A good time to be a doctor?

Amid all the voices chiming in on the health care debate, one group of people ought to have a unique perspective on the future implications of reform: pre-med students.
As future doctors, should they be concerned about change, or should they embrace it?

Most agree that costs are ballooning out of control, and that something needs to be done.

However, just like the rest of the country, there is little agreement about how exactly to go about it.

While many pre-med students don’t necessarily oppose reform, they are wary of sweeping changes. It is, after all, a costly career to pursue.

Medical school tuition is currently the highest it’s ever been and is increasing rapidly.
Since 1984, median tuition and fees have increased by 165 percent in private medical schools and by 312 percent in public medical schools.

Some medicinally-focused students point out that doctors make a significant investment studying for many years and thus deserve to be paid well. Investing so much money in a career path that could potentially undergo changes just in time for a pre-med’s graduation from med school is unnerving.

Many pre-med students expect decreased pay in a government-controlled health care system, although such expectations seldom seem to cause a change in career path.
However, in a survey taken by Kaplan, 49 percent of students taking the MCAT cited money as a motivating factor in becoming a doctor, compared with 71 percent of law-student hopefuls taking the LSAT.

Senior Cristiano Piron, a pre-med student, said, “I’m not looking forward to coming out of med school, residency and possible fellowship training with a mountain of debt only to see the earning potential drop significantly, but that’s an inconvenience I am willing to deal with.”

A notable majority of future doctors have other reasons for choosing medicine besides money.

Some IU students have even been inspired while working in foreign medical systems that pay doctors less. One student’s experience as a medical intern in Costa Rica, a country with universal health care coverage, encouraged her to continue in medicine, despite the comparatively low pay doctors receive there.

Other students still strongly oppose universal coverage. A few predict a brain drain of doctors when the U.S. can no longer attract top foreign doctors with high salaries.

Most doctors are now compensated for each service they provide, an incentive structure that some say encourages unnecessary and costly procedures.

But there is a push to change the way doctors are paid, perhaps to merit pay based on “quality of care.”

The hope is that a structure that rewards the best diagnosis using the least resources will help rein in the wild increases in health care costs.

The problem, as several pre-med students pointed out, is finding a fair measure of quality.

A few students pointed out a similar problem in education, where many teachers oppose merit pay because of the benchmark used to define quality, namely standardized test scores.

Others expressed concerns that doctors who are paid on an outcome basis would not accept risky cases where the likelihood of failure is significant.

High on the list of concerns is the impending cost of malpractice insurance. With a lawyer around every corner, doctors “practice defensively,” ordering extra tests to ensure a missed diagnosis doesn’t open them up to litigation, and driving up the cost of care in the process.

So-called “tort reform” has been a major point of contention in the health care debate, with Republicans advocating caps on awards juries can hand out and limitations on the powerful lobby representing trial lawyers leaning hard on Democrats to crush that possibility.

Overall, very few pre-med students feel that reform is a cause for a change in career – at least, as long as medical students were never in it for the money.

Most medical students just hope to be able to live their own dream of practicing medicine – regardless of whatever type of medical system is in place.

“It is known that there is a shortage of doctors and that role is going to need to be filled as the looming prospect of a geriatric baby-boomer generation faces the health care system,” Piron said. “So for someone with a real desire or calling to help patients, I’d say its a good time to go into medicine.”