HJNO Jan/Feb 2025

DIALOGUE 16 JAN / FEB 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS part of everything we do; and start reward- ing that. If people make other choices that aren't well, maybe that's some of the things that insurance says, "I just won't cover." And they're already starting that. If you're a smoker, if you're overweight, if you don't manage your diabetes, your alcohol con- sumption, all of that, they kind of tend to start minimizing some of the coverage on that. Those are personal choices. I think that they're going to start to limit some personal choice advocacy in that. That didn't answer your question. But if I knew the answer, I would be president. Editor Yes, you would. Peoples Yeah. Editor Why do you think we have a physician shortage in the U.S.? Peoples The cost of school is very high, and they go to school forever. So what happens is they go to school anywhere from four to 12 years, they get out of school, and they get in debt. You got college, then you got med school, then you got residency, and then you've got fellowship. All this time, they're working and not getting paid; they're paying a college tuition or med school tuition. And then they get out in a ton of debt. And then at 30 years old, when they do get out, they come into the workforce and they may get a salary and people think, "Wow, they're doing good." They're still just surviving because at 30, other people incrementally got there. But now they've got a lot of school loans. They're probably married by 30-something. They're hoping to start a family, and they're starting out already behind the eight ball. They got to buy a car, they get a house, they got to get whatever. So, they're doing it all at once because they waited sometimes to get out of school when they're 30. And then when they get into the work- force. I see it all the time. They get burn- out relatively quickly because you've got IT issues, you've got to run by a computer. Insurance tells you, "No, I'm not going to approve the [blank]," they just want to take care of the patient. They really aren't looking for all the peripheries. They don't ask you who your payer is. They just want to take care of the patient. But there's an immense amount of regulatory requirement that comes with it. At that point, they say, "I don't know that this was what I was bargaining for when I first got out." So, I noticed some docs don't advocate that their family members go into medicine. And I always tell them, "You have a passion for it, and I do too. Take away all of that." And we try to — take away all that and just care for your patient. That's your best day. But when you got to chart and stay all weekend trying to put it in the computer because you have to have certain things documented for anything to get paid, it's cumbersome. It's extraordinarily paper laden. You spend equal amount of time on the paper part and the fixing part as you do on the caring part. So, they see half the patients than our older docs. You saw 40 patients in a day. Our younger docs might see 20. So then it makes it really difficult to be able to get the revenue that you need to support a private business, somany of them are affiliated with a hospital. Editor In the U.S., approximately 60% of applicants to medical schools are denied admission. Why don’t we just let more into medical school and train more physicians? Peoples Well, I think there's a couple of reasons. They should, but it all becomes, again, everything is about resources and payment. You’ve got to have more instructors. You’ve got to be able to get somebody where they can get trained. Sometimes they'll go to a variety of organizations. They do, after a certain period of time, get paid. So, you have paid GME [graduate medical education] slots. Those are either affiliated or supported by the state or the feds. And so that's why they have X number of GME slots, slots that you have to advocate for, because they also have to be funded. A school doesn't have the funding to pay. Some of these people get a small salary when they're going through. Who's going to offset the pay, and the teacher's pay, and all of that? I think some of it is a funding requirement, too. But should we advocate for that? Yeah, if you want to cure the healthcare thing. But that comes, again, from the federal government and policy makers. Editor Thank you. There was a hospital in Arkansas recently that, to get more residency programs, had to lower the amount of money that they got from Medicare to be able to let the extra residents go in there. And it just felt so backward to me. They had to draw it to a lower, rural hospital level payment structure. They were trying to solve the shortage by getting more residency slots, and they got financially penalized for doing it. I just felt that was so punitive. Peoples Yeah, I guess the federal ... I don't know that they're saying, "Look, I'm paying you for X, and I'm not going to pay you for all the GME slots." Now, when you get a GME slot, just so you know, a lot of times, they'll give you a different type of reimbursement. And the reason why is because students, as they're in medical school, they tend to be learning. We, as an organization, will get reimbursed an additional amount. What that means is that's because they order more tests or they're learning — there's a little bit of an additive that's on that. So, they get reimbursed at a higher rate than our hospital would because it’s an academic center. That hospital may have said, "I want to be an academic center." But they said, "Fine, then I got to lower something else to give you that other additive." I don't know