National Health Coverage, The AMA, AMSA, etc

The American Medical Association, aka the AMA, said it would cooperate with the Obama administration in an effort to make health coverage a reality. Now they say they do not approve of a nationalized system. Profit appears to be their primary concern. I thought patient care was behind the oath physicians take.

First, let's get something straight. The proposed plan is not a full nationalized system. Those who are happy with what they have can keep it. Those who are not covered because they cannot afford insurance costs can be covered under the government system. It should create competition with the private insurers and bring costs down for all of us. Think of it as capitalism with a government edge. Competition is, after all, healthy and beneficial to the consumer.

The American Medical Student Association, AMSA, has long been a proponent of a single payer system as reflected in their publication, New Physician. It seems that the young up and coming future doctors in this country are at odds with the current AMA bunch. It must be pointed out, however, that not all physicians are at odds with AMSA. It's the AMA which has decided to make the conflicting statement. In other words, the AMA does not speak for every physician, unfortunately.

Let's look at pay under the British NHS, something I know a little bit about after doing my clinicals there. The starting salary for the first year resident equivalent, the house officer, can range from £25,000 to £35,000. Pay increases in successive years. In American dollars, using a rough exchange rate, that comes out to $50,000 to $70,000 a year for someone just starting out. Do our first year residents make that kind of money? No. The cost of living is also higher in England, but residents still do quite well over there. Residents in the US still struggle.

Do No Harm
There is an interesting debate when public health care is framed under the physician's motto, "Do no harm."

In one aspect, covering the uninsured and focusing on preventative care would improve health among our citizens. Depriving our citizens of health care would do harm. It would be in our philosophical interest to make some attempt at serving the community by offering coverage. Doctors will still get paid.

On the other hand, some doctors argue that if we nationalize the health system, they will be forced to treat more patients with less pay. They argue that patient care in hospitals, for example, would suffer as a result of overwhelming workloads. Less attention would be given to each individual patient. While that might be somewhat true under a completely nationalized system, ie: single payer, again, that's not the system being proposed by the Obama administration. This argument against government coverage needs to be modified to reflect the reality of the policy.

When doctors appear like their only concern is what's in their wallets, it makes us out to be those stereotypical money hungry arrogant jerks who care very little about patient care. On one side, medical students are being hit with medical ethics, the importance of a good history and physical, establishing rapport, and learning to be empathetic. On the other side, they are beat over the head that money dictates care.

What would remedy the workload concerns? Let me make a suggestion. There is already a shortage of physicians in the US, yet the USMLE (United States Medical Licensing Exam) passing score requirements have gone up over the last few years making it more difficult to move on from the 2nd year of medical school to the 3rd. Upon graduating, medical graduates must participate in the residency match program, a centralized system where hospitals match up their choices with potential candidates. The NRMP is somewhat flawed in that hospitals only take so many new residents a year. Thousands of potential physicians go unmatched every year. Yes, thousands. Get those folks into the workforce to take some of the load off.

Let's face it guys. Doctors and patients get screwed by the insurance companies. Insurance companies end up dictating how much a physician will make. The 10 minute consultation is a direct result of the demands insurance companies place on physicians. In order for a family practitioner to cover the costs of his office, he has to see more patients per hour in order to get paid by each insurer. It's really a nightmare trying to appease everyone. Patient care suffers as a result. Doctors who spend more time with patients end up providing better care to each individual patient.