Bernie Sanders is the most vocal proponent of single-payer health insurance for all. In an ideal world, wouldn’t it be wonderful if no one had to worry about where they are going to get the money to pay for health care? Other than the fact that nothing in the real world comes for free, it just isn’t going to happen.
But regarding the idea of health insurance for all, there is one major subject that is never talked about: The expense to become a physician.
The average debt of a student upon completion of medical school is $200,000. Following graduation from medical school, one must do a minimum of three years of postgraduate training and for some up to six years. The pay for those post graduate years is about what the average American earns.
The reality is those students will have the equivalent of a “mortgage payment” without having a house. If we simply have a system with Medicare for all, and physicians are paid what Medicare pays a physician for services, it would be a horrible return on investment and unaffordable to become a physician.
There is a viable solution: It is time to develop a partnership between the federal government and medical schools. The partnership I propose would solve not only the expense problem but the shortage of primary care physicians as well.
Now, nearly all entering medical students have, at minimum, a bachelor’s degree, which includes taking all the required prerequisite courses. That usually takes four years to achieve. My plan would maintain the prerequisite course requirements, but allow students to enter medical school after three years of undergraduate work without a bachelor’s degree.
After medical school, everyone would complete a one-year rotating internship, rotating through primary care services such as Internal Medicine, Pediatrics, Surgery and Ob-Gyn. After successful completion, each and every one would enter the Public Health Service for two years and do primary care in public health clinics throughout the nation.
The public health clinics would be staffed by full-time, board certified physicians. This two-year experience would provide health care throughout the country along with providing invaluable experience for the new physicians. Following completion, the physicians would be able to enter residency training in the field of their choosing.
In return, tuition for medical school would be capped at $5,000 per year. For the two years of public health service, the individual would be paid $55,000 per year, along with a housing and food allowance. The government would compensate the medical schools by making up the difference needed.
Unknown to many people, the government has a similar program now for a limited number of medical students that includes paying 100 percent of their tuition and, in return, the physician pays the government back in time. My proposal would add more than 50,000 providers to public health clinics to care for virtually everyone.
This would make the cost to become a physician affordable. An added benefit to the young physician is they would provide invaluable primary care and learn how to deal with people on a one-to-one basis. Whether one later becomes a primary care physician or a cardiac surgeon, those interpersonal skills are important in caring for a person.
All that is necessary to make something like this happen is to get the government, schools, the American Medical Association and American Osteopathic Association to grasp the concept and make it work for We the People.
Rein, D.O., is an Adjunct Professor College of William and Mary and Past President Virginia Society of Anesthesiologists.