Obamacare's Med-School Debt Problem

Would-be primary care doctors could take a financial hit from health care reform, but most students say it's worth it to fix a broken system

Huntoon has found resistance to the new law while interviewing for residency positions. "I'm encountering attending after attending who's not supportive of the Affordable Care Act, not supportive of branching out health care—that's bizarre to me," she says. "It's incredibly frustrating to be on rounds and hear, 'This patient has this infection, and this is the ideal treatment for them, but they don't have insurance, so I can't give them the ideal treatment.'"

Obamacare also seeks to expand Medicaid to cover 15 million Americans just above the poverty line. But many doctors don't accept Medicaid payments because they average just 56 percent of what insurance pays. Huntoon says physicians should suck it up and accept that lower costs for patients will require lower fees for doctors. "Personally, I believe doctors have to look at their own salaries and ask if they're overpaid," she says. "Do I really need to make half a million dollars a year? No. Hospital administrators have been among the worst offenders—does a hospital need 20 administrators? The top end is way too heavy."

Siegel says the views of his NYU students are more diverse: "Some are just optimistic, wet behind the ears, eager, idealistic. Others are concerned that they won't have what their parents had, what the prior generation had, that the golden years are over. A lot of people will continue to go into the field, because of the desire to take care of people, to do science, and to provide health care. That's very exciting. But the fringe won't want to go, the people who did it for the money or for the prestige and privilege."

President Obama and his staff were 
all smiles as they watched the House of Representatives vote to approve the Affordable Care Act in March 2010.
Pete Souza/Wikipedia
President Obama and his staff were all smiles as they watched the House of Representatives vote to approve the Affordable Care Act in March 2010.
NYU’s Siegel worries that reform will mean fewer students entering grad school.
Courtesy doctorsiegel.com
NYU’s Siegel worries that reform will mean fewer students entering grad school.

Good riddance, responds Huntoon, but one of her poll's findings was particularly telling: Almost half of the students said they were "unsure" whether the new law would improve the quality of care. "It's a large-scale experiment," she admits.

Just as Obamacare gets set to go into effect, meanwhile, a new threat has come from the prospect of cutting Medicare to reduce the deficit. Medicare cuts could slash the number of residency and training programs for medical-school graduates. Universities have already been expanding their medical schools in anticipation of the looming physician shortage, and fewer residency slots would send graduates scrambling. Dr. Lisa Mellman, a dean at Columbia University's College of Physicians and Surgeons, notes that she has already seen students trying to improve their chances by obtaining additional degrees, such as a master's in public health, or by working as research fellows. "An additional year of research or an additional degree does mean more debt, however," she says.

For Griffin, the chief administrative officer of the Brooklyn Free Clinic, a student-run facility in Bed-Stuy, the new law presents additional unknowns. "We've been thinking about how Obamacare is going to affect our patient base and if there's going to be a need for us anymore," she says. "And I definitely think there will still be uninsured people who need health care."

Still, Griffin says that she's pleased Obamacare passed. "I'm glad insurance can't reject people with preexisting conditions. I'm glad that young people can stay on their parents' insurance. And it extends access. But I just don't think it's based on the belief that access to health care is a basic human right, and that's what I believe. Hopefully, it's just the beginning."

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