What I am Thankful for in Healthcare

In keeping with the great American tradition of Thanksgiving– I thought it would be good to stop and appreciate some of the many good things happening in health care.

It is easy to get lost in the upheaval of transition as we alter our entire health care delivery system- it is easy to be a skeptic.

But so many good things are happening! Many are under the radar- most do not get celebrated in the news or around the proverbial water cooler.

So in honor of Thanksgiving- Here are my top four things I am thankful for in health care today.

1. I am Thankful that Applications to Medical School Are Up

In 1997 I published predictions for what would happen to American medicine in the backlash against managed care. My predictions were for 20 years out- which means the target year was 2017- Ironically (horrifyingly?) we are just about at that marker now!

One of the things I anticipated way-back-when is that enrollment in medical school would decline– that the changes in practice and reimbursement as a result of managed care would ultimately turn the best and brightest youth toward other professions. I certainly wasn’t the only one saying that- but I am still delighted I was absolutely wrong.

A few weeks ago the Association of American Medical Colleges (AAMC) released a report stating that more than 52,000 people applied to medical school in 2015 — up more than 56% from 2002! Not only were applications up- thanks to the building of more medical schools (and expansion of existing programs) in recent years- 25% more of those applicants were able to actually enroll. That is great news for all of us.

And it is not only the number– it is the breadth of applicants that is exciting. African American and Hispanic applicants and enrollees both increased- and the split in gender is now 52% men and 48% women. We still have a long way to go- but we are starting to build a physician population that reflects- and understands- all of our country’s communities.

But best of all- the flood of applicants means that young adults aspiring to be physicians have not been deterred by reducing reimbursements or increasing regulation. That makes me feel good about our future- and yes- I am thankful.

2. I am Thankful for our Increasing Focus on Primary Care

For decades we have witnessed the increased specialization of medicine. Partly that is driven by scientific breakthroughs and increasingly advanced treatment options available- but it has also been driven by the significant disparity in income between physicians in specialty care vs. primary care (Family Medicine, Internal Medicine and Pediatrics primarily).

As discussed at length in HealthLeaders Media in 2010, Primary Care is Unappealing to Many Medical Students. But if we are going to start treating chronic disease better- in fact prevent it in the first place- we will need a lot more primary care physicians.

Why is that important? Chronic disease has for decades been the arena where our outcomes are the worst below any of the other high-income nations in the world- even though we are spending 93 cents of every Medicare dollar trying to battle chronic disease.

Don’t get me wrong- we need (and I admire) specialty physicians. But we don’t need more specialty physicians than primary… ideally we should have a 70/30 split. Unbelievably we have had the opposite70% of American doctors are “specialists” and only 30% are in primary care.

And that imbalance has many problems for us as a society as well as for us individually as patients. Specialty care helps raise our costs– but more importantly it causes a fragmentation of our care.  The role of primary care to coordinate a patient’s care, including all of their specialty interventions, and that is sorely lacking for most patients today.

So yes- I think the increased emphasis on primary care- whether through the establishment of “Medical Homes” , or increased resident slots attributed to primary care,  or evening out the disparities in income in order to attract more young physicians is exciting.

We need to refocus on primary care. And we are- and for that I am thankful.

3. I am Thankful for Advances in Medical Science

Day in and day out there is investment in excellent medical research in our country and elsewhere in the world.

Here in America we are experiencing huge upheavals precipitated by the Affordable Care Act and changes in our health care delivery system that generated the law- as well as the politics attached to all of the above.

Yet in the middle of all of that commotion- science continues to move on. And the results have been spectacular- and promise to continue to be so.

Having been a young Neuro nurse in 1978 to 1980- with tours of duty through oncology and pediatrics and obstetrics in the years following- breakthroughs in medical technologies rock my world.

I get teary-eyed when I see glimmers of hope that spinal cord injury patients might walk again– when there are treatment options for cancers diagnoses that were so bleak back in my day- when I hear about the survival of premature newborns that was unheard of in the 1980’s- or new mothers that would have never known that joy if they had been my patient all those years ago (remember- most of us predate In-Vitro Fertilization!).

In every field of medicine there have been advances just as profound as those that touch closest to my own experiences. Science marches on even when our attentions are elsewhere…

And for that I am truly thankful.

4. I am Thankful we are Moving Forward

Heaven knows the roll-out of the Affordable Care Act has been controversial and I am well aware many of my readers will not – do not- view it as a good thing. But here is an undeniable fact- like it or not it was a move forward. And that had been needed for a very, very long time.

Franklin D. Roosevelt attempted health care reform- as did Presidents Truman, Kennedy, and Johnson- and we will all remember the Clinton attempt- and defeat.

But it has not been only our Democratic AdministrationsNixon wanted it before his administration got mired in other issues- George H. W. Bush understood the importance of reforming our health care system- as did  George W. Bush.

In fact- most Presidents since the 1940s- regardless of ideology- have understood that our health care delivery system was not sustainable over time.

So- on March 23, 2010 it was a really big deal that a President of the United States signed a law putting comprehensive health care reform into place.

The Affordable Care Act may not be perfect- and it undoubtedly will not be the last law we will need on the issue- but it was a beginning. We actually moved forward.

And for that I am truly thankful.

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