The Wall Street Journal recently ran two articles on the changing tendencies of medicine. The first, flaunting pictures of surgeons and scalpels, proudly and bluntly proclaimed that medicine has more preventable and disguised errors than any other profession. It accused medicine of cheating the system of criticism, and holding itself above efforts to streamline and perfect. The second, dominated by the portrait of a physician, subtly (Not!) remarked on a “doctor to the top one percent.” It told the story of a referral base for the rich and corporate medicine. And it set up a tale of selfish medicine, of exploitation and bureaucracy.
So what’s really going on? Are doctors conspiring to charge higher fees, to spend less time with each patient at the same time as seeing more patients, to neglect admitting mistakes on purpose, to commit Medicare fraud and to reject Medicare patients, all so that they can go home sooner with fatter wallets? Obviously, that’s not what’s happening. There’s a lot of confusion about the Affordable Care Act, also known as Obamacare. The fact is simple — it won’t work, for the same reasons that doctors are already charging higher fees and spending less time with each patient.
Let’s discuss why it won’t fly, at least in the way Obama intends it to. First, define how he intends Obamacare to work: about 25 percent more of the nation will receive the necessary care they deserve, simply because they are human beings. Now that’s a novel idea — everyone deserves care when they’re ill. The problem is where care is coming from when provided. It’s provided by doctors and by individuals.
So, why is that a problem? Training to become a doctor is the single most time, dollar, brain-cell and life-consuming professional development curve since becoming a referee in the National Football League. On average, doctors come out of training at age 32 indebted an estimated $280,000. They work 80-hour weeks (if you think hospitals really follow the new resident rules which, I can tell you from observing, they don’t). And it doesn’t include time spent researching, reviewing charts, doing paperwork and any time “off call” spent in the hospital.
Again, why does this matter? It’s important because medical schools are not increasing class sizes, not significantly increasing nationally in number and not decreasing training requirements. What does all of this point to? By 2015, there is an expected shortage of 63,000 doctors across the nation. Training for doctors isn’t becoming any easier, shorter or cheaper. Couple that with the 44-percent increase (from 50.7 to 73.2 million) in covered patients by 2025, and that spells trouble with a capital “T.” Let’s just wave the white flag now.
Back to The Wall Street Journal articles — what does all of this signify for medicine? It means two things: first, that doctors accepting Medicare will spend even less time with patients. Less time means less engagement, insight and foresight. Those factors add up to more preventable mistakes, since the focus would be on quantity, not quality. Not that the quality would be poor, just that it will be worse than it is currently. Second, it means that a larger contingency of doctors will switch to private practice.
All in all, this symbolizes the fragmentation of medicine by class divisions. It means more low-income patients will wait longer for care, provided that they will indeed, at some point in time, receive it. And it points towards the privatization of the “boutique physician,” who will provide brilliant care for wealthy patients.
Is this S-graph of medicine really what we want? Maybe; most doctors are amazingly intelligent and diligent people, who, despite the obstacles thrust upon them, will pursue perfection as they always have. But to accuse them of selfishness and conspiracy is outrageous. The well-publicized issues of medicine are derived from external pressures, not internal motivations.
I’ve been advised more than once (or twice or three times) not to go into medicine for the money but to do it because it’s “the good fight.” With that knowledge, I refute the fact that doctors are acting solely in their own interest. The whole reason they went into medicine is to care for others, and there was no sudden change of heart convincing all physicians otherwise. I’m all in support of expanding care to the masses, but we need to look at the cogs of the operation as well. Ultimately, we need to redefine how to care for those who care for us. We must care enough about them to let them care enough for us.
Eli Cahan is a sophomore in the Ross School of Business.