Transcriber: Itzel Mancilla-Murillo Reviewer: Elisabeth Buffard
In one way or another, we are all feeling the health care crisis.
But there is a bigger, more ominous threat:
we are running out of doctors.
Think about the last time you tried to get a doctor’s appointment.
Was it urgent?
Have you ever had a doctor who left the practice?
How long did it take for you to be seen?
In the Seacoast, we are lucky.
The answer, may be just a few days but in most other places, on average,
the wait to see a doctor is about 30 days or longer.
And it’s about to get worse, much worse.
There are 7,000 areas in the US
that have health care professional shortages.
Of these areas, two thirds are rural.
When we ask people in those areas,
one out of four would say
that they could not get the care they needed
because the doctor’s location was too far or too difficult to get to.
In New Hampshire, we only have one fifth
of the primary care doctor that we need.
One fifth.
The truth is that in the US,
we only have half the number of doctors per thousand people
that in most countries of similar economies.
Could it get worse? Yes, it could.
Unfortunately, it could.
It is estimated that by 2025,
in only three years, in only three years,
we will see 75% of the healthcare workers leave their profession.
Imagine that, we will have a deficit
of more than 30,000 primary care providers
30,000 primary care providers.
And to make matters worse,
the new census data revealed that by in about ten years,
we will have more seniors than children in the US for the first time in history.
And I have news for you.
We are not getting any younger.
(laughter)
So who’s going to take care of you?
Or me?
I am very worried about this.
And I think that you should be very worried, too.
This is not good.
So what’s going on? How can we fix this?
To try to explain and offer a solution,
let’s follow the path of a typical medical student.
We’ll call her Maria.
Actually, Maria is her name.
Maria is kind and very bright.
She loves working with people.
She is a first generation college student.
Her parents migrated from South America.
Maria is one of 30,000 graduating doctors in the US this year.
She was in a four year pre-med track at a prestigious university.
Then she went through a grueling selection process to get into medical school.
Only the luckiest, the best and hardest workers even get in.
About 40% only get in.
How about graduating?
One out of five don't graduate.
You have to be smart, dedicated and very determined.
And it should be that way.
After all, you'll be charged to taking care, preserving,
protecting the health of your fellow humans.
At this point, Maria has had eight years of education after high school,
and like all her fellow grads, she is deeply in debt.
Deeply in debt.
But now she’s a doctor, right?
So she can get to work, pay back all that debt,
doing what she has been trained to do, practice medicine.
Well, not so fast.
Despite being highly skilled, Maria and her fellow doctors cannot,
are not allowed legally to place an I.V.,
stitch a wound or even prescribe an aspirin.
In most other countries, even countries of similar economies,
medical school is shorter, less expensive.
And you get a license to heel, to practice medicine, right after you graduate.
Not here. To be able to work as a licensed physician in the United States,
Maria must first go through a residency training program in a chosen specialty:
surgery, internal medicine, pediatrics, dermatology, you name it.
As a resident,
you have the privilege of working up to 80 to 100 hours a week
for about 60 grand a year, making about $12 an hour.
Brutal hours, by the way. Brutal hours.
But maybe for Maria, who has dreamed of becoming a doctor
since she was 3 to 4 years old, this will all be okay.
A final hurdle to achieving her dreams.
Except, to get a residency, you must go through what’s called the Match.
And here is the bottleneck of us having enough doctors
who can actually take care of us.
The match is basically a lottery.
Many more thousands apply to the match than there are residency positions open.
So imagine that, thousands apply and very few residency positions open.
That means that every year, thousands of physicians are unmatched,
being left forbidden to practice the career that they had trained
for so long and so hard for.
Despite this situation, the current regulations are very hard to reverse,
mainly because of partisan politics
and the exorbitant, astronomical costs of doing so.
Even today in 2022, these hurdles continue.
Why?
The simple answer might be
that most people outside of the medical community
are not aware of this bottleneck
and its dire consequences.
Yes, our country is deeply divided.
But there is something that we all may agree on.
We need more doctors and we need them now.
So Maria wants to become a surgeon, so she finds the best surgery programs.
She sends the applications.
And not just one or two like the average medical student,
she sends up to 70 applications.
By the way, the cost of these applications sum up to thousands of dollars.
And remember, Maria is already deeply in debt.
And then she waits.
Meanwhile, the programs, the medical programs they receive, sort,
select and reject the applications.
Filters are set in place for grades,
honors, achievements, your nationality, whether you are a native English speaker,
etc., etc.
Most of this process happens without any human intervention.
It’s automatic, the algorithm biases are real.
Maria is actually lucky.
She gets a few interviews, she goes interviews, she feels good.
She thinks that went well.
So now she has to wait.
In March, she and her fellow grad will get an email.
Maybe “Congratulations, you matched”.
Or maybe the dreaded “We regret to inform you.”
That day could be the best or the worst day in her life.
If she’s selected, Maria, on the third Friday in March,
will get a letter letting her know where she matched,
which program selected her.
Could be anywhere.
But at this point, Maria would be grateful to get anything,
to get something.
So she would accept, she would pack her bags,
Say goodbye to friends and family and go.
Life is about to get good.
Unfortunately, Maria, like 2,000 of her fellow grads,
didn’t get good news.
She did not match.
That means that she has to go
into what’s called the Scramble or the SOAP,
the Supplemental Offer Acceptance Program.
This program’s attempts to fill any empty spots
the best possible left over candidates.
From the hospital’s perspective, the programs, they attempt to fill
any spots, they want no empty spots.
Their young doctors are already way overworked.
They're almost burned out,
and they can’t afford to run the hospital without these residents.
From Maria’s perspective and with a debt of $400,000 or so,
she wants to get anything.
She would think that she wants to be a surgeon,
but who cares if she wants to be a surgeon?
At this point, she will take anything, a family practice opening.
It’s not what she likes but at this point,
she really, really needs a job.
She is part now of a revolving group
of 11,000 chronically unmatched physicians,
graduated physicians who are
prohibited, forbidden, not allowed to work.
Imagine if we spread that number across 50 states, every state.
New Hampshire will get 220 brand new physicians.
So I don't want to paint an awful picture of the U.S. medical education system.
We have amazing academic programs,
community teaching programs that provide
some of the best teaching and care in the world.
We train some of the best specialists, no doubt about that.
But what about the doctors that we aren’t training?
The doctors left unmatched like Maria.
There is a better way in many countries, from Europe to Latin America,
from Canada to Finland to Venezuela.
The system is very, very different in those places.
Medical education, medical school is subsidized,
free or very inexpensive.
So upon graduation, those young doctors…
those young doctors basically start working
in what they were trained to do.
Paying a debt to society,
working as doctors.
Working as doctors for one or two years in underserved or rural communities.
After that, they can go to do, choose a specialty to practice on.
These recent grads, in a supervised fashion,
become the backbone of the country’s health care system.
I did that right after medical school.
There's no doubt that that experience made me
a much better doctor than been forced to pursue a residency in a specialty
that I wasn’t interested in.
So I dream…
I propose that we adopt
such a system for the heck of Maria
and all those aspiring doctors, inspiring doctors, but most importantly,
for the heck of those patients who can’t seem to get care, health care.
I dream.
Imagine those doctors out
in our underserved communities across America
providing timely care with expertise,
compassion, and empathy.
I dream.
The pandemic has really proven that our health care needs fixing.
The inequity, the unfairness,
the barriers to access to healthcare is real.
Remember here in Portsmouth, we are blessed in so many ways.
Maybe the wait to see a doctor is not too long, maybe we have choices.
But in many other places in the country, like in most of the world,
things are very different.
A long long wait to see a doctor or maybe no doctor to see at all.
I believe we could adopt such a system.
We must.
And maybe Maria can b your primary care doctor.
She will gladly take you as a new patient right away.
And believe me, Maria will b the best doctor that you ever had.
Thank you very much.