August 3, 2012
A Discussion on a Train
By Rebecca Gao
While on the train from London to Oxford, I was discussing typical premed woes, from organic chemistry to MCATs to volunteering to possible future (albeit very far in the future) specialties with some fellow students. I mentioned that oftentimes medical students who didn’t get their first choice residency positions would go into primary care instead, one of the least popular choices, as only 2% of medical school seniors who choose internal medicine residencies become general practitioners, according to a 2008 study in the Journal of the American Medical Association.
We happened to be sitting across from a middle-aged couple, and the lady on my left suddenly interjected, “General practitioners are actually the most important doctors that exist and the best actual doctors.” Dr. Erin Quinn, who was to my left, added that “some of the smartest doctors [she knows] are general practitioners.”
The lady was a general practitioner from Australia who was well-versed in global medicine, having practiced in developing countries for many years. Her husband was from the States and is involved in the public health management post-disasters.
They emphasized how crucial primary care was to the health care system in Australia, which operates with 60% of physicians as GPs, compared to only 30% in the United States. In Australia, GPs will refer patients to specialists, but more often than not diagnosis and treat the diseases themselves. The GP follows the patient throughout his/her care and this close-knit relationship allows for more holistic and well-rounded treatment. The GPs are the foundation of healthcare system. In fact, specialists defer to GPs, as they would be out of business without their referrals.
Gabrielle Yee and Rebecca Gao (author) at London Bridge. Photo by Sandy Lee.
In the U.S., however, specialists are generally more highly regarded than GPs, and patients can bypass GPs to directly consult specialists whether or not their condition actually required specialist attention. Dr. Quinn gave the example of patients with back pain seeking spinal surgeons and patients with mild headaches booking appointments with neurologists.
When we discussed why there was such a disparity in GPs between the countries, it seemed as though the U.S. healthcare system shouldered the largest burden of the blame for incorrectly incentivizing the medical field. In Australia, GPs are paid higher salaries and specialists significantly lower, and medical school loans can be repaid by working in primary care for a few years, earning both a standard salary and a set amount of loan forgiveness. Medical malpractice insurance is drastically lower, and the cost of medical school is a fraction of the U.S. cost.
The elitism surrounding American doctors also factor into an unwillingness to enter primary care, which is less “prestigious” than specialties. In fact, the Australian GP said that she refused to hire American GPs because they were the “worst” and “useless” because “they did not know enough general medicine at all.” They also “refused to even take blood pressures because they felt that it was beneath them.” Apparently, she preferred South African and French doctors.
We also discussed the U.S.’s cavalier attitude towards the botched Haiti disaster relief effort – sending in surgeons to perform advanced surgeries when the patients would die later due to lack of clean water, proper sanitation, and other basic health concerns.
However, what I really took away from the conversation (one of the only times I appreciated a longer travel time), related to primary care. Dr. Quinn, the man, and the Australian GP all seemed completely convinced that the current U.S. system would change – and soon, within 20-30 years. “It’s unsustainable,” the GP said simply.
I wasn’t quite sure where they got their confidence. Although 20 years is a long time – longer than I’ve been alive even – I wonder if we can essentially tear down and rebuild our system within a few years. Learning more about European and other countries’ healthcare systems throughout this trip, I marvel at the U.S.’s doddering, juvenile version of healthcare. As terribly as we’re doing, I’m surprised we even managed this much.
I met a native British man on the plane from San Francisco into London; he was a banker on a business trip for a few days. I asked him about what he thought about the British healthcare system, and he paused for a moment, slightly perplexed and bemused. “What do I think? I’m not quite sure…I haven’t really thought about it, since it’s not really an issue at all.”
Rebecca Gao is a senior at USC pursuing double majors in Biology and Global Health from Fremont, California.