Being accepted to medical school was once seen as a ticket to a prosperous and fulfilling career, but today's students face far less certain futures under Obamacare.
As the Affordable Care Act faces key implementation challenges in the coming year, medical schools have responded to the anticipated spike in demand for health care by adding thousands of slots. For educators and students, big questions loom as to what the medical profession holds for America's next generation of physicians.
"I would say the biggest problem with the Affordable Care Act for people entering medical school is, 'What is my life going to be like? What kind of living am I going to make?'" said Dr. Beth Haynes, executive director of the Benjamin Rush Society, a free-market doctors advocacy group. "The whole profession is just a political football right now."
The most pressing question is whether there will be enough residency slots to accommodate the growing influx of medical students. A medical school graduate is required to complete a hospital residency before practicing medicine, but training positions funded by Medicare have been capped since 1997.
Another 32 million Americans are projected to enter the health care market under "Obamacare," just as the first wave of baby boomers hits 65, the age at which the demand for health care surges. At the same time, many baby boomer doctors will begin to retire.
The result is predicted to create a gaping national physician shortage. The American Medical Association anticipates a shortfall of 62,900 doctors in 2015, a figure that is expected to double by 2025.
"While medical schools are expanding enrollment to meet future needs, [graduate medical education] positions have lagged far behind," the AMA said in a statement. "As a result, U.S. medical school graduates will exceed the number of available residency slots by as soon as 2015."
In debt, out of work
The bottom line: Thousands of newly minted MDs may be unable to find work as doctors while wrestling with enormous student loans. The median debt for medical students in 2012 was $170,000, according to the Association of American Medical Colleges.
"We're looking at the reality of medical students in 2016 graduating and having no residency programs available," said Christiane Mitchell, AAMC director of federal affairs. "If you can't guarantee residencies, then our best and brightest may look elsewhere."
Those who do find residency slots could be practicing medicine in a very different environment from previous generations. Caps on Medicare reimbursements, combined with increases in paperwork, are expected to accelerate the trend of doctors working on salary for large hospitals rather than as independent practitioners.
Jeet Garam, a third-year medical student writing this week on the Forbes.com blog The Apothecary, said the mismatch between medical school graduates and productive residency slots points to a larger failure of the president's national health care overhaul. The looming bottleneck "should be seen as a cautionary tale about centralizing decision-making in health care," he wrote.
"I fear that as Obamacare moves more decision-making to the federal level, we will see a similar lag emerge in other areas of our health care system between a need being identified and it being met," Mr. Garam said.
Still, a poll of 843 medical students shows that most support Obamacare," even though only 48 percent said they understood the law. Of those who said they understood it, 72 percent said they supported the Affordable Care Act, while 11 percent had no opinion, according to a survey conducted in January 2011 by Dr. Tyler Winkelman, a resident at the University of Minnesota.
At the same time, 69 percent agreed that doctors were obligated as professionals to participate in implementing the law, said the survey, published in the November 2012 issue of JAMA Internal Medicine.
"The interaction I have with students — they're young and enthusiastic, and I don't think they've had that much real-life experience understanding what lies ahead," said Dr. Haynes, who also serves as senior policy analyst for Docs 4 Patient Care, which opposes the president's health care law. "More physicians are going to become employees instead of small-business owners, and I have no problem with that decision, but then you're getting to be more like civil servants."
Not that there's anything wrong with that, but Dr. Haynes and other physicians worry that the nation's straight-A students aren't pulling all-nighters in order to work someday for the medical equivalent of the Department of Motor Vehicles.
"What kind of individual is going to want to enter the medical school under those circumstances?" said Dr. Haynes. "That's the concern of where things could be headed."
The AMA is backing legislation introduced March 15 — known as "Match Day," the day on which medical students are matched with residency openings — that would require the federal government to create 15,000 more residency positions.
The bill, which is estimated to cost about $2 billion over 10 years, is sponsored primarily by Democrats, but includes one Republican sponsor, Rep. Aaron Schock of Illinois.
The market already has responded by adding medical schools. The Association of American Medical Schools noted in a survey that between 1986 and 2004, its accrediting committee did not certify a single new U.S. medical school. Today, at least 18 universities are establishing medical schools, including at least a dozen that are in the pipeline to obtain accreditation.
Conservatives would prefer to allow the market to take an even bigger role in addressing the looming physician shortage by having more private dollars flow to teaching hospitals, something that is unlikely under Obamacare, which is scheduled to be fully implemented later this year.
"The ACA continues what I think is a broken system of administration pricing," said Dr. Haynes. "It prevents a functional market. All the things we're trying to achieve, like lower costs, they're doing through burdensome regulation and administration."
Nobody expects the Democrat-led Senate to pull the plug on Obamacare, nor the Republican House to approve $2 billion needed to fully fund it, which means the prognosis for medical students — and by extension, their patients — remains uncertain.
"The medical schools took the first step by expanding class sizes, which involved resources," said Ms. Mitchell. "Now we really need someone to take the second step."
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