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Future doctors have a lot at stake, even if they don’t know it: A student's take on the Affordable Care Act

“You’re going into medicine? Let me give you a piece of advice: Don’t.”

A community physician said those words to me more than three years ago, right before I started medical school, and I’ve heard variations on the theme ever since: Medicine is a thankless profession. Contrary to popular opinion, it’s hardly the path to riches. You can’t spend enough time with patients. It’s depressing.

In recent days, I asked several peers at different medical schools what they thought of the ACA. The overwhelming answer: “I don’t know enough to have an opinion."

Now I stand poised to enter the world of MDs. And with the passage of the Affordable Care Act, my classmates and I, the newest generation of doctors, look out at the horizon without knowing the shape our careers will have. We are reasonably sure about one thing — along with providing unprecedented access to insurance for Americans, the new health care law will change how we practice medicine, including how many patients we see and possibly how we get reimbursed.

Yet when the endless wave of media coverage crashes over us, it’s rare to find an examination of how the law will affect us, your future health-care providers. Instead, we get a big dose of political posturing from all sides.

Why does this matter? Because the first and probably saddest truth I can tell you is that most medical students know very little about the Affordable Care Act, or about insurance and health economics in general. We get the occasional lecture about health systems, but the information shows up on none of our exams or evaluations. In recent days, I asked several peers at different medical schools what they thought of the ACA. The overwhelming answer: “I don’t know enough to have an opinion.”

I find myself in a unique position. Thanks to Stanford and NBC News, I’m spending the year learning more about health journalism. So I’ve pulled my head out of the textbooks and hospitals and gotten a chance to really see how health-care issues affect communities. If not for this opportunity, I probably would have been one of those students who knew next to nothing about a law that will alter my career.

As medical students, we're exposed to certain physicians who don’t consider costs and money; they tell us that such thoughts are not only unbecoming of a physician but also a distraction from caring about your patient.

I don’t see it the same way. Physicians are meant to be advocates for patients, and that means pursuing appropriate medical treatment in the context of a patient’s real life. Being uninsured is a health problem, pure and simple. A 2009 study revealed a direct correlation between lack of insurance and increased mortality, suggesting that nearly 45,000 American adults die each year because they have no medical coverage.

Whether or not you support the Affordable Care Act, that figure alone makes it our business to care about this issue.

“I think the ACA has accelerated changes,” Joanne Conroy, MD, told me in an interview. She is the chief health care officer for the Association of American Medical Colleges, a group that represents medical students and medical education. In addition to expanding insurance coverage to patients, Dr. Conroy said the law includes a “commitment to experimenting with new ways of paying for care that reward value rather than volume.” She added, “That is kind of the green light for people to start thinking about changing” how doctors will treat patients.

The law will also impact some doctors in immediately tangible ways. For one thing, it has provisions that boost primary care – classifying primary care under “essential services” and granting a limited 10 percent Medicare incentive payment to eligible primary care physicians, among other provisions.

What it does not do, however, is provide infrastructure to meet these needs. I recently attended a public forum about the new law. In speaking to State Sen. Jerry Hill, I asked him if California was prepared to handle the influx of the newly insured and their potential backlog of medical needs. “Absolutely not,” he replied.

While medical school enrollment continues to climb, the number of federally funded residency training positions has remained frozen since 1997. Without authorization from Congress, there won’t be enough physicians to meet the demands of our population.

It will behoove medical professionals to dig their heads out of the sand and become informed about the successes and failures of the Affordable Care Act. “One would find it hard to navigate the future without a strong health policy background and also without a strong awareness of the cost or the value of the care that we deliver,” Dr. Conroy said.

Doctors also need to be informed about the Affordable Care Act in order to advise their patients. Doctors and nurses topped the list of trusted sources of information about the new law, according to a Kaiser Health Tracking Poll from August.

Medical schools and residency programs, therefore, need to lead the charge in creating doctors who are informed, connected and ready to help shape the future of health care instead of letting it shape us. We owe it to ourselves and to our patients.

Hayley Goldbach is the 2013-2014 Stanford-NBC News Fellow in Media and Global Health. She graduated from Brown University and recently completed her third year of medical  school at the University of Pennsylvania. This piece first appeared in the Peninsula Press, the website of Stanford's Journalism Program.

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