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A Reasonable Balance
A New York Times blog by Dr. Karen Sibert has been lighting up the blogosphere. Dr. Sibert asserts young women doctors who work part time lack sufficient commitment to the profession and are a poor investment for the system.
“Medical education is supported by federal and state tax money both at the university level — student tuition doesn’t come close to covering the schools’ costs — and at the teaching hospitals where residents are trained. So if doctors aren’t making full use of their training, taxpayers are losing their investment. With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.”
Gender and generation issues aside, Dr. Sibert’s arguments touch on a very real issue in medical education and the health care system, the issue of social responsibility. Dr. Sibert brings the issue of social responsibility to the individual level. And her argument could be extended beyond the number of hours doctors work. She brings up the issue of primary care:
“This gap is especially problematic because women are more likely to go into primary care fields — where the doctor shortage is most pronounced — than men are. Today 53 percent of family practice residents, 63 percent of pediatric residents and nearly 80 percent of obstetrics and gynecology residents are female. In the low-income areas that lack primary and prenatal care, there are more emergency room visits, more preventable hospitalizations and more patients who die of treatable conditions.
An individual social responsibility argument could be made that medical students have a professional duty to choose high need specialties, like primary care. Or specialty physicians, whose incomes drive some of the primary care-specialty gap, have a professional duty to re-evaluate and adjust their incomes to support primary care choices for medical students.
Even beyond medical student career choices, it should be recognized individual physician practices are collectively helping to drive the high cost of health care in the country. A fee for service system creates a perverse incentive to do more – see more patients, do more procedures. This see more, do more practice has questionable benefit for patients, but it also drives up the cost of health care - threatening critical programs like Medicare and Medicaid and limiting access for underserved communities.
Individual responsibility is important. However, a narrow focus on individual responsibility distracts from medical school, teaching hospital, and payment system policies that are incentivizing individual decisions. And simply put, I can’t fill a bucket one grain of sand at a time. In order to achieve the level of effect needed to address the health care shortage and access issues in the U.S. changes must happen on the system level. And if done right, quality of life for doctors and high quality patient care should be able to find a reasonable balance.
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