Tuesday, March 6, 2007
America's health care system is fraught with problems. More than 45 million people don't have health insurance. Some doctors say they're working harder than ever for less money. And prevention of disease isn't funded nearly as well as treatment. So why would anyone want to go be a doctor? KPBS Health Reporter Kenny Goldberg tries to find out.
At UCSD Medical School, Dr. Jim Dunford puts his 4th year students through the paces.
Dunford: Okay, this third lady, we saw her. She just wasn't feeling right. We knew nothing about her, she's presumably pregnant. The next thing we know, she's seizing on the table. Who wants to talk this one through? The experts give us….
It will be some time before Lindsay Frost can take part in this kind of discussion. She just started medical school. Frost says she's not concerned about all of the science and medical information she'll have to master over the next four years. It's the challenges of working in the health care industry she's concerned about.
Frost: Knowing that it is there in the future, and it's probably going to become even more difficult for us to deal with, it's a little bit intimidating.
To get up to speed, Frost has been attending meetings of the San Diego County Medical Society. Frost says the experience has been a real eye opener.
Frost: So far I've learned it's much larger that what I expected. Really there's a whole lot more people who go into making medicine what it is, than just the doctors, the nurses. There's lawyers, there's politicians, there's businessmen, I mean the lobbying contingent in Sacramento is huge. And it's very complicated.
Insurance companies, malpractice coverage, disparities in care. These are just some of the issues that doctors-in-training will have to confront some day. And then there are the attempts to reform the healthcare system, like Governor Schwarzenegger's plan.
Dr. Jess Mandel is UCSD's associate dean for undergraduate medical education. He says for years, medical schools concentrated exclusively on building students' knowledge and skills. But Mandel says schools now realize doctors also need to know about health policy.
Mandel: I think there's a lot of feeling in medicine that doctors do need to be involved in these types of decision making, really to produce the optimal outcome, and that perhaps medicine really missed the boat a little bit 20, 30 years ago, by letting others make these decisions that really had profound impacts on the care that patients receive.
Delivering patient care is ultimately what medicine is all about. Yet the realities of the business, like low reimbursements and the high number of uninsured, loom large.
Second year med student Ben Hulley says he and his classmates have done a lot of thinking about it.
Hulley: Almost my entire class came into medical school really enthralled by the idea of helping people. And now, I would say because of all of the problems in the health care system we identify and the classes that we take that focus on these things, the vast majority of us, probably ask ourselves, at least once a week, why we're doing this.
Hulley has decided to leave medical school, and get a PhD in health policy.
Hulley: I've had a long-term interest in sort of just the bigger picture of medicine and just population health in general. I think having a practice is going to be a little small-sided. And so, I think by doing policy and by affecting peoples' lives that way I can have a bigger impact.
Second year medical resident Bart Smoot, on the other hand, thinks he can have a big impact working in family medicine.
Dr. Smoot says he really enjoys working in community clinics, and treating the underserved.
Smoot: From my end, family medicine isn't just about the individual patient, it's about the whole family, and about the community that we're in.
Smoot thinks some form of universal care would be a good solution to America's healthcare crisis. And he'd like to see the system put more money into preventing disease, rather than waiting until people are sick to offer care.
Business wise, Smoot could have chosen more lucrative medical specialties like surgery. But he says family medicine just makes more sense.
Smoot: It fits more well within my personality. Yeah, the returns aren't as good in terms of money, but there are other things besides money that drive medicine.
Despite the shortcomings of the medical profession, there are plenty of people who want to get into it. Take next year's entering class at UCSD, for example. The medical school had 5,500 applicants to fill fewer than 140 spots.
Kenny Goldberg, KPBS News.