The Enduring Impact of Healthcare Reform

Many young physicians are anxious about the healthcare environment that awaits them.

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We've all heard something about healthcare reform in recent months; we also know that the present U.S. government has set healthcare reform as one of its priorities during its current term. However, for various reasons, new reforms could end up affecting many patients in unexpected ways.

Due to the many intricacies of healthcare reform, the proposals that made it through a contentious Congress permitted certain exceptions that were thought to be concessions to some opponents. The result of many of these exceptions could affect not only Americans' access to healthcare, but also trainees' medical school and residency training experiences.

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In apparent response to recent healthcare legislation, many large employers have enacted cost-saving changes that affect accessibility to care. It seems employers are responding to escalating healthcare costs; a recent study by the Kaiser Family Foundation found that insurance premiums have risen 134 percent since 2000, with premiums for an average U.S. family totaling more than $15,000 per year.

In addition to the impact these changes have on employees, the medical education of students and residents may similarly be affected. Many large employers have altered their employees' health plans in the following ways:

Higher deductibles: High deductible insurance policies cause patients to have higher out-of-pocket costs if they seek care. As a result, patients may have an incentive to seek less preventative care, in an effort to avoid expense, if they are covered by high-deductible plans.

Variable premiums: Some large employers, such as Wells Fargo, the nation's 12th largest, have implemented programs in which employees pay lower premiums in exchange for higher direct costs to employees. Current legislation allows employers to introduce these plans, which, according to reports, they often do in pursuit of cost reduction.

How could this potentially affect your educational experience? One way is an influx of newly insured patients—a New York Times article estimates that there could be more than 30 million new patients who would gain eligibility from these reforms. This phenomenon could have an effect on the amount of time physicians have with each patient, and consequently the amount of time they would have available to teach trainees.

As for how these changes are affecting current medical students and residents, a survey of recent residency graduates sheds some light, finding that many young physicians are anxious about the healthcare environment that awaits them.

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They noted concerns about cuts in reimbursement, heightened malpractice risks, and the uncertainty of the impact of healthcare reform as their main worries related to entering the healthcare workforce. One third of the new graduates surveyed stated that they would have chosen a different career if they had the opportunity to choose again.

The silver lining: The same survey noted a substantial increase in demand for physicians across specialties. The survey noted that 78 percent of new graduates had received 50 or more job solicitations. It also stated that, even in a receding economy, average salaries for newly minted physicians across specialties continued to rise.

Despite this trend, physicians continued to express concern about recent developments in healthcare. A new graduate interviewed by the New York Times commented that she felt she was entering her new career burdened by unexpected school debt and unanticipated healthcare legal changes.

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"We need to figure something out before it reaches a tipping point," Dr. Katherine Imborek, a recent family medicine graduate of the University of Iowa said. "There are too many patients to be seen and not a lot of doctors to take care of them."

It remains to be seen what impact recent legal reforms will have on healthcare. What recent studies have appeared to show is that large employers are trimming benefits offered to workers to reduce costs, and that a new generation of physicians report a growing disillusionment with the direction in which healthcare is headed. Whatever the outcome, it is important to be aware of these trends in planning a future career path in medicine.

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.