University of Medicine and Health Sciences
  • There are no suggestions because the search field is empty.
UMHS-logo
Virtual Tour
Apply Now

Obamacare: Impact for Medical Students & New Doctors

Posted by Scott Harrah
August 07, 2013

The Affordable Care Act (Obamacare) is in the news daily, is controversial and something everyone has an opinion about, but it is crucial to understand just what it means to medical school students and new doctors.

To give you all the facts, and different perspectives (both pro and con), the UMHS Pulse compiled information and opinions from numerous sources about the ACA (the common acronym for the Affordable Care Act) for various points of view, including UMHS medical students.

UMHS student Jasmine Rivas feels the ACA could eventually be beneficial to American healthcare. "I believe that the U.S. healthcare system needed change,” she says. “However, I am not convinced that the Obamacare system is a permanent solution as it stands. Nevertheless, as an international medical student who plans on practicing in the U.S., I am optimistic that Obamacare will open doors to ideas on how to optimize the availability of health care, without discouraging physicians from independent practice. The process of becoming a medical doctor involves plenty of sacrifice and hard work. Physicians, together with their patients, should be in control of choosing the right procedures and treatment plan for the patient—not the government."

Annals of Family Medicine published a study in its November/December 2012 issue predicting a shortage of 52,000 doctors by 2025.Researchers say that a “trifecta of circumstances led by population growth, exacerbated by the aging of the population and fueled by the health insurance expansion would drive the demand for primary care doctors.”

October 1st Deadline

October 1, 2013 is an important date for the ACA. The news wire service Reuters reports in a July 14, 2013 article, “Analysis: Obamacare Struggles to Meet Make-or-Break Deadline“ that U.S. officials have less than two months to launch the new online health insurance exchanges by President Obama’s October 1st deadline. The White House and such federal agencies as the Department of Health and Human Services and the Internal Revenue Service must ensure that working marketplaces are open in all 50 states by October.

Italo M. Brown, MPH writes in a June 5. 2013 article on KevinMD.com “What Should Medical Students Expect from Healthcare Reform” about the factors to consider regarding the ACA:

  • The ACA “seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will be infused into the health care system over the next 18 months.”
  • “With the burgeoning demand for care set to spike in 2014, the opportunities for frontline care providers seem abundant. And though still in training, budding physicians should be cognizant of the impending care demand and its implications. Further, it is paramount for students and health care stakeholders to share open dialogue about the unique role medical students fulfill as valued assets to the evolving health care system.”

Pros & Cons of the ACA

Health insurance under the ACA will be rated by levels. Image: 123rf.com/Keith BellAn article by Veritas Prep in an issue of U.S. News and World Report in December 2012 says that, although the president of the American Medical Association supported the ACA in an official memo, a survey indicates that “40 percent of medical students may not even be aware of the provisions of the act.”
U.S. News and World Report gives two positive sides to ACA:

(Photo, inset right) Health insurance under the ACA will be rated by levels. Image: 123rf.com/Keith Bell

  • More medical students may be drawn to primary care specialties. The magazine says, “With a new emphasis on higher reimbursements for primary care specialties, including internal medicine and family medicine, the direction of medical education could be affected. A prominent healthcare economic think tank posits that healthcare reform will expand scholarships and loan repayment programs in order to draw medical students into primary care specialties. Not so long ago, many medical graduates were drawn into subspecialties.”
  • There will be more admissions slots at existing schools, and more medical schools. “For the first time since the 1990s, there are 18 medical schools in the United States in various stages of accreditation and development,” the article continues.“Eleven have opened since 2007, and enrollment in both allopathic and osteopathic medical schools has expanded in recent years. The Association of American Medical Colleges has also said that a record number of minority students enrolled this past year [2012].”

U.S. News and World Report also discusses potentially negative factors of the ACA:

  • The larger number of M.D.'s will compete for the same number of residencies.The magazine writes, “Though the ACA has expanded the number and diversity of U.S. medical graduates, the number of residency spots, funded by Medicare, has remained unchanged since a Congressional Balanced Budget Act took effect in 1997. A larger number of U.S. medical graduates could find themselves unmatched after graduation; in fact The Chronicle of Higher Education reported that Texas, which ranks 42nd in the United States in the number of doctors per 100,000 people, will graduate more medical students than it has residency slots available by 2014.”
  • Physicians may elect to work fewer hours, thus decreasing access to care. The article continues, “A report issued by the Kellogg School of Management at Northwestern University indicates that portions of the ACA, specifically addressing cost containment and Medicare reimbursement, may end up ultimately decreasing the access to care Based on data obtained after the establishment of the State Children's Health Insurance Program (SCHIP) in 1997, the report concludes that the program expanded access, but it eventually led to shorter patient visits and to significant numbers of physicians electing to work fewer hours.”

In “How Obamacare is Transforming the Way Medical Schools Teach America’s Doctors,” an article on Thinkprogress.org, Sy Mukherjee writes that the ACA is changing the way medical schools train future doctors. The author points out the following:

  • Modern Healthcare says “medical colleges are expanding programs to teach doctors how to coordinate care with other health care workers, focus on patients’ comprehensive, long-term care, and encouraging more general practitioners and primary care providers in anticipation of a changing medical landscape under Obamacare.”
  • Obamacare “hopes to transform the American medical industry by shifting it from an expensive system of private practices to a coordinated care model in which hospitals, nurses, general practitioners, and physicians work together to provide centralized and patient-focused care — what some in the industry refer to as a ‘medical home’ — to lower costs and improve health outcomes. But this strategy’s success depends entirely on a medical workforce that understands how to coordinate care and work in teams.”
  • Medical homes and accountable-care organizations “make doctors responsible for soup- to-nuts care and patients’ health over the long term.”
  • Some medical schools are “teaching would-be doctors how to work more effectively with other health professionals so that they may lead the changes rather than get swept up in them. They are putting a heavy premium on teamwork among doctors, nurses, nurse practitioners, social workers, health aides and physician assistants.”
  • A few teaching hospitals are expanding programs for alternative degrees in public health and hospital administration to help medical students “get ahead of the coordinated care curve.”

In a June 11, 2013 Washington Times article, “Medical Students’ Prognosis Unclear with ‘Obamacare’; Many Don’t Understand Law”, Valerie Richardson points out the downsides to the ACA, including:

  • 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.”
  • “An estimated 32 million Americans are projected to enter the healthcare 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 possibility of 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.”

Resident Physician Shortage Reduction Act & Training Tomorrow’s Doctors Today Act

Health Care Reform. Image: 123rf.com/Keith BellSome are nervous about how residencies will be affected, since the U.S. government funds medical residency spots from the federal to state levels through Medicare, but there is hope. Two bills were introduced to Congress this year to help funding for residency spots. The Resident Physician Shortage Reduction Act was introduced to the U.S. Senate, and the bipartisan Training Tomorrow’s Doctor’s Today Act was introduced to the U.S. House of Representatives. The American Medical Association’s website says the bills will fund 15,000 Medicare-supported graduate medical education (GME) positions over the next five years.

 Image: 123rf.com/Keith Bell

“The bills use different formulas to allocate the new residency slots, but both pieces of legislation give priority to hospitals that already offer more residency slots than the number for which they receive funding and those in states with new medical schools,” AMA’s website says. “The bills also target expansion of residency programs and specialties in which a shortage already exists.”

To understand how the ACA affects healthcare, doctors and insurance for consumers, medical students and the general public might benefit from looking up unbiased consumer comparison websites such as http://www.fairhealthconsumer.org/ (published by the independent, nonprofit organization FAIR Health).

The ACA is complex indeed, so researching the perspective of each side (for/against) on the many facets of the law will help medical students be more informed on the myriad issues. Websites that focus on both sides of the ACA include ProCon.org (run by a nonpartisan, nonprofit public charity) at http://healthcarereform.procon.org  (offering pro and con responses to many aspects of the ACA, from whether it will worsen the primary care shortage to whether most physicians support the new law).

(Top photo) Educate yourself about all aspects of President Obama’s Affordable Care Act. Photo: Obamacarefacts.org


About UMHS:

Built in the tradition of the best US universities, the University of Medicine and Health Sciencesfocuses on individual student attention, maintaining small class sizes and recruiting high-quality faculty. We call this unique approach, “personalized medical education,” and it’s what has led to our unprecedented 96% student retention rate, and outstanding residency placements across the US and Canada. UMHS is challenging everything you thought you knew about Caribbean medical schools.

Posted by Scott Harrah

Scott is Director of Digital Content & Alumni Communications Liaison at UMHS and editor of the UMHS Endeavour blog. When he's not writing about UMHS students, faculty, events, public health, alumni and UMHS research, he writes and edits Broadway theater reviews for a website he publishes in New York City, StageZine.com.

Topics: Medicine and Health

Add a comment