Since 2007, the arc of my college career has bent towards medical school. During that time, I had always been enamored of the prospect of solving difficult medical puzzles. I enjoy their complexity and the diversity of knowledge it requires to crack them. I was spurred on by shows like House, and if I could take his sheer capacity for problem solving, sans his acerbic disposition, and blend it with the humanity of Dr. “Hawkeye” Pierce of M*A*S*H* fame, that’s the brand of doctor I’d have emulated.
In late 2012, when I finally finished my degree and applied, I didn’t get in. Not necessarily a surprise. Tens of thousands don’t at their first, or even second crack. There’s much competition for a limited number of seats. I had intended to regroup for another go-around, except this time getting certification for medical assisting first for a couple years; the idea being to get my foot in the door and so be able to interact with patients, even minimally. “Bolster the resume” type of work.
Then the Obamacare shoe dropped in 2013, and with it, the realization that the face of medicine was being forced to change quite rapidly. Individual insurance policy cancellations in the millions. Doctor shortages in the tens–and soon to be–hundreds of thousands. Premiums skyrocketing. Shrinking provider networks. All at the same time I faced the prospect of making a long term personal investment of my time and fortunes. What to do, then?
I chose to abandon those long laid plans. Most people entertaining the idea of entering medicine do so with the intentions and hopes of healing people. Saving lives. Cultivating a sacred trust with their patients. And yes, earning a good living. By this point, I was batting a thousand.
But such ideals can only carry one so far, and eventually, they must confront the realities of the system. For me, the reality was rather bleak: face the prospect of a minimum 7 year and a quarter-million dollar investment, all to get into an industry facing upheavals; one marked by rampant uncertainty, and would be undeniably different by the time I finished my training; or, switch gears. Just as I couldn’t in good conscience invest $250,000 dollars in a company whose fiscal stability was in doubt, so too could I not make this investment. I’m out. Many other’s face the same quandary.
The frustrating part of this is that Obamacare was and is an unforced error. No one was screaming for government to swoop in and make scrambled eggs of a full one-sixth of the economy. If it never existed, myself and others would never have been put in a position to make such a decision. I’d be plodding through school right now, just getting my foot in the door, if we hadn’t been cursed with government intervention in health care. That much I know for sure.
This legislation will do nothing to enhance care for those who already have coverage, or for those who stand to gain coverage. Blame several things, starting with our physician shortage. While it’s true that medical schools have responded to the shortage by increasing enrollment, funding for residency programs–administered by Medicare–hasn’t changed since 1997. The result is that a growing number of newly minted MD’s will be clamoring for a unchanging number of residency slots.
Which means that more and more patients will be overwhelming a stagnant pool of new doctors. Your time in front of a doctor will go down as they try to minister to more people. Quality of care goes down. Wait times go up. Obamacare inexplicably provided no solution to this glaring insufficiency. There’s no point in having health coverage if you can’t get health care.
And for those students who graduate med school but can’t get a residency spot? Tough luck. You’re now saddled with massive debt and no way to pay it back. I’m supposed to be comfortable with this possibility?
Beyond the doc shortage, Obamacare is shuffling a disproportionate number of applicants onto Medicaid. According to the Heritage Foundation, on average, Medicaid physician payments are only 56 percent of what private insurance pays. This only discourages doctors from accepting new Medicaid patients, further diminishing access. Under Medicare, doctors face the prospect of deep cuts to reimbursements under that program as well, as the Independent Payment Advisory Board is tasked with cutting spending to meet budgetary goals. This further enhances the burdens doctors face under Obamacare, even leading some to consider retiring early.
Does anyone think that Medicare and Medicaid makes the medical profession as whole–not to mention the state of the nation’s finances– more stable or less stable? If you believe the latter, as I do, then why should anyone expect different from Obamacare, a law engineered to affect not a just a small subset of people as does Medicare (the elderly) and Medicaid (the poor), but the entirety of America’s 315 million citizens?
We’re already seeing that government’s attempts to administer such a behemoth health care law effectively is sending vast ripples of uncertainty and instability through the entire industry. If the house of cards collapses, and I have no objective reason to believe it won’t eventually if we continue our current trajectory, I don’t want to be standing under it when it does. Such is the choice any presumptive medical school student must face.
Given these facts, the study of medicine is just no longer attractive. I’m no Albert Schweitzer, but I could have done people a service. But at this point, I feel I wouldn’t be able to dispense the sort of medicine any good doctor wants to, and Obamacare is solely to blame. A noble profession is dying a slow death, and it didn’t need to. Such is the disease of big government. Obamacare is no cure.