Emanuel's Medical Education Cuts Would Slice at Heart of Physicians

Did you read this article, co-authored by Ezekiel Emanuel, MD, one of President Obama’s health policy advisors, that appeared in the March 21 Journal of the American Medical Association? This is scary news if you are a physician.

In this article, Emanuel calls for cutting short the training duration of medical residents as a way to curb and cut costs. We all get the idea - Medicare shells out tons of money to training hospitals each year to help fund medical training. As Emanuel sees it, if we cut off some (or a lot) of that training time, we can reduce the amount of money that Medicare has to pay to teaching hospitals across the country.

He argues that the last year of residency does not do much for a resident’s education - that by the last year, they are well-trained enough and do not need a final year.

Wow.

While I think we all can agree that there is room for reforming and tweaking medical education from both the medical school curriculums to residency programs, I do not agree that slicing off a year of residency training is a good idea.

In fact, I am alarmed at this proposition and I think you, as a physician, should be too.

[For another take on Ezekiel Emanuel's healthcare opinions, read "The Death of Health Insurance?" ]

First, as physicians, we are constantly compared to other healthcare providers in terms of our role, what we offer, and how well we perform. It is my perception that our reputation in our society has been diminishing over time: there is a general perception that we are greedy and working alongside the insurance companies to make them more money. Yes, this is a generalization, but the perception remains.

If we start cutting back on our training, we will literally be slicing into our professionalism, something that as always helped us stand out from other healthcare providers. This is not a knock on any other type of provider, but going through the rigors of medical school and residency is vastly different than the training a PA goes through or a chiropractor endures. We sacrifice so much to reach our goal of being a physician.

But in the last 10 years to 20 years, our patients and the healthcare system have tended to undervalue this process. Patients forget that we had to put our families and personal lives on hold for not just one year but a minimum of seven years to become a physician. No other position/job/role in our society has to endure as much as we do.

For most of us, we do this because we enjoy helping others and know that the sacrifice is well worth it. I am afraid once we start cutting back on our training that will be the start of the process in making us seem more mediocre. The less training we do, the less we should be valued (and paid), and the more we are like all the other healthcare providers.

What’s to distinguish us from the PAs and NPs and other practitioners? Right now we know that our training is so much superior. But when that training is cut (and at first it will be one year, but who knows what follows), we become more mediocre.

Next, we should probably get more training, not less. Cutting back on our training may result in saving Medicare money, but I am afraid this will potentially result in doctors who are not as qualified to perform each day which ultimately leads to more errors, more complaints, more lawsuits and worsening outcomes. I think there are many unintended consequences from this action.

Lastly, I am afraid that cutting back on our training is a way for us to be pawns of the system even more than we already are. Let’s face it, we are the middlemen in the healthcare system and the push to make us less trained will diminish our professionalism. We already have to comply with the rules of the healthcare game, and I am afraid that cutting back on our training is a slippery slope that can ultimately lead to places that worsen our reputation and position in medicine.

Medicine has stood for ages as a noble profession. Becoming a doctor is difficult and takes the special blend of endurance, a big heart, and tenacity. Yes, our healthcare system is far from perfect, but let’s not lose sight that here in America we have the best trained physicians anywhere in the world. Cutting back on that training only hurts us.

And because of that, you should be alarmed. So many of us are already unsure of the future of medicine - I think Emanuel’s ideas only make that future seem so much more uncertain.