Penn Med, HUP see reform's effects

With the new health care legislation passed and signed into law, the direction Penn School of Medicine students choose to take may change over the coming years.

“More medical students will start to think about practicing in one of the primary care specialties,” Center for Bioethics Director Arthur Caplan said, adding that there will be a “higher demand” for such specialties, which include family medicine, internal medicine, general surgery and pediatrics, among other areas. He said the changes may apply to both medical and nursing students.

School of Medicine Chief of Staff Susan Phillips agreed.

Phillips wrote in an e-mail that an “incredible need” for primary-care doctors — caused by an increase in insured patients — will “hopefully” attract more medical students to that field.

“The trend away from primary care has been going on for a long time,” second-year Medical student Ari Friedman said, due to the pay gap between specialist and primary care doctors growing and Penn Med focusing on advancing specific technologies and research.

He added that although the recent bill “will strengthen primary care somewhat,” the changes will neither be dramatic nor immediate.

First-year Medical student Austin Kilaru also believes specialties may shift among future classes, but emphasized that “choosing specialties is complicated and … is not all about economics.”

“In terms of [primary care] specialties, I think that the demand is going to increase,” he said. “But I’m not sure if, at Penn, it affects our decision-making.”

According to Professor of Medicine at the Hospital of the University of Pennsylvania David Grande, apart from increasing demand, students’ specialization plans can also shift as a result of economic incentives.

The bill will also encourage policy- and health-outcome research through federal and other grants.

Grande explained that the Recovery Act, passed as part of the stimulus package last year, provided a “big push to fund comparative effectiveness research,” which entails comparing different treatment- and delivery-system models to find effective systems.

Because of the recent health care legislation, “funding will be secured over a much longer term” through both earmark dollars and other sources, Grande said.

Caplan called the legislation “helpful” in that more people with insurance will enter the system and be referred to Penn Medicine’s hospitals.

“We should see some relief of the emergency room,” Caplan said, adding that people who would generally receive emergency care will now “start to move into more primary care and get referred earlier.”

Grande explained that although it will take a few years until the insurance coverage makes a “big impact,” it will “dramatically decrease” the number of uninsured patients. He said a large number of such patients are commonly treated in Philadelphia.

Friedman said HUP sees a “disproportionate” amount of uninsured patients.

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