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Sidebar: Those Pesky Economics
We asked Sonia Lohiya if she'd taken the time, with all the demands of her clinical coursework, to think about the dark side of medicine--the business realities of running a profitable practice: "Aaaahh! I unfortunately forgot to take the class on medical finance. Oh, wait. It was never offered!" she exclaims. Like her peers, Lohiya's focus has been on preparing to take care of people, not to draw up a business plan--but she recognizes that will eventually have to change. "I am getting lost in the branches of the financial jungle that I was never taught to maneuver," she says. "Going through rotations was a stark reality check on how bad the situation has really become, and I am finally admitting that I need help. If anyone has ideas on how to learn it all without going crazy, I'd love to know."

Laura Faye Gephart advocates a little coverage-and-cost education for all of her peers. "All medical students need to widen the scope of their focus to include the politics and economics of medicine," she says. "Clinical medicine is not practiced in a vacuum." Not when medical students assume an average debt burden of $150,000 just to receive an education. That issue "occupies my mind a lot," says Parker Duncan, a fourth-year medical student and MPH candidate at UCI. He already sees the difficulty doctors generally have walking the line between wishing cost was never an issue in quality care and recognizing that it is--for every patient, every visit, every day of every year. Young doctors especially, he notes, are "working so hard on the clinical side that it's really hard to focus on the larger picture. We'll be working so hard we won't be looking at whether we're working in the most cost-effective way. I'm pretty convinced that I'm going to be a good physician. What I don't know is how well I'll be able to contribute to taking care of the care system itself."

Liisa Bergmann, a second-year student at UCLA's David Geffen School of Medicine, is one of those medical students who's probably put as much thought into the system as she has into patient care; she was a policy major as an undergrad, after all. "If I go into private practice, dealing with so many insurance companies will be a frustrating waste of my time, especially when they so frequently reimburse physicians at rates lower than stated," she says. One of her ideas for a solution is income-based loans, where minimum monthly payments are based on monthly income, and the difference between that and a defined "normal" repayment plan is forgiven. That would allow recent grads to pursue primary care residencies in large metropolitan areas--like Los Angeles--without going into further debt. Her favored option, though, like many of her peers, is "a single-payer, national healthcare system similar to England's and Canada's." And then there's first-year student Jessica Bentley, who has devoted more time than most to coverage and cost issues. "I would say that I haven't become as concerned with clinical issues yet," she comments. "I think that that will come in time. Coverage and reimbursements are issues that mask a greater issue: human rights. We are a community, and our responsibility as physicians is to promote a healthy community."
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Sidebar: The Future of Associations
Medical societies, take notice. Tomorrow's doctors plan to join, to be active, and to stay active. They're focusing their zeal for greater access for patients and more realistic practice conditions for physicians on the political process like never before, and that includes the internal politics of the profession itself. They don't toe any lines, and that includes organizational lines, but they appreciate the value of organized medicine, in large part because it offers at least an approximation of that other kind of organizing, the kind doctors can't do. "Physicians can't unionize," notes Aislinn Bird. "So medical societies are a great way for doctors to come together and have a unified voice. You can't remove politics from healthcare."

Karen Studer, a Class of 2010 medical student at LLU who already has her MPH from there, couldn't agree more. Doctors must organize to be heard, she points out, and they should make their views known in a way that the people they're making them known to will understand. In other words, "to deal with Washington, you need people who know how to play the game," she emphasizes. "If we want to change healthcare, we have to form a consensus and gain back control over our profession. I plan on being an active member in both the California Medical Association and the American Medical Association as long as I am a doctor." Many of the students who feel the same way--and most of them seem to--don't even agree with all those organizations' positions; they value the representation itself more than its specific content.

Of course, they're not about to sit idly by if they don't like the content. Jessica Bentley notes how far apart the American Medical Student Association and the American Medical Association are on some issues. Guess whose views will soon be subject to pressure for change. "My goal is to help channel student energy from AMSA into concurrent and life-long participation in the AMA," she says. "While the organizations are currently very different ideologically, I believe the gap will steadily close over a one-generation period, and that the AMA in the future will reflect the current AMSA ideologies. If students can realize the difference they can make now and over time through our careers, the future of American healthcare is in good hands."

You'll get nothing but agreement from Laura Faye Gephart on that. She calls organized medicine "our hope for future changes on a systemic level that positively benefit both doctor and patient." And as an experienced student leader--including this alphabet soup of recent posts: AMA-MSS Vice Speaker, CMA-MSS Vice Chair of Chapter Development, LLUSM Alternate Delegate and Delegate to CMA/AMA-MSS and LLUSM Vice President--she knows what she's talking about. "I plan on being involved in the future and inspiring others to join and be active as well," she says. She can count on her fellow student Liisa Bergmann to do the same. "I hear repeatedly, 'In DC, there's no money for...' We need to stop telling ourselves that and ask for what we really want!" she emphasizes. "If we ask for an inch, we will be lucky to get a quarter-inch. But if we ask for a mile, we might get a quarter-mile! I plan to remain involved in organized medicine, and see it as a professional obligation to myself, to my fellow physicians and to my patients."