Each new physician will contend with both a national doctor shortage and increased demand as 30 million uninsured people gain access to health care. And while the student-loan debate rages on for undergraduates, these grad students went into debt under brutal new rules that require them to pay more in interest, and sooner.
Before the ceremony for the 265 members of Jefferson Medical College's Class of 2016, I ask the keynote speaker how he'll bridge the chasm between what he learned 40 years ago and the adventure awaiting these students. The veteran cardiologist assures me that the young guns will be too busy to fret over the new health care law.
"Things haven't really changed," insists Howard Weitz. "Medicine is about people. It always was. It always will be."
Medicine's bottom line
In line to get into the ceremony at the Crystal Tea Room in the Wanamaker Building, Martin Harari has money on the brain. Not what he'll earn, but what he'll owe.
"People think we start out making $300,000 a year," Harari, a 23-year-old from Argentina, says with a laugh. "I've already figured it out: With $280,000 in loans, I'll have more than $30,000 in interest."
None of the students I spoke to has any illusion of making a killing saving lives. I don't know if this is refreshing or depressing, but they talk about medicine the way reporters talk about journalism: as a calling that lifts your spirit but will not make you rich.
"I'll have to live frugally. I might not be able to buy a house or go on vacations," says Alexis Flowers, a first-year student at Jefferson from Telford, Montgomery County, whose mother is a pediatrician and whose late father was a cardiologist.
Flowers majored in neuroscience at Lafayette. Her older brother just started medical school, too, across town at Penn, so they can commiserate about picking this moment in history to become M.D.s.
"A doctor told my brother, 'If you were really smart, you'd go into business.' " The sobering takeaway from the old pro? "Why choose medicine now with everything so messed up?"
The siblings' answer is decidedly old-fashioned: Knowing what they know, they still feel drawn to spend their lives having "direct contact with people," cleaning up that proverbial mess.
Is it necessary?
Jefferson's future docs will be schooled in patient interaction sooner than their professors were, but they'll have to wait a year before they meet David Axelrod, the internist who teaches the course that delves into health-care reform at a practical level. In the second section of "Introduction to Clinical Medicine," he explores the mystery of insurance reimbursements, patient confidentiality, and disparities in access to care.
"There's definitely much greater awareness in training now on the costs of tests you order," Axelrod explains, "on evidence-based medicine." So today's students will debate the economics of end-of-life care and the value of prescribing both lower doses and generic drugs. They'll even talk about the financial and physical impacts of referring patients to specialists.
"Our students must think about the costs to society and the harm that can be done by excessive tests," Axelrod tells me. Now more than ever, "they must always be thinking, 'Is this necessary?' "
Contact Monica Yant Kinney at 215-854-4670, email@example.com or @myantkinney on Twitter. Read her blog at philly.com/blinq.