3 Ways Healthcare Reform May Impact Medical Education

Future physicians may emphasize primary care in light of revenue shifts.


Healthcare reform has been all over the news lately. Wherever your beliefs lie on this issue, there's one certainty: Healthcare reform will have a significant impact on the careers of future physicians.

Knowing that going to medical school and completing a residency involves a substantial investment of time and money, many medical students cannot help but wonder how recent proposed—and implemented—changes might affect their career plans.

[See U.S. News's rankings of Best Medical Schools.]

Overall, it's difficult to say. Continuing challenges to proposed reforms in Congress, and lawsuits filed by various states' attorneys general, could change some of the key components of the reform measures.

However, many of the reforms could have a direct impact on medical education, and most certainly aspiring physicians' future careers, in three key ways:

1. Shift of emphasis on primary care: For years, primary care—the doctors with whom the majority of the public interacts—has been relegated to being the unwanted stepchild of medicine. Time and again, medical students have eschewed primary care specialties like family practice and internal medicine for more lucrative subspecialties.

[Read about how to tell if primary care is right for you.]

A study published in the April 25 issue of Archives of Internal Medicine found that the proportion of aspiring physicians indicating that the appeal of primary care influenced their decision to pursue medicine fell from 57 percent in 1990 to just 33 percent in 2007.

That same study of fourth-year medical students indicated that just 2 percent of this group had a desire to practice general internal medicine.

With proposed changes in healthcare reform, the amount physicians are paid for primary and preventative care by Medicare (and potentially private insurers, who typically follow Medicare's lead) could rise substantially. The higher fees currently paid out to subspecialty physicians who do procedures—such as cardiologists and gastroenterologists—could fall significantly.

Though most premeds do not choose medicine for financial reasons, given the substantial student loan burden many graduates ultimately carry, this shift in revenue is something that will likely not be overlooked by future physicians when selecting specialties.

[See how medical schools are investing in primary care.]

2. Volume of patients: As most premedical students enter medicine with noble intentions, the expected influx of newly insured patients—and thus patient volume—into the existing healthcare system could provide important opportunities for clinical training and exposure.

On the other hand, for medical students and residents, a substantial increase in patient volume can have an unintended effect on education, supervision, and ultimately, the quality of patient care. The volume of newly insured patients has largely overwhelmed physicians in Massachusetts, for example, where health insurance has been compulsory since 2006.

3. Change in compensation: Everyone thinks about pay, though many in medicine avoid discussing it outright. Regardless, potential changes in physician compensation are among the utmost concerns that current medical students and residents report, particularly in primary care.

Many detractors to healthcare reform in the medical field cite burdensome student loans as a decisive factor in determining many students' specialty selection at the end of medical school. They also note that in places with broader access to healthcare, such as France or the UK, medical school tuition is heavily subsidized, leaving their graduates less burdened financially when making their specialty selections.

[Learn about loan forgiveness programs for primary care physicians.]

Supporters, however, contend that medicine attracts individuals with a higher sense of purpose than financial compensation, and that society as a whole benefits from increased access to care. A rise in the number of insured patients could even increase compensation for some, reform supporters say.

Whether healthcare reform remains in its current form, or is altered by legal or legislative action, a consensus is emerging that the current system in the United States leaves millions of patients without insurance or reliable access to care. As a result, it is important to be aware of the impact of such changes not only as an aspiring medical student, but also as a potential patient.

Ibrahim Busnaina, M.D. is a graduate of the University of Pennsylvania School of Medicine and coauthor of "Examkrackers' How To Get Into Medical School." He has been consulting with prospective medical school applicants, with a special focus on minority and other nontraditional candidates, since 2006.