Increase In Insured Will Spike Demand For Doctors

Should President Obama's health care proposal make it through Congress, estimates indicate there would not be close to enough doctors to care for the millions of newly insured. That's because America is facing an alarming shortage of primary care physicians. Many doctors turn to specialty practices to pay off massive loans. Host Michel Martin speaks with medical students Dan Henderson and Travelle Franklin-Ford about the decisions they'll soon face as new doctors and what they think should be done to support students and entice new recruits to the profession.

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MICHEL MARTIN, host:

A major health care vote is in the offing that will affect millions of American patients. But we wanted to know how it will affect doctors and those who aspire to be doctors. So we've called now two medical students. Travelle Franklin-Ford is president of the Student National Medical Association. That's a professional organization for medical students of color. She's a student at the University of Wisconsin's School of Medicine and Public Health, where she is a medical student and a candidate for a PhD. She joins us from Wisconsin Public Radio in Madison.

And Dan Henderson, a student at the University of Wisconsin's School of Medicine. He took this year off to work with the American Medical Student Association, where he's currently a health justice fellow. And he joins us from NPR West in Culver City.

I thank you both so much for speaking with us.

Mr. DAN HENDERSON (Student, University of Wisconsin School of Medicine; Health Justice Fellow, American Medical Student Association): Well, thank you. It's great to be here.

Ms. TRAVELLE FRANKLIN-FORD (Student, University of Wisconsin School of Medicine; President, Student National Medical Association): Thank you for having us.

MARTIN: Dan, I'll start with you because you just wrapped up the American Medical Student Association annual conference in Anaheim. And as, of course, we all know that Congress is expected to take up this health care overhaul bill this week. And what are the medical students saying about this? Is this very high on their radar? What are they saying? What were they saying at the conference?

Mr. HENDERSON: Oh, it's very high on their radar. You know, health care reform has been at the top of AMSA's priorities for many years. As a medical student, you know, we're really focused on our values and doing what's right for patients. And there's nothing more painful than seeing a patient who doesn't have insurance, who you have to tell, you know, maybe you could find some money or maybe if you go to a free clinic. You can't do what that patient needs to be better.

MARTIN: And Travelle, what about you your organization?

Ms. FRANKLIN-FORD: Our organization actually looks at health equity and looks at decreasing the number of disparities that affect minority communities. And one thing we're really excited about and hoping the health care bill will address is access for marginalized and minority communities who may not have the high tech facilities in their neighborhoods or people working shift work who can't necessarily get to the physician. So we're excited that those people will be able to receive care.

MARTIN: You feel that - you are optimistic? Well, I guess what I'm wondering is are you optimistic, A, that this overhaul measure will pass and, B, that it will do the job that it's supposed to do by extending care to people who currently don't have it?

Ms. FRANKLIN-FORD: We are optimistic, absolutely. The time is now. I mean, we can't continue what we're doing. The number of underinsured continues to grow. And just more and more people become marginalized because of the cost of health care or the access issues.

MARTIN: One of the things that we've talked a lot about on this program with people who are already in practice is the shortage of primary care physicians. The federal government's Department of Health and Human Service estimates that 16,000 more primary care doctors are needed right now. And that if more people come into the system, there'll be even more of a need for primary care physicians.

And as I understand it, to make matters even worse, the number of med students who go into primary care has dropped in half in the last decade. So I wanted to ask you two - Dan, I'll ask you first, what are your classmates saying about going into primary care? Why is it less attractive than it has been in the past?

Mr. HENDERSON: Well, I'll tell you, Michel, that is such an important question to me. I'm really interested in primary care. And this year has brought that out because I have been thinking about my values and why I went into medicine in the first place. But when I tell my classmates about this, and I'll tell you, my best four friends are going into general surgery, ear, nose and throat and dermatology.

When I tell them I want to do primary care, they either say, really? Or good for you in kind of the same way they might respond if I told them I was going into the Peace Corps or something. You know, primary care is kind of viewed as a sacrifice. And to tell a really interesting story that highlights this, last year - I go to University of Connecticut, actually. I'll correct you, because I wouldn't be a good Husky if I didn't.

MARTIN: Thank you, I appreciate that.

Mr. HENDERSON: So, we're a state school. So all my professors and doctors are state employees. And so their salaries came out last year in a list of the top 250 highest-paid state employees. Now, in the top 10, the first three are Jim Calhoun, who everyone knows is the UConn head coach of the men's basketball. The head coach of football and Geno, who's coaching the amazing women's basketball team. So the top three are in the athletic department. Five more on the list of the top 10 are doctors, and those doctors are infertility, dermatology and neurosurgeon.

So, when you look at that list - and this is 250 docs - at the top, you can see how much these people are making and how much more they're making than the primary care docs. Now, my old adviser in emergency medicine was on the last page of this seven-page list. And my new adviser, who's a primary doc, isn't even on the list. And I won't share anyone's names or how much they're making, but it is about four times less than the infertility doc who was number four on that list. So that's a pretty powerful, you know, sign for people who are thinking about what they want to do with their careers.

MARTIN: Travelle, what about you? I'm going to put you on the spot, as well. What do you think?

Ms. FRANKLIN-FORD: Sure. I think Dan hit it on the head when we talk about values. And for a lot of the students in the Student National Medical Association, you know, we look to serve the communities that we come from. It's been statistically shown that minority students return to their communities to help those people most in need. And sometimes their choices, you know, you don't necessarily go into family practice, but, you know, you join medicine because you want to help people and you have that passion to serve.

And so you definitely a conflict with, you know, your salary versus treating the patients you want to treat, because you have loans and you have other responsibilities that you have to meet after your time invested in medical school. So, it is a concern, but from our end, we're optimistic about, you know, some of the reform and increasing slots for primary care, increasing incentives for primary care and really looking to preserve our passion for this area.

MARTIN: You know, one issue that has been - that has gotten a lot of attention recently is just the level of debt that many medical students are graduating with. At least some - that there are some people graduating in the range of $200,000 in debt. And I wonder, Dan, does anything in the health care overhaul bill address that?

Mr. HENDERSON: Well, you know, there are a couple of great things in the health care bill that I hope will be retained. One of them is the National Health Service Corps, and this is a program that basically helps med students by excusing, or rather, forgiving their debt if they go into an underserved area in a field that's needed, particularly things like primary care, psychiatry and OB/GYN. You mentioned debt. You know, the average right now in the last year's class is about 150, $160,000.

I mentioned I go to a state school, and I actually get about a 40 percent break on my tuition because I'm a Connecticut resident. But I'm still paying about $50,000 a year. So, over four years, you hit it right on the head. That's 200 grand. I mean, that's a big thing to be carrying around on your shoulders when you're looking at, you know, what you want to go into.

And I'm lucky. I have parents who can support me for the extras that I need to get by. A lot of people are kept out of the profession of medicine, particularly people from underserved communities who would really benefit the provider workforce if they could go into it.

MARTIN: That's one other question I had for you, Travelle, is that - I'm guessing, I'm speculating here - but the number - the numbers of your association, other students may be the first in their families to go to college, let alone the first to get a professional degree. And I'm wondering if you all ever talk about that, about the - sort of the tension between wanting to do well and wanting to do good.

Ms. FRANKLIN-FORD: Oh, absolutely. And we definitely encourage Title 7, Title 8 programming, which puts more funds into pools like the HRSA or Health Corps or even other pathways, nontraditional pathways into getting into medicine, including Peace Corps and AmeriCorps. So...

MARTIN: But I'm asking more on a personal level: Do members of your association just find it kind of personally complicated in trying to figure out whether they go to an area which is underserved, which may be an area that they come from, and grabbing for the brass ring of success, as it's commonly understood in this country? Is that a conversation that other students have with you and with each other?

Ms. FRANKLIN-FORD: I think we do have them internally. Thank you for clarifying. I think that's one of the strengths of the Student National Medical Association is that we can come together, because a lot of us have similar backgrounds, and kind of be a support for those outlets, and then get mentors to kind of see what kind of practice we want to have and who we want to serve and how to best customize our interest in policy or outreach or primary care.

MARTIN: And what about you? What are you thinking about?

Ms. FRANKLIN-FORD: I'm actually thinking about surgery. But I want to focus on ophthalmology and do something with diabetic retinopathy and actually help patients who suffer from debilitating diabetes.

MARTIN: How'd you get interested in that?

Ms. FRANKLIN-FORD: Well, because I'm a MD/PhD student, I knew that I wanted to combine my love of research and medicine. And my research project actually allows for drug delivery, and some of the applications are ophthalmologic. And in doing so, we can basically deliver drugs to the eye over a long period of time. And I thought that that was something that I can have an impact on my community with, because I'm basically treating a disease that many African-Americans are debilitated by.

MARTIN: I understood about under half of what you said, but I take your point. It's really important, and you're going to do something about it. So that's fair.

Dan, I want to ask you - I'm going to give you the final word. I'm going to ask you the question I asked Travelle, is: Are you optimistic that the issues that you and the other students who belong to your association care about are going to be addressed and will addressed soon?

Mr. HENDERSON: You know, I think so. I think that we're really getting to a critical point, and I know people say that almost every year. In AMSA, we're optimistic that the health care reform bill is a good first start. We need to go much farther, however.

You know, I think that doctors are technicians and teachers. That's why I went into it. I was doing stem cell research beforehand. But what I really like is the teaching part of being a doctor. That's the only part that saves money. That's the part that we should value, but we're not paying for it. You know, doctors, if you think of the job of a primary care doc like that, you're paying them about half the time, at half a doctor's pay, and the other half at half a teacher's pay. So they end up much less getting paid than specialists.

Now, if we pay doctors for saving money by keeping people healthy, which there is some stuff in the bill to do that. It's called Medical Home - we can end up saving a lot of money for the health care system and making our patients happier because, you know, they won't have to go to the doctor because they'll be well.

MARTIN: All right. Dan Henderson is health justice fellow at the American Medical Student Association. He is soon to be a third-year student at the University of Connecticut School of Medicine. Go Huskies.

And Travelle Franklin-Ford is the president of the Student National Medical Association and is pursuing a degree in medicine and a PhD at the University of Wisconsin School of Medicine and Public Health.

And I thank you both so much for speaking with us, and good luck to you both.

Ms. FRANKLIN-FORD: I appreciate it, Michel.

Mr. HENDERSON: Thank you so much, Michel. And Travelle, good to hear your voice again.

Ms. FRANKLIN-FORD: You too, Dan.

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