Doc? Doc? Doc?!

Most countries seeking to move up the economic ladder have found ways to support students smart enough to get into college, finding money wherever they can to educate and train their best and brightest for the future. In the United States, we’re going the other way. Public education (at every level!) suffers continuing cutbacks from state legislatures, resulting in years of cost-of-tuition increases (well beyond cost of living increases) at public colleges with concomitant cutbacks in financial aid.  All the while, U.S. high school students continue to plummet in worldwide testing, falling from first years ago to 31^st in math and 24^th in science today (CBS report, December 3^rd), prepared even less for college that too many can no longer afford.

In the private sector, except for the rarified air at the top of the academic food chain, tuition has consumed decades of cost increases that are a multiple of the inflation rate. Congress has reduced grants, increased the cost of student loans, and even as the job market dried up for the young and restless, made bankruptcy relief for student debt virtually impossible. It’s cheaper to get solid degrees in Canada and the UK than back in the USA.

“More than 10,000 Americans are earning graduate and undergraduate degrees in Canada, and 15,000 are pursuing degrees in the United Kingdom. Even with extra fees for international students, colleges and universities outside the United States, in many cases, cost less than the tuition at private colleges or the out-of-state charges at public universities.

“In some places, American student interest has gone up as tuition rates rise here nationwide and state spending for higher education declines. The University of British Columbia, for example, reports a 33 percent growth in U.S. applications since 2008.

“Because of California’s ‘sagging economy’ and cutbacks in public aid to higher education, ‘I am encouraging my students to look beyond our state’s borders, and that includes other countries, such as Canada,’ said Jill Montbriand, a counselor at Rio Americano High School in Sacramento.” mcclatchydc.com, October 30^th.

It’s even worse for students pursuing professional degrees, with the highest tuition costs of all, beyond their undergraduate years (MBAs, JDs and MDs), where grants are rare and loans are rampant. My son (MBA) and daughter-in-law (MD) are recent grads in the job market (they are the lucky ones having gotten jobs with organizations they love doing the work they were trained for). Stephanie, Dr. Dekom to many, is a wonderful example of what we wish our children to become. Her chosen field (where she is current a resident at a major Los Angeles hospital) is pediatrics.  She plans to pursue a fellowship and sub-specialize in neonatology after completing her residency in general pediatrics. “I know it isn’t a particularly well-paying field,” she says quite simply, “but I didn’t go to medical school in order to make a lot of money. I really just want to help people. That’s reward enough.” She’ll note that she is in the better-paying part of pediatrics, which certainly is among the lower pay scale of medical specialties.

With serious (and I do mean serious) six figures of student debt and her first job paying her around $50K a year, Dr. Dekom faces years of lower-level pay before she begins to earn her relatively modest (given her education) living. I am humbled by her dedication and commitment and angered by a nation that seems to have abandoned our educational priorities to our children.

Society is beginning to see the blowback from these hideously stupid policies. We simply do not have enough doctors to serve our most basic needs, and our federal government’s obsession with cost cutting has made serving the poor and the elderly a non-starter to too many physicians. In January, “[M]illions of additional Americans will be covered by [Medicaid], many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.

“Community clinics, which typically provide primary but not specialty care, have expanded and hired more medical staff members to meet the anticipated wave of new patients. And managed-care companies are recruiting doctors, nurse practitioners and other professionals into their networks, sometimes offering higher pay if they improve care while keeping costs down. But it is far from clear that the demand can be met, experts say.

“In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and are unable to take on more low-income patients. Dr. Hector Flores, a primary care doctor in East Los Angeles whose practice has 26,000 patients, more than a third of whom are on Medicaid, said he could accommodate an additional 1,000 Medicaid patients at most.

“‘There could easily be 10,000 patients looking for us, and we’re just not going to be able to serve them,’ said Dr. Flores, who is also the chairman of the family medicine department at White Memorial Medical Center in Los Angeles.” New York Times, November 28^th. That’s the pressure from governmental programs. But private insurers are also pressuring doctors who are in preferred provider programs (most doctors) to spend less time with their patients and cut their service costs as well. Some of this is prudent cost-cutting. Some of this is just cost-cutting without any accountability for the medical damage inflicted. But the trend continues.

While most of us have this image of a fat-cat doctor, driving an expensive Mercedes and living in a top-of-the-hill mansion, the “plight” of more than one Beverly Hills plastic surgeon, most doctors don’t live in that rarified air, preferring to serve their patients with care and understanding for levels of pay far, far beneath those stereotypes.

Make going to medical school exceptionally costly with little or no financial aid outside of loans, but make sure that those who graduate face time and cost pressures that can make their work miserable. The result: a very widespread shortage of doctors, particularly hitting rural communities and smaller towns hard. It’s not just Medicaid patients who are impacted by the shortage of doctors; it is all of us. Punishing our education-directed children in the short term will punish us all down the line.

I’m Peter Dekom, and it truly saddens me to watch politicians embrace such long-term policies that can only damage our competitive future and our quality of life for decades to come.