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PHOTO: TOOLBOX STUDIOS (PILL BOTTLE)
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Doctor's Orders
By KRISTEN GERENCHER
Primary-care physicians seem to have both the best and worst of the U.S. health-care system wrapped up in their job descriptions. As general internists, family doctors or pediatricians, they can lead fulfilling careers helping patients with a wide variety of medical needs and establishing trusting relationships with entire families. But they also have to speed through office visits, haggle with insurers and pore over paperwork, while bringing home incomes that are much lower than those of specialists and subspecialists. MISMATCH I caught up with a future primary-care physician to see what inspires and scares him most about his chosen career as the primary-care shortage intensifies and U.S. lawmakers prepare for the final round in this year’s historic health-reform debate. Ryan Van Ramshorst, a fourth-year medical student in Houston, is a National Health Service Corps scholar who’s working towards being a general pediatrician. After graduating from medical school this spring, he will go on to a three-year residency program, where he will become the first doctor in his family. The National Health Service Corps offers scholarships and loan repayment programs to students training to become primary-care doctors, dentists, nurse practitioners, certified nurse-midwives or physician assistants, in exchange for their commitment to practicing for two to four years in areas where there are shortages of those health professionals. More than 30,000 primary-care clinicians have served in medically underserved areas since the program began in 1972. Expanding the NHSC is one of the proposals on the table for bolstering the dwindling supply of primary-care doctors as health-reform efforts look to extend coverage to about 30 million more Americans. Mr. Van Ramshorst, 25, acknowledged that problems are likely to arise if and when a primary-care shortage meets the added demand of newly insured patients seeking care. But he says the mismatch is no reason to reject or scale back efforts to extend health insurance to more Americans. In fact, he says, a health-care overhaul would start addressing the mismatch by increasing residency training slots for primary-care physicians and raising their pay. Since the legislation wouldn’t begin phasing in until 2013 at the earliest, the lead time may help in strengthening the pipeline. “It’s kind of a chicken-and-egg issue,” Mr. Van Ramshorst says of the shortage of primary-care doctors. “I think we can do a better job as a profession of teaching why it’s important and incentivizing it financially and making sure students understand how they can best serve.” He says he’s seen many of his classmates opt for better-paying medical subspecialties such as dermatology and ophthalmology. While the money and lifestyle those professions offer are hard to ignore, those factors haven’t won him over. “I truly went into this to serve,” he says. ‘IT’S A RIGHT’ Mr. Van Ramshorst, an active member of the American Medical Student Association, says he has been following the health-reform debate with interest. If a bill passes, it won’t be perfect, he says, but it will still count as progress. “It’s been a long time coming that all Americans have access to high-quality health care,” he says. “I would really like to be able to practice in a world where everyone has equal access to health care that they so very much need and deserve.” Mr. Van Ramshorst has worked with uninsured children and seen how barriers to care can affect them. A simple ear infection that goes untreated because the family doesn’t have a clinic to go to or the money to afford coverage or medication can turn into a more serious bone infection called mastoiditis, for example. What scares him about his chosen path? Mr. Van Ramshorst says a lack of autonomy over how much time he spends with patients is high on the list. The brief length of the average office visit reflects pressure to see 30 to 40 patients in a day. “I’m still learning, but I cannot comprehend how you can do everything and be the best advocate for your patient in 15 minutes,” Mr. Van Ramshort says. “It’s up to us as future health professionals and future leaders to make sure that changes.”
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