a cookbook!

  • Mark

    Medical students should be passionate about learning medicine. I have no particular political or economic expertise to add to the healthcare reform debate. I have little hands on experience with how the system actually runs. It’s foolish to think we have much more to add to the debate than the average engaged lay person. Your classmates are not being uncurious, they’re just being modest and realistic.

    • http://Abnormalfacies.wordpress.com Jim

      I tend to fall on this side of the fence. I conduct interviews for my school, and unless a candidate has a degree in health policy, I don’t even touch this topic.

      I really was going to offer my two cents, but I think you hit the nail on the head, Mark. The only thing I would like to add (and this echoes Tom, below) is that many of my friends in school have never held a job outside of being a student – as a group, we don’t really know much about anything.

      I always think it’s best to be a cautious observer before throwing your hat in the ring when it comes to how politics intersect with your career.


      • http://www.dialdoctors.com Dial Doctors

        I have to agree that doctors don’t need to spend time learning how the system works. After all whether or not that patient has insurance, his copay or the hoops he has to jump in order to get care are not important to us. All patients are the same, in theory of course, we want to help them get better. I don’t think what they had to do to get in the hospital should affect us.

  • Tom

    Um, actually, the latest health care bill isn’t ours, or at least not mine. Obamacare works well as a descriptor, because he was the main driver for a poorly thought out, poorly executed piece of legislation. Though I could see Pelosi/Reidcare.

    Agree with Mark, medical students are often dangerously naive, and can lend themselves as props to cynical opportunists. Best to learn all sides of the debate, and who profits, before interjecting yourself in the debate.

  • http://www.1docsopinion.com Doc B

    “Collective” is an excellent word to describe what we are NOT allowed to do. Having been in practice for more than 20 years has left me with the feeling that we, physicians, are treated very much like civil servants. As a group, physicians are one of the last to be allowed to organize to speak with a unified voice. Even Federal employees are allowed to collectively bargain with their employer.

    If you truly wish to have the ability to shape the future of medicine, whether in terms of economics, practice structure or policy, we need to speak strongly, passionately and precisely with one voice.


  • gzuckier

    “The dirty little secret of the massive health reform bill is that its failure or success will be largely determined not by the specific regulations contained within but by how well they are executed. ”
    Succintluy put. I can only quibble that it is no dirty little secret; but rather is a true description of the many complex processes we engage in in real life, which do not resemble a pop quiz where the right answer to the question is defined in the back of the book.

    In fact, there is no perfectly-defined goal we will know we have reached, much less any perfectly defined path to get there. Each door we open merely leads to another set of doors, and so on and so on and so on. Sometimes, we will take the wrong door; but very often you can’t go back, you just have to figure out which of the new doors you face will improve things.

    It appears your equally wise caveat regarding mixing personality issues into the success or failure of something we should all be striving for the success of has fallen on some deaf ears. Perhaps they could be more constructive by explaining to the rest of us how a health plan written in the Senate by Bob Dole, Tom Daschle, and Howard Baker gets the name Obamacare. (On a more partisan note, I am reminded of a cartoon I saw recently: “Well, what part exactly of Obamacare do you object to?” “The Obama part!”.)

    But that just gets us back to the stark truth of American politics; the success of one party requires the failure of the other. Should heatlh care reform succeed under the Democrats, the Republicans will face a huge uphill struggle next election; this is not a novel situation for career politicians, they know exactly how to deal with it. And that’s why it’s “Obamacare”, and that’s why “Obamacare” is such a travesty that must be totally rolled back.


    Ladies and gentlemen, let’s go over this one more time for the newbies.

    We will have ALL of the trappings of EMTALA, 1964 Civil Rights Law Article VI, hospital privilege mandated uncompensated on call services, TORT, reduced payments for services rendered, increased services rendered, increased overhead, ACA aka OBAMACARE by any other name is still a bureaucratic nightmare of compliance black boxes, RAC auditors and the great Medicare take back via the eat what you kill repo-men RAC auditors sold as fraud and abuse recovery, ACOs and their invitation to “share in the savings” what the !@#$ does that mean?

    Here is the really good part….the Republicans with Democrat and reality complicity, will not fund it….but the legal obligation to provide will, to a great extent, be maintained.

    My experience has been that most docs are weak and don’t seem to mind getting bitch slapped with their own hands. I guess I am just tired, angry and frankly disgusted with my peers…but not yet defeated.

    I don’t care how “messy” politics are. Get involved and be tenacious. If no one agrees with your opinions, you are probably on the right track. Don’t look for integrity with your hospital or your politicians ‘cuz there isn’t any. There is however a way to be heard. The US Supreme Court says that the way to be heard is with MONEY. Our system of equal opportunity corruption is open for business.

    The rules are clear. Spend more, get more. Make sure, however, you understand the motives of your dog in the fight.


    Oh yeah. Enjoy your Match Day.

  • Dylan Mann

    The CEO of the largest healthcare system in San Diego County gave a fantastic explanation of the healthcare reform legislation to a room full of insurance brokers and foundation staff that were invited. He spoke for 90 minutes straight and the information was coming fast and furious the whole time. While it remains to be seen how well the federal plan will perform for the country, it’s safe to say that doctors will almost certainly be better off for it. Starting in 2014, 30 million Americans who currently have no way to pay for their healthcare will have the ability to pay for their care. So, doctors will have more paying patients and that will be good for them. In 1965, the American Medical Association vehemently opposed the enactment of Medicare, falsely assuming it would make physicians worse off. The year after it was instituted, the average physician earned 11% more than the prior year. There had been a lot of old people who were forgoing medical care b/c they couldn’t pay for it. Medicare solved that problem for patients and physicians, though there was substantial cost for the American taxpayer.

    At the presentation, the CEO made reference to a tool the Kaiser Family Foundation created. It’s an entertaining and simple animation that explains the tenets of healthcare reform in 7 minutes. http://healthreform.kff.org/The-Animation.aspx

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