USP Seminar on “The U.S. Health Care Crisis”
For our first USP seminar of Fall 2009, I decided to invite scholars and guests with a vested interest in health care to discuss the current crisis in the U.S. health care system. Ideally, I’d hoped to get folks thinking more broadly about system-wide reforms rather than focusing solely on the insurance issue. To that end, I asked several of our scholars from the School of Nursing and the School of Medicine, along with one of our grad students who works on medical sociology, to join Professor Brenda Nevidjon, from the School of Nursing to share their perspectives and experiences in the health care system, their reasons for pursuing their various paths into health care, and their ideas on the challenges we currently face, from the standpoint of policy, practice, economics, etc. and ways in which the system could be improved.
I asked the University Scholars to reflect on how they decided to pursue nursing vs. physician’s assistant vs. medical school programs, as well as their interests in particular areas of specialization vs. generalization. I also asked them to consider what kinds of roles they could imagine themselves playing in an ideal health care system. Professor Nevidjon also shared her experience about choosing nursing, working in both the U.S. and abroad in Switzerland and Canada, and her knowledge of developments in health care reform since the early 1970’s.
What was striking about all of the nursing school students and physician’s assistant program students was their conscious decision NOT to go to medical school. All of them had gone to excellent undergraduate institutions where the norm was the pre-med path and where faculty strongly encouraged them to continue in that direction. However, they all realized that being a physician’s assistant or a nurse was a better career path for them in terms of personal temperament, areas of intellectual interest, and lifestyle.
As one student remarked, being a physician’s assistant rather than a medical doctor allows for increased time with patients, and greater job satisfaction gleaned from the flexibility of the work schedule and the possibilities to switch specialties multiple times. Of course, he also confessed to switching his major multiple times as an undergrad, so clearly, flexibility is important factor!
Our nursing school students also were drawn to nursing over practicing medicine because it allowed for more patient contact. For them, nursing combines interests in health care, counseling, education and prevention. Becoming a nurse practitioner, for example, will allow one of the students to make a difference in low-income communities, providing free mammograms at the local clinic, and to be involved in preventive care education and outreach. Similarly, Professor Nevidjon shared how she had been strongly encouraged to go into medicine, but chose nursing for the in-depth continuous contact with patients.
In all cases, what came through was the frustration with the social hierarchy of health care providers. Professors had questioned why they wanted to go into nursing or be a P.A. instead of a physician, especially since they had the “grades” and the “intellect.” Being a physician carries a higher status, however, in our society, despite the fact that oftentimes patients spend much less time with their physicians as compared to nurse practitioners or physician’s assistants, who take the time to fill in the gaps about how to deal with certain illnesses or conditions, how to use appropriately certain medications, how to make adjustments in nutrition or exercise. In short, the nuts and bolts of day-to-day living with illness more often comes from a nurse or N.P. or P.A. than from the physician. Of course, there are plenty of physicians who do spend the time with their patients to educate and treat them thoroughly. However, for our panelists’ experiences, this was the exception, not the norm.
The student who is pursuing medical school is also pursuing a joint degree in business. He had the chance to attend the Aspen Health Policy summit over the summer and shared with the audience some of the “big ideas” discussed at the summit:
1) Health care as social justice (the median price of housing is a predictor of obesity)
2) Transparency empowers consumerism (the lack of transparency in the health care system leads to a gap between doctor and patient, provider and consumer, and a decreased understanding of the true costs of health care)
3) Health care as a delivery science (draw upon N.P.’s and P.A.’s as resources to address health care needs, and reduce costs)
4) Use comparative health care research as a tool (i.e. “tools not rules”) to practice best medicine accessible to individuals’ needs.
5) Factor prevention into policy (small steps towards reducing costs)
~Tori L.
