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Will a New President Affect Medical Education?

Colinson72x723Colin Son -- In case you somehow missed it, a month ago the United States elected a new President. I’ll spare you my personal politics except to say I’m smiling. I will point out the obvious: it appears we are in for a little bit of a change in this country.

What that might mean for health care is a matter of some contention. Major health care reform is undoubtedly expensive, and the current economic climate may make such reform difficult. At least in one jump. Not that Obama's health care plan is comprehensive; it lacks any serious discussion of how his dream reforms would control rising health care costs.

What I’m interested in right now, however, is what an Obama presidency may mean for medical education. Admittedly, a new president is likely to have less of an immediate impact on how physicians are educated than on how health care is delivered to patients. But there are some things that may change, especially concerning how medical students finance their education.

U.S. physicians earn more than their counterparts just about anywhere else in the western world. But many trainees have to take on substantial debt: nearly $140,000 for the average American medical graduate. The burden of repayment over many years with interest can be substantial, especially early after graduation when newly minted physicians are serving as residents. In addition, medical student debt may be affecting health care in the United States, as circumstantial evidence suggests that increasing debt loads are pushing students away from primary care careers.

Last year in the reauthorization of the Higher Education Act, the federal government eliminated the 20/220 economic hardship deferment for residents, which had allowed them to defer a large portion of their federally guaranteed loans for most of their residency, until they were earning substantially more as fully practicing doctors. While Obama hasn’t commented on the 20/220 deferment, and the HEA isn’t up for reauthorization any time soon, I feel safe in declaring that the potential for new advantageous repayment options is substantially better under the incoming administration than under the current one.

Obama may also need to consider longer term changes to how we finance medical education. His health care plan stays away from calling for a single payer system, but it limits the long-term viability of private insurers and potentially brings federally run "insurance" plans in direct competition with them. While a near future without private health insurers is not inevitable, it certainly isn’t unreasonable to imagine either.

In a single payer system, it would be difficult for the physician lobby and their legislator allies to maintain physician reimbursements at their current levels. In other places, global budget systems have done much to lower health care costs, including physician practice costs, so bringing physician earnings more in line with the rest of the world may not be the catastrophe that some physicians make it out to be.

What would have to happen in such an admittedly hypothetical world, however, is that the cost of medical education would have to decline significantly. If physicians are to earn less, it must cost substantially less for them to be trained.

President-elect Obama has many big issues on his plate as he comes into office. The expectations are incredible, and I don’t doubt that health care reform will get its time. Let us just hope that medical education gets its time as well.

December 18, 2008 in Colin Son | Permalink


Well said - have you emailed this to anyone i the Obama camp? As a single mom in year 4 who wants to go into primary care in an underserved area I often wonder about the debt I have taken on to finish school. I hope the new administration will take steps to examine both the loan debt incured in medicine and the struggles with the rising costs in healthcare while reimbursment rates are declining.

Posted by: Irene | Dec 18, 2008 4:56:48 PM


Posted by: | Dec 23, 2008 4:20:35 AM

Excellent! And I agree with Irene, you should become a health policy advisor for the Obama camp. My debt will thank you ;)

Posted by: | Dec 23, 2008 2:03:50 PM

It always amazes me when a doctor or medical student supports the anti healthcare, anti patient, anti free market, anti personal income, anti personal rights, anti free society Democratic party.

We are not in for "change," but more of the same that we had with every Democrat administration we have had in the last 200 years.

It is scary to me, as a medical student with ethics, what Obama wants to do with healthcare. He wants to permanently take away the rights of unborn patients. He wants to take away the income of healthcare professionals. He wants the government in their ultimate lack of wisdom to micromanage healthcare. He wants to tax those of us paying off massive student loans heavily and "spread the wealth" to people who aren't earning it.

His idea of "change" is also to continue the policies of the last two years of Democratic control of Congress which have gotten us into this financial mess in the first place. These are the same policies that got us into financial messes before YOU were born. I remember, I'm quite a bit older than you are. The "change" is nothing new. It has been tried over and over and has never worked before.

Recap: Obama wants to take away doctor's personal income, make medical decisions for doctors, take away patients' rights, implement policies that will make the current economic crisis more permanent, and tax doctors heavily.

Bad plan. Keep the change.

Posted by: Justin | Dec 23, 2008 4:17:55 PM

Re: Justin's post. U.S. physicians' disproportionately high incomes must be contextualized--our outcomes are sadly inadequate; moreover, capitalist medicine necessarily implies that the money made in medicine represents stolen labor and life from the poor. Your ethics are nothing but egocentrism, and your supposed "pro-democracy" and "pro-patients" stance would only ensure the rights of a privileged few. Not surprisingly, most U.S. physicians are to be counted among those privileged few. Doctors: shame on you.

Posted by: Anon | Dec 23, 2008 10:29:22 PM

As a medical student in England, I must say that Justin is among those who think it will bad to work in a government controlled system. In England most Drs would see it as unethical to work in a medical system where the poorest people can't get healthcare equivalent to the richest!

Posted by: Imogen | Dec 25, 2008 6:23:13 AM

If this Justin is the same person who commented on other blogs, such as "The Difference Between a Nurse and a Doctor," then I fear for all of his future patients. He is the best example of the imperfections involved with medical school admissions; who would let such an egocentric bigot into medical school?

Posted by: Judy | Dec 27, 2008 10:22:50 PM

Thanks to Obama. I now I hope I never make more than 250,000 dollars a year, unless it is 400 thousand a year or more. Other wise someone making 150-200 thousand a year is now equilvilant to the guy down the road making 300 thousand a year. I guess all my hard work won't pay off after all. Thanks Obama

Posted by: Bob | Jan 28, 2009 3:35:07 AM

The future of Americas medical system is going downward. I'm glad that that I have decided not to enter medical school even though I was accepted to three schools. I'm sticking with Engineering. I will eventually make more money with less schooling. Thanks to Obama's agenda. Most people don't realize that without engineers the medical profession would still be stuck in the 18th century because without engineers America's Medical Technology would be non-existant. I just hope that I don't get sick any time soon b/c I probably wont be able to see a doctor within 2 years. I sure am thankful that my wife is a Veterinarian. A real doctor who will always be able to take care of me.

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