Dear Sir,
It is often a calling and always an honour to care for patients. Medicine is one of the few professions offering an opportunity to make a significant difference in a person’s life on a daily basis. The satisfaction that arises from performing a challenging procedure or seeing a patient return to an elite level of activity is a consistent reminder of the intrinsic rewards of being a physician.
As I navigate the daily challenges of evaluating patients and conducting orthobiologic research, finding the time to understand the new United States healthcare law is not one of my priorities. The Patient Protection and Affordable Care Act, an oxymoron also known as Obama Care, was passed in the United States Congress via a technical measure known as ‘reconciliation’ in 2010. It is now being implemented. This convoluted piece of legislation includes a new excise tax on medical devices, an individual mandate to purchase insurance and dozens of other provisions, including higher reimbursement for primary care physicians at the expense of specialists. The lack of any malpractice reform in the more than 2500-page document is an egregious error. Recently, the US Supreme Court affirmed the constitutionality of most of the law. Polls, however, reveal a significant division in our country about this new medical paradigm. The debate will continue through and beyond our upcoming presidential elections.
Medicine in the USA is undergoing seismic shifts on several fronts. If this law is fully implemented, a two-tiered system will emerge where established surgeons with elite reputations may choose to offer their services in a fee-for-service model, eliminating all types of insurance. Others may choose to leave medicine for alternative employment or may simply retire. Newly minted surgeons, often with over US$200,000 in educational debt, will have little choice but to practise within the established system. Students considering orthopaedic surgery may re-evaluate that equation and seek other careers. The combination of these events will lead to a paucity of surgeons and, thus, insurance without timely access to specialist care.
I hope we can find some middle ground in our quest to reform medical care in the USA and apply some Yankee ingenuity at the same time. Some provisions of the healthcare bill are important and should be retained, such as the ability to obtain coverage despite having pre-existing conditions. It may also be possible to seek out novel solutions to combat ever rising healthcare costs instead of relying on government bureaucracy to solve problems. We need to emulate our computer science colleagues and establish a Moore’s law of medicine. We should be able to harness the power of predictive genomics or systems biology to double our efficiency in caring for patients every two years while reducing costs. A co-ordinated effort towards such a goal could unite our divided states.
Allan Mishra, MD, Orthopaedic Surgeon, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025, USA
