It is an open secret that the U.S. healthcare system faces a huge issue of how to provide care to tens of millions of new patients following healthcare reform legislation. Combined with the influx of the newly insured is the problem of our aging population, which is sure to strain healthcare infrastructure and exacerbate rising costs.
The goal, and it is a lofty one, will be to address these problems without drastically lowering quality of care or increasing government expenditure. One part of the problem is the massive shortage of primary care doctors that the nation currently faces.
According to the American Academy of Family Physicians (AAFP), the number of U.S. medical students going into primary care has dropped 51.8% since 1997. This drop is occurring while our nation needs to dramatically increase the number of family physicians. The AAFP predicts a shortfall of about 40,000 family doctors by 2020. This means much longer waiting times for simple doctor visits, and lower quality of care as each doctor will need to see many more patients.
A solution that was put forth in a recent New York Times opinion piece by Dr. Peter Bach and Dr. Robert Kocher suggests that the U.S. should make medical school free while charging for specialty training.
“We estimate that we can make medical school free for roughly $2.5 billion per year — about one-thousandth of what we spend on health care in the United States each year. What’s more, we can offset most if not all of the cost of medical school without the government’s help by charging doctors for specialty training.”
The idea, however radical, is intriguing. What better way to encourage people to go into primary care than by providing financial incentive to become a family doctor and disincentive to become a specialist?
Unfortunately, the plan runs into some logistical problems. First of all, the plan will end up costing much more money than originally estimated in order for it to work. This is because there is an existing shortfall of residency positions—a shortfall that will grow in the future. Residency positions are largely funded by Medicare; however, in 1997, Congress imposed a cap on funding for medical residencies which prevents hospitals from being able to increase the number of positions due to financial reasons (Medicare currently pays these hospitals 9.1 billion dollars). Along with making medical school free, Congress would need to garner significant political will in order to increase the funding cap and allow more residency positions to be created.
The most attractive aspect of this plan is that it increases the number of primary care doctors with almost no cost to the government. However, this cost neutrality is gained by charging prospective doctors for specialist training. Once the plan starts working and medical students begin transitioning to primary care, this source of revenue will decrease, which will cause the true costs of the plan, in the long term, to be relatively large. Despite the modest relative cost as compared to total healthcare expenditure, it would be hard for Congress to support and enact a plan that advocates paying for doctor’s education in a meaningful time scale as doctors are some of the most richly rewarded professionals in America (primary care physicians median salary is still $190,000), especially if that plan’s self -sustaining funding model will dry up just as it begins to work.
Something needs to be done about the looming shortage of primary care physicians. The free medical school plan is enticing, but imperfect and– in this political climate– untenable. There are no free lunches in Washington, and it is unlikely that there will be a free medical school plan either.
Photo Credit: Kaiser Family Foundation
