Last week demonstrators marched in Washington D.C to protest Obamacare on the anniversary of the bill being signed into law. Throughout the Republican primaries, the one thing that all of the candidates have agreed on is that as President, they would repeal this law. In the midst of this political impasse between Republicans and Democrats, the Supreme Court is examining the constitutionality of the individual mandate, which requires all Americans to purchase this health insurance or otherwise pay a large tax. Now that I have offered a brief exposition on what has been going on in respect to this bill, I will present my concerns about this bill as a prospective doctor. There is something to be said here as to how this bill may affect my trajectory as well as other current and prospective doctors.
President Obama advertised this bill to Congress by presenting the fact that 32 million Americans who were once without insurance will be covered by this bill. Conservative leaders and activists have presented their valid arguments in opposition to the bill, namely the fact that the United States simply cannot afford to pay for this legislation. Despite these arguments, I have yet to hear from anyone opposed to the bill about how the Affordable Care Act will affect the current doctor shortage in the United States. For those unaware of this escalating crisis, the American Medical Association predicts that by 2020, there will be a shortage of 150,000 doctors in the United States at the current graduation and training rates. The writers of the Affordable Care act refused to include provisions proposed by medical professionals, which would have increased the number of residency positions in the United States. I was unable to find any reasoning as to why these provisions were not included.
One of the attempts of the Affordable Health Care Act is to increase the number of primary care physicians in the United States. The bill attempts to incentivize this field of medicine by increasing Medicare reimbursement for primary care doctors by 10%. The bill also de-incentivizes specialized medicine by keeping their reimbursement rates consistent, while leaving open the possibility of reducing them in the future as needed. All you have to do is look at the expenses and revenue of a doctor to see that neither of these provisions will help the physician shortage. The average medical resident has a salary of $35,000 and holds $156,456 in student loan debt (according to the AMA). After three to seven years of being a poor medical resident working absurd hours with stifling debt, doctors will get a pay raise that superficially seems fantastic. However, you will see that this pay increase does not exactly translate as lucrative, to say the least. Let’s say you become a primary care physician and your salary goes from that poor $35,000 to $130,000, which is the average starting salary. Oh no! It’s the one percent!!!! Not so fast.
Starting salary= $130,000
Federal Income Tax= -$29,861 at a tax bracket of 22.97%
Malpractice insurance= -$15,000 (varies significantly by state, but we’ll go with the average)
Student Loan payment = – $3,370 per month (x12)= $40,440
What you have left= $44,699
That’s roughly what a doctor ACTUALLY makes, and a 10% increase on this (now making roughly $50,000 a year) is not going to bring anyone into the field. This is after four years of brutal undergraduate work (organic chemistry, anyone?), four brutal years in medical school, and three to seven years as a peasant worker (I mean, resident) with no sleep, and making about what a waiter at Denny’s makes. Furthermore, the hours of a doctor after residency are still brutal. I don’t even want to think about what this works out to be as an hourly wage. Who would ever want to be a doctor?
Wait, Joe! If you are really passionate about being a doctor, you should do it regardless of how much you make.
Why yes, of course I will still pursue this career, precisely because I am passionate about practicing medicine. I think that the excruciating path to becoming a doctor merits a significantly larger salary, but you are right. I will become a physician because it is my calling, not because it makes me money. Nevertheless, the demand of doctors in the United States is not being met by the number of doctors coming in to practice, and it is absolutely necessary to bring more people into the field. Qualified students are not going to work in these conditions when they can make six-figure salaries, and without as much time in school in other careers. There needs to be some financial incentive at the end of this 11-16 year path to becoming a doctor that keeps those qualified in the game.
What happens in the actual implementation of Obamacare? I am inclined to argue that Obamacare will augment the doctor shortage. What happens when the national debt becomes even more stifling and the government needs to cut costs? The obvious area to tackle will be reimbursement rates and tax hikes. Either way, that $44,699 is going to shrink, and shrink.
Now, Joe! Doctors are going to get 32 million more customers with the Affordable Care Act. That means they are going to see a significant pay increase right?
No. Doctors do not need more clients. A shortage of people in need of health care has never been the problem, and it never will be. The average time a patient gets to spend with a doctor is roughly 21 minutes. Overload doctors offices with these 32 million people around the country and doctors will have a significantly shorter time to spend with patients. That will inevitably translate to a lower quality of health care, which we obviously know will translate into higher costs of healthcare. Wasn’t the point of Obamacare to cut healthcare cost through preventative care? What will the high cost of healthcare mean for doctors? That’s right: even lower reimbursements and higher taxes to compensate for the staggering costs. What we will see is a vicious cycle of rising healthcare cost perpetuated by the Affordable Health Care Act. The answer to this doctor shortage problem is so obvious, but for whatever reason, lawmakers fail to recognize it.
Why was there no urgency in this bill to bring more doctors into the workforce? There are a lot of things that this bill should have included to deter this well-known problem. If this bill hadn’t been abruptly pushed through a vote, it might have included grant awards for medical school tuition, tax credits for struggling residents, or any number of implements to bring doctors into the field. If you look at the portion of the healthcare.gov website’s page for doctors, it boasts about “training and development of more than 16,000 new primary care providers over the next five years” through loan forgiveness for people working in underserved areas. When the bill plans on bringing in less than a fourth of the positions that will be needed in the United States, literally every area in the U.S will be “underserved”.
As a conservative, I believe that the health care issues in the United States can eventually be resolved through the private sector. This fundamental argument about healthcare cannot even be discussed because this bill has the potential to destroy the quality of health care as we know it. As an undergraduate pre-med student at Georgetown University, I am not concerned about how lucrative being a doctor will be, but if it will allow me the means to live and pay my immense debt. Will there be a day when that $44,699 shrinks to a number that precludes me from paying my student loans, paying rent, and raising a family? Americans need to seriously consider the possibility of a day when a doctor is out of reach. The answer is simple. Repeal Obamacare and work for a bipartisan solution to maintain quality healthcare.