Wednesday, July 13, 2011

Medicine IS Politics

As I sit here cramming in a few last hours of study before sitting for my American Board of Family Medicine exam tomorrow, my smart phone repeatedly lights up. The #saveGME campaign is underway.

While I should keep studying, I cannot. Over the past several days, I have been reading articles and blog posts about the most recent spin in the deficit reduction “circus”—cut GME dollars out of the Medicare and Medicaid budgets. Neither of these issues has gotten traction in the mainstream media, and I know why. None of the journalists had the knee jerk reaction I did to the news: how will we train new doctors? While it is bad enough that most Americans, many of them eager to cut “entitlement” programs, don’t appreciate that about a quarter of our insured population is covered under government insurance (, a.k.a. “socialized medicine”, I presume even fewer residents—doctors in training, a.k.a “medicine’s future”—realize that their paycheck and much of the funding that keeps their training program up and running, comes from the Medicare and Medicaid budget. And if you are in a primary care program, one that is unable to generate tons of income from your services due to a flawed, procedure-based reimbursement system, you are especially dependent on these government funds.

And if the money dries up, the programs close. The vulnerability of primary care programs has been outlined in other blog posts here and elsewhere. The pre-existing shortage of primary care physicians is well known. Heck, the ACGME even titled its 20th report last year “Advancing Primary Care” (a title that sounds ironic at this moment), and mandated the U.S. increase its proportion of primary care physicians from the current 32% to at least 40%, the critical point at which health outcomes improve and costs decrease.

Despite this, GME funds are on the table.

So as the baby-boomers age, and the generation known as “the first to not outlive their parents’ life expectancy” enter adulthood and pile on their chronic, life-style-induced diseases, and as a morally just health reform law requires more Americans be given affordable health insurance, the roster will bloom with patients. These patients will be sick; they will have multiple disease processes, limited resources, and will demand increasingly complicated and expensive technology in their treatments. And if the GME cuts go through, and specialty programs survive by simply doing more procedures to generate more income for them and more debt for the American public, and the primary care programs shrink instead of grow, our nation’s health will suffer deeply.

The AAFP is mobilizing its members to contact their representatives. It has been lobbying members of Congress for a GME primary care carve-out that would send some funds directly to community-based primary care training programs (currently 100% of GME dollars are distributed to hospitals, who then decide which programs to fund), and it has iterated several more demands to the President directly. But it can do more. In my mind, the fact that most Americans, and most residents, don’t know that Medicare and Medicaid dollars are the key funding source for training all the doctors in this country is not acceptable. We need to use the media better and educate the public on how healthcare is delivered in this country. I think if they knew, they would be outraged.

Tomorrow I will be tested on knowledge that will allow me to say I am Board Certified in Family Medicine. Sadly, out of hundreds, there may only be a single question that tests my knowledge on the politics of medicine. And that’s too bad—because these days, medicine is all politics.

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