Medical students wary of the future - concern over Bill Clinton's health care reform proposals that may limit number of specialists

0 Comments | Insight on the News, Dec 27, 1993 | by Gayle Hanson

The program works, according to Dean Ronald D. Franks, because the school has a carefully defined mission that draws students interested in general medicine. "We nurture their interest during their first two years," Franks told the Journal of the American Medical Association. By the time the students graduate, "they've had enough exposure to family practice that it has taken."

Others have pointed out that, in addition to providing stimulating environments in which to study primary care, medical schools could offer financial incentives to lure students to family practice. But neither of these solutions addresses the question of whether quotas are fair, or even needed. After all, despite almost universal consensus that this country has too many lawyers, no one has seriously advocated quotas on the number of students entering the legal profession, never mind on those specializing in personal injury litigation.

"There are other ways to address the problem other than setting up even more regulations," says Michael Tanner, director of health and welfare studies at the Cato Institute. "One thing that could happen is that you could loosen up licensing laws to allow nonphysicians, such as nurse practitioners, to take on a larger role. But if you get physicians getting out of medical school with massive debts and you start restricting their income, then there are going to be problems." In addition, some predict that restricting the number of specialists might send physicians already in practice scurrying to leave the profession, wary of increased government interference and bureaucracy.

"People say that we spend too much money on health care, but in fact only 2 percent goes into research and development," says Tanner. "The fact is that other nations like England and Canada that have socialized medicine rely on the United States. They piggyback on us because we have always been at the forefront of innovation, and now that could well be lost."

Research to eradicate even a single disease takes huge amounts of time and money - not to mention specialists - and critics of the Clinton plan fear that progress toward cures will slow if the plan is implemented.

"In the past 20 years our research has been able to reduce the mortality rate of childhood leukemia from 70 percent to 20 percent," says Dr. Harvey Cohen, a pediatric oncologist and the chief of staff at Lucile Salter Packard Children's Hospital at Stanford. "With continued research I have hope that we can reduce it even further."

The hospital provides a wide range of services, from outpatient clinics offering well-baby care to pediatric units designed to save the lives of high-risk infants. At the same time, many of its residents and physicians are involved in cutting-edge research. Cohen and others have hammered away at leukemia, the No. 2 cause of childhood mortality, but for the very young the probability of death after contracting the disease remains high.

"If this were 1954 and we were trying to set up a system for managed health care, we wouldn't be asking how to cure polio, but we would be asking how many iron lungs should be in each hospital," says Cohen. "It is a crime that there are children who are not immunized and that many women do not get prenatal care. But it is also a shame that kids are still dying of cystic fibrosis and childhood cancer, and we need a health care system that will also address the need to improve the overall survival of these children."