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Join us for an insightful conversation with Brendan Pulsifer, a medical student, as we explore the realities of practicing medicine in Georgia, recently ranked as one of the worst states for physicians. We’ll discuss the impacts of limited Medicaid expansion, high rates of uninsurance, and physician burnout on the health care system.

Brendan Pulsifer is a medical student.

He discusses the KevinMD article, “Full Medicaid expansion needed to retain Georgia’s physicians.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Brendan Pulsifer. He’s a medical student, and today’s KevinMD article is “Full Medicaid Expansion Is Needed to Retain Georgia’s Physicians.” Brendan, welcome to the show.

Brendan Pulsifer: Thanks so much for having me.

Kevin Pho: So, you’re a medical student, and you co-wrote this KevinMD article, “Full Medicaid Expansion Is Needed to Retain Georgia’s Physicians.” Tell us, before talking about the article itself, what led you to write this in the first place?

Brendan Pulsifer: Yeah, so I’m a medical student at Emory University in Atlanta, Georgia, and one of the extracurriculars that I’m involved in is a club called Health Students Taking Action Together. It’s actually a little more than a club—it’s a nonprofit organization, so it’s its own 501(c)(3), fully separate from the university.

And it’s a collection of health profession students throughout the state of Georgia. There are Emory medical students like me, but also nursing students, public health students, law students, and others from schools like Emory, Mercer, and GSU. It really is interdisciplinary, bringing together professional students.

And our broad goal is to improve the health of Georgians. The organization has been around for about 20 to 30 years and has taken many different forms. Currently, one of the things we’re focusing on is Medicaid expansion. This has been a focus ever since the Affordable Care Act allowed states to expand Medicaid eligibility to low-income individuals. Georgia is now one of only nine states that have not done so. One of our advocacy pushes is figuring out how we can convince the state of Georgia to allow more people to gain access to health insurance through Medicaid expansion.

Kevin Pho: Alright, go into more detail about that in your KevinMD article for those who didn’t get a chance to read it.

Brendan Pulsifer: Yeah, we’ve tried a few different ways to advocate for Medicaid expansion. Some of that includes direct legislative work, rallies, and community organizing. The focus of the KevinMD article is a kind of mini research study that we conducted.

There are already many compelling arguments for why Medicaid should be expanded from the patient’s perspective. People need health insurance to access medical services, and their health outcomes worsen without it. This has been well-documented and makes a lot of sense. But as health profession students, we also have a unique view of the provider perspective, and there are arguments we think are important but don’t get enough attention—arguments for Medicaid expansion from the physician’s perspective.

We conducted a survey of a little over 250 medical trainees throughout Georgia, including medical students, residents, and fellows. We asked about their perceptions of Georgia’s health care system and their future plans. The results were pretty revealing. For example, 81 percent of respondents said Georgia residents do not have access to quality medical care. A similar number noted that the high uninsurance rate contributes to physician burnout. Around 60 percent said they’d be more likely to stay in Georgia to practice if there were better options for patient insurance coverage.

This highlights that while patients need Medicaid to access care, Georgia also needs Medicaid expansion to retain a competitive physician workforce that’s numerous, widespread, and effective at treating patients across the state.

Kevin Pho: So, talk more about the link between uninsured patients and physician burnout. What are some comments, stories, or insights you’ve heard from physicians that illustrate this connection?

Brendan Pulsifer: That’s a great question. I think everyone wants to feel effective and valued in their work. For example, if you’re a mechanic fixing a car, it feels good to know someone is safely driving a car you repaired. For physicians, it’s a bit more complicated. Let’s say you work in a public hospital like Grady Memorial Hospital, where I train.

If a patient comes in with an acute exacerbation of COPD or uncontrolled HIV with opportunistic infections, you can help while they’re in the hospital. But if you discharge them to the street or can’t ensure long-term care—such as medications or follow-ups—you feel ineffective. It’s disheartening to know the care you provided might unravel because the patient lacks access to consistent health care.

Physicians want to feel effective: prescribing a medication, performing surgery, or otherwise improving a patient’s life. Without adequate tools, like medical insurance, to ensure long-term care, physicians feel burned out. Many may believe they could be more effective elsewhere, in states with better systems in place.

Unfortunately, this dynamic creates a twofold problem. Georgia’s lack of Medicaid expansion not only encourages physicians to leave but also exacerbates health disparities. Patients already facing significant health challenges have even fewer resources, worsening outcomes.

Kevin Pho: To clarify, you’ve heard that some physicians have left Georgia partly due to the lack of Medicaid expansion or the high uninsured rate?

Brendan Pulsifer: What I can comment on more specifically is what we learned from our survey. While the statistics I cited earlier were from Likert-scale questions, we also included open-ended questions. Many trainees mentioned they couldn’t see themselves practicing in Georgia because of the challenging conditions. For example, medical students and residents expressed concerns about training or working in an environment where they couldn’t be as effective.

This speaks to the broader issue: trainees are considering other states where they feel their professional goals align better with the system in place.

Kevin Pho: Can you provide historical and political context for Georgia’s decision not to expand Medicaid?

Brendan Pulsifer: Medicaid has been around for decades, but the Affordable Care Act, or Obamacare, brought one of the most significant expansions. This aimed to address the coverage gap for individuals who weren’t poor enough to qualify for Medicaid but couldn’t afford private insurance. Millions of Americans gained health insurance through this expansion.

However, a Supreme Court decision allowed states to opt in or out of Medicaid expansion. Most states have opted in—North Carolina was the most recent—but nine states, including Georgia, have not. Georgia’s alternative is a program called Pathways, which includes work requirements and projected coverage for 100,000 Georgians. Unfortunately, it fell short, enrolling only 3,500 people—just 3 percent of the original projection—while costing taxpayers $26 million. In contrast, full Medicaid expansion could have covered 350,000 Georgians and cut state spending by $710 million.

Kevin Pho: Is there hope for Medicaid expansion in Georgia’s near future?

Brendan Pulsifer: Georgia’s legislature meets three months a year. For 2025, the session begins soon, and we’re seeing some positive signs. For example, North Carolina, a similarly politically conservative state, expanded Medicaid. That’s encouraging. Last session, Georgia came closer than ever before, with some Republican members agreeing to hearings on Medicaid expansion proposals. Each year, it seems increasingly possible.

Kevin Pho: You’ve been actively advocating. Can medical students and trainees influence these decisions?

Brendan Pulsifer: Absolutely. Advocacy takes many forms. While some efforts involve lobbying at the Capitol, others focus on direct community work. For example, our organization runs programs targeting heart disease prevention among Black Americans, conducting health screenings in community centers like churches and barbershops. These grassroots efforts, combined with legislative advocacy, can make a significant difference.

Kevin Pho: Brendan, let’s wrap up with your key takeaways for our audience.

Brendan Pulsifer: Full Medicaid expansion is essential for Georgia. It’s critical for retaining physicians, improving patient outcomes, and addressing burnout. Medical students and trainees can drive change, no matter their background or level of training.

Kevin Pho: Brendan, thank you so much for sharing your perspective and insight, and thanks again for being on the show.

Brendan Pulsifer: Thanks for having me.