Dean's Message: An Academic Perspective on Health Care Reform

Unless you have been in hibernation the past year, you are keenly aware of the intense discussions under way regarding health care reform. These are complicated issues with no easy answers.

Unfortunately, at times the debates have devolved from thoughtful exchanges into more primitive forms of expression. I hope that by the time you read this message, additional progress will have been made in forging a plan that will move us out of the downward spiral of the status quo.

Some aspects of health care reform that are especially relevant to academic health centers have not received as much attention as they should. I am referring to our woefully inadequate supply of healthcare professionals.

Currently, we do not have enough physicians (or nurses, pharmacists, dentists or other providers) to serve disadvantaged rural and urban populations. True healthcare reform must address this maldistribution and growing shortage of clinicians. If we fail to do so, insurance and financial barriers will simply be replaced by workforce availability barriers.

This is why our school's innovative rural and urban programs - the Wisconsin Academy for Rural Medicine (WARM) and Training in Urban Medicine and Public Health (TRIUMPH) - and our undergraduate pipeline program, Rural and Urban Scholars in Community Health (RUSCH), which you've read about in these pages, are so essential. They will help us direct new physicians to Badger State communities where the opportunities for service are the greatest.

A corollary to this issue involves medical student debt. Many students enter medical school with a vision of and commitment to serving the underserved, but over their years of training they find significant financial impediments to achieving that vision. When one is facing a student loan burden of more than $130,000, it is difficult not to let compensation become an important factor in deciding where to launch one's career.

When I was in medical school in the 1970s, the federal government offered capitated support, allocating thousands of dollars to the nation's medical schools for each enrolled student. While that probably is not the best model for solving the student loan problem, health care reform must address the real costs of medical education if it is going to have a lasting impact on the geographic and specialty distribution of physicians.

Reform must also focus on our research and clinical missions, because academic health centers play such a vital role in not only training physicians and treating patients, but also in providing new discoveries, treatments and methods of disease prevention vital for maintaining health most effectively and efficiently.

We cannot rely solely on government support for these issues. To address student debt burdens, we are launching a new campaign involving our alumni family in an effort to create need-based financial support that will allow our students to follow their dreams. We soon will be announcing the details, which include a window of opportunity for obtaining substantial matching support that will make all of our contributions go that much further. Please stay tuned.

To paraphrase a famous statement, "Ask not what your government alone can do for healthcare reform, but ask what you can do to help our medical students pursue careers of service where they are needed the most."

By Robert N. Golden, MD

This article appears in the fall 2009 issue of Quarterly.