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Spandorfer J, Pohl C, Nasca T, Rattner SL, eds. Professionalism in Medicine : A Case-Based Guide for Medical Students. Cambridge: Cambridge University Press; 2010.

Video: Commitment to Improving Access to Care | Commentaries


A Medical Student Perspective

As a third year medical student one will certainly witness the inequalities of the U.S. healthcare system. In this vignette, patients are denied visits to sub-specialists because they have Medicaid Insurance. Even as a student, it is always disheartening to witness the healthcare system fail a patient. It is intellectually satisfying to make a diagnosis and effective treatment plan, but demoralizing for yourself and the patient when the treatment is unattainable because of insurance. Speaking with individual specialists does not solve the problem, because the policy regarding which insurances to accept is usually made by the practice administration and not an individual physician. It is not the place of a third year medical student to navigate the labyrinth of reimbursement and coverage.

Unfortunately, rejection by specialists is becoming even more common for Medicaid patients, which covered 15% of non-elderly Americans in 2003 (1). Among specialists, about 20% of medical specialists and surgical specialists are no longer accepting Medicaid patients (2). Physicians commonly note low reimbursement rates, excessive administrative demands, delayed reimbursements, full practices and the high clinical burden as common reasons for not accepting Medicaid patients (2).

As in this vignette, most medical students will participate in a student run clinic where many patients either have Medicaid or are uninsured (3). At these clinics, students have the opportunity to act as an advocate, which may entail speaking with a caseworker, contacting specialists directly, or providing patients with information about outside resources. Learning to become a physician-advocate is becoming increasingly important in securing the best healthcare for your patients. In fact, advocating for not only individual patients, but also for larger projects (local public health projects, policy changes, global health etc.) related to health is apart of a physician's professional responsibility (4).

As the next generation of physicians, we must collectively remember that the only way to effect permanent change is to become more involved in advocacy beyond individual patients. If the current healthcare system remains, we will have an increasing number of uninsured and underinsured patients, a high average of student debt, and declining real incomes (5). The challenge that lies before us is to balance our principles of equal access, social justice and integrity with the practicality of earning an income that provides us with a comfortable lifestyle. We need to learn from and look to those physicians already in practice on how to handle these issues. By observing the behavior of our physician-colleagues, we can begin to develop our own guiding principles regarding balancing care for people and financial reimbursement. During my own practice, I hope to treat and be an advocate for many insured, as well as uninsured and underinsured patients. Ultimately one will have the choice to provide or deny care to certain populations.

The question one must start answering now is: what kind of physician will you become?

References:

  1. Chua, Kao-Ping. "Overview of the U.S. Health Care System" February 10, 2006 http://www.amsa.org/uhc/HealthCareSystemOverview.pdf

  2. Cunningham, Peter J., May Jessica H. Medicaid Patients Increasingly Concentrated Among Physicians. Tracking Report No. 16 August 2006. http://www.hschange.com/CONTENT/866/ site accessed June 24, 2008.

  3. Simpson, Scott. Medical student-run health clinics: important contributors to patient care and medical education. J Gen Intern Med. 22(3):352-6, 2007 Mar.

  4. Gruen, Russell, Pearson, Steven, Brennman, Troyen. "Physician-Citizens -- Public Roles and Professional Obligations" Journal of the American Medical Association. Vol291, No. 1 January 7, 2004.

  5. Ha T. Tu, Paul B. Ginsburg Losing Ground: Physician Income Tracking Report No. 15 June 2006

Kimmie Pringle
Medical Student, Jefferson Medical College