Viewpoint: Emergency Medicine Needs a New Deal, too: Emergency Medicine News


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President Joe Biden has shown tremendous bravado in handling the pandemic during his first 100 days in office. His unabashed determination to loosen the rusty wheels of US policy sends Washington rushing like a train toward the light at the end of the COVID tunnel.

Three million vaccinations are given each day, well ahead of schedule, while the recent passage of the American Rescue Plan Act of 2021, worth $ 1.9 trillion, also known as the COVID-stimulus plan. 19, became one of the biggest relief bills in history. Closely following, plans for a gigantic infrastructure bill amounting to an additional $ 2 trillion have already been announced. Those who say President Biden is the spitting image of FDR and his New Deal might be on to something.

Yet despite all this progress, several cases have extinguished the hopes of medical students and residents, especially in emergency medicine. Senators Chuck Schumer (D-NY) and Elizabeth Warren (D-MA) called on the president in February to cancel $ 50,000 in federal loans per student, essentially wiping out all debt for 80% of borrowers (CNBC. February 17, 2021 ; and reducing the median amount of $ 200,000 owed by graduate medical students. (AAMC. October 14, 2020;

This would solve the huge debt incurred by students during their college and medical studies, which has increased by eight times the rate of salary growth since the 1990s (SoFi Learn. April 9, 2020; But President Biden seems reluctant to exercise that authority.

Supporters argue the higher education law allows it, but he insisted on investigating the extent of his loan forgiveness powers through the Justice Department. Until then, students and residents must be content with his suspension of accrued interest and payments on federal loans until September, an initiative launched under President Trump.

Even more affected residents and current emergency medicine fellows. Despite serving in the deepest trenches against COVID-19, facing more than 31 million cases and more than 560,000 deaths to date, medical graduates in training have found themselves in a professional twilight zone. (CDC COVID Data Tracker; departments and intensive care units were inundated with COVID patients, but overall visits fell 42% at the start of the pandemic. (MMWR Morb Mortal Wkly Rep. 2020; 69[23]; 699;

This has taken a toll on the programs’ ability to train their cohorts through exposure to bread and butter cases (STEMIs, appendicitis, nosebleeds). It can be improved somewhat by simulated learning and reading Tintinalli, but the sudden disappearance of employment opportunities cannot.

Applications for doctors have fallen 30% this year alone. (AAMC. February 25, 2021; The American College of Emergency Physicians also recently completed a two-year study showing a surplus of 9,000 emergency physicians by 2030. (ACEP EM Physician Workforce of the Future; the same time, emergencies have attempted to stem the $ 50 billion bleeding last year and the $ 122 billion blow expected this year (American Hospital Association. February 24, 2021;, despite mass vaccination and the increase in the number of patients.

Federal help was provided, but Janis Orlowski, MD, director of health care for the American Association of Medical Colleges, said she thought she was “nowhere near covering the losses.” (AAMC. February 25, 2021;, institutions worsened the economic conflicts of their emergency personnel, reducing working hours in 83 percent of the hospitals surveyed. (CAPE EM’s Future Medical Workforce;

Even more, the injuries of physicians battling COVID have been further compounded by the 10.2% reduction in the new physician fee schedule for 2021 (ACEP. has been successful in convincing Congress to freeze some cuts and increase assessments of the code, but a 2% drop persists, with the moratorium set to expire in 2024.

The Democrats’ new power must be wielded to help emergency physicians and students. For the new cohort of future physicians, the costs of undergraduate and medical school tuition, USMLE exams, and the residency matching process need to be reduced. This means expanding tuition reduction programs offered by public institutions, better access to loans and scholarships for medical students, and more income-based tuition rebate programs, like the Excelsior scholarship. from New York.

This shifts the financial burden from students to taxpayers who need well-trained providers, mirroring tax support from other public programs. The priority for Congressional oversight for private institutions can be found in the Civil Rights Act of 1964 (Titles VI and VII) and the Education Amendments Act of 1972 (Title IX). There is simply no excuse not to pass a law that protects students and new doctors.

President Biden must aggressively lobby for increased protections and benefits for residents and fellows, as he has done in other sectors. Doctors are vulnerable during training; they are nascent members of the American workforce who receive minimal compensation for disproportionate hours of service and debts. Their salary of $ 65,000, which barely exceeded inflation by one to one and a half percent, puts residents at the mercy of an ever-rising cost of living while spending thousands of dollars on it. step 3, on-the-job reviews and board reviews. (Medscape Resident Salary and Debt Report 2020. August 7, 2020;

President Biden need only follow another revered Democratic president for advice. President Lyndon Johnson signed the Amendments to the Social Security Act of 1965, establishing Medicare with funding for resident training. Now referred to as graduate medical education payments, these salaries are calculated based on hospital costs for training residents and fellows using convoluted formulas and 1984 data adjusted for inflation and location. .

But only the portion applicable to Medicare patients is reimbursed by the federal government. The rest belongs to the hospitals, and this is where the shoe pinches. (Committee on Governance and Funding of Higher Medical Education. September 30, 2014; Resident salaries should not be determined by 37-year-old data or based on a single demographic group. Why should an ME resident’s salary depend on the prevalence of dialysis? Why should the salaries of pediatric emergency medicine fellows be set according to these criteria when they never look after patients over 65?

The solution is simple. We need legislation that protects the hiring of emergency physicians based on non-pandemic volume and creates separate funding for the compensation of training physicians. We could easily combine the 75 million Medicaid registrants and 62 million Medicare registrants from 2020 (minus 12 million duplicate registrants) and double the patient volume incorporated into resident reimbursement. (Centers for Medicare & Medicaid Services. November 2020;; CMS. February 2021;; The Medicare Resource Center. June 10, 2020;

Residents simply can’t be blamed for jobs in low-volume Medicare hospitals after an algorithm over which they have minimal control puts them there. They also can’t be expected to work 60 hours a week, fight COVID-19 and lose valuable training with no guaranteed hiring afterwards, all for $ 22 an hour.

President Biden has a huge task ahead of him. He must heal a country battered by political parties and a pandemic. Yet as he strives to “build back better,” following the lead of FDR’s New Deal and LBJ’s Great Society, he cannot leave our residents and emergency medicine students behind. We are also citizens. We have dreams for this country. We want to work. All we need from you, Mr. President, is our own New Deal.

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Dr Penais a resident in emergency medicine at George Washington University.

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