Monday Q&A: You still want to be a doctor?

Richmond’s medical community has a big dog in the health-care fight. The industry is one of the region’s largest and is at the front lines of a system that seems dysfunctional to most parties involved.

Medical students at MCV see that dysfunction first-hand – with patients who run out of meds because they’ve been laid off (and they’re hearing that more and more) and ERs jammed packed with patients who could have been treated far more cheaply before they became so sick.

And then there is insurance and paperwork – the scourge of the profession.

Fourth-year medical students Adam Garber, 28, and Ravinder Brar, 26, sat down last week in the crowded student center at MCV to chat with BizSense about the system and how it’s even affecting what specialties students choose. Both are currently applying to residency programs.

Below is an edited transcript.

Richmond BizSense: Are you guys keeping track of the health-care debate in Washington?

Adam Garber: I follow it somewhat and have a broad overview.

Ravinder Brar: It’s hard. We are on intense rotations now, but I try to listen on the radio.

RBS: Part of the debate – at least in the best news articles I’ve read – is about incentives. How do you guys think the pay structure is affecting you and your classmates as you pick specialties?

AG: There is a common misconception that physicians make too much, but they don’t make as much as people think. I have a wife and kid, so it’s a factor in my decision. But I’ll be doing internal medicine (which is at the lower end of the doctor pay spectrum). Family is also important, and internists pay well, but it will also be a practice where I can have a more normal schedule and won’t be called to the ER all hours of the night.

RB: People don’t realize how much money we owe. It’s around $200,000 for most medical students, and we give up seven years of earnings for school. Plus there are extra costs like board exams and traveling for residency interviews. That stuff costs thousands more. So lots of students are considering specialties where they make enough not to worry about that. Everybody thinks about the loans.

RBS: The main issue, especially for business owners that have to pay insurance, is costs. Does your training prepare you at all for weighing financial considerations into treatment?

RB: We are being taught evidence-based medicine, with emphasis on the physical exam rather than a whole host of expensive tests. And then we can decide whether we need further images. You’d also be amazed at how many patients ask for brand name medicines that they hear advertised on TV. There are usually just-as-good generics that are much cheaper.

RBS: How about a public option, which would let businesses buy insurance from the government?

AG: There needs to be some type of coverage so people can get the care they need, but I don’t know another good alternative. I’ve also heard of small companies coming together as a co-op. I’d say all approaches need to be considered.

It also seems that for-profit insurance companies drive up the costs even more because they need their cut of the profits.

RBS: How do you see financial concerns playing out on a daily basis?

AG: We see a lot of the social problems that result from the current system. It’s a much greater problem than I realized when I came in to school. Patients ask for prescriptions that they can fill for $4 at Wal-Mart. We also see patients getting sick and coming in because they ran out of free samples of their medication and don’t have money for more. And sometimes patients stay in the hospital because there is nowhere else to send them.

RB: Medical students do the intake interview when a patient is admitted, and more are telling us they lost a job. That’s led them to avoiding doctors until they are really sick or avoiding taking medicine until they have an incident. So we see the effects of the economy, too, and it’s getting worse here.

Aaron Kremer is the BizSense editor. Please send news tips to Editor@richmondbizsense.com.