In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a 2nd year medical student. The overwhelming majority cited their respective USMLE Step 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses all are worth their respective weights, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.
This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will be infused into the health care system over the next 18 months. With the burgeoning demand for care set to spike in 2014, the opportunities for frontline care providers seem abundant. And though still in training, budding physicians should be cognizant of the impending care demand and its implications. Further, it is paramount for students and health care stakeholders to share open dialogue about the unique role medical students fulfill as valued assets to the evolving health care system.
The stakeholders
For years, the health care workforce has struggled to meet the service demands of patients; in some respect, this has been attributed to a disproportionate patient-to-provider ratio. According to the American Medical Association (AMA), trend data projects a workforce shortage of roughly 63,000 providers in 2015 (interestingly, this is when most 2nd year medical students will be graduating). Naturally, stakeholders (i.e. providers, chief executive officers and board members at respective non-profit and for-profit hospitals) are engaged in dialogue to develop new models of resource management. Many have speculated that this dialogue will yield innovative strategies to incentivize primary care providers and supportive staff. However, the role of medical students has yet to be fully elucidated, and therein lies a tremendous opportunity.
The National Resident Matching Program (NRMP) recently reported that, for the 2013 cycle, about 26,400 medical students were offered positions in domestic residency programs; 45% of the positions offered were primary care-oriented. A year prior, roughly 24,000 medical students were successfully matched to programs; in 2011, that number was 23,400. When compared across a five-year span (2009-2013), the change in positions-offered (between years) has grown six fold (from a 382 position difference to 2,400 position difference); the largest bump observed when stratified by specialty was in Internal Medicine. Though the infusion of 2,400 more residents may seem miniscule – in a time crunch, accented by both a provider underage and the impending demand of larger patient panels, it proves to be rather significant. Moreover, it supports the notion that medical students are shifting into a workforce repository tailored to the ACA; it’s as if a primary care space is being carved for wearers of short white jackets while their longer coats are still being measured. By virtue of fact, medical students should be heavily involved in the ongoing conversations surrounding resource allocation.
What should medical students expect?
Current medical students should be sensitive to open enrollment and consumer information campaigns (led by government officials, community organizations, and advocacy groups), lending special attention to indicators of early adoption. If the enrollment statistics in the first three months demonstrate a significant growth rate, it is likely that reflex opportunities will emerge, in both short and long-term forms. Generally, medical students should anticipate that the increasing patient pool will drive residency programs, in particular – primary care residencies, to increase the quantity of available positions. Likewise, medical students should expect an increase in service corps positions to match the structured training of a primary care workforce; in fact, expansion of loan-repayment and scholarship awards for service has already been underwritten by the ACA (extending from 2011 to 2015).
Amidst the incentivisation, it is important to keep perspective – the developing health care system is far from perfect, and will require the collaborative efforts of all stakeholders to achieve sustainability within the first 5 years of implementation. In that vein, the greatest expectation, and in some regards – the greatest privilege that students should own is the opportunity to pioneer health reform. Greater responsibility will be placed in the hands of oncoming primary care providers as they reshape the face of modern care delivery in America.
Italo M. Brown is a medical student.
