Will a New President Affect Medical Education?

Colin 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.