...With Liberty and Health Care for All

President Obama at a rally in 2009. Photo: Creative Commons license. Over the coming months, Neighborhoods and Nations will present a series related to policy issues in U.S. health care, with a specific focus on the Affordable Care Act and its impact as its provisions take effect. Our community partners and CCNY faculty and students who are studying policy and working directly with the public will provide insight into how the law changes the landscape for health-care professionals, formerly uninsured individuals seeking care, and others.

The Patient Protection and Affordable Care Act was enacted in 2010, validated by the U.S. Supreme Court in 2012, and is on its way to having its most significant provisions—including bans on denying coverage because of pre-existing conditions—effective by 2014. All elements of the law are set to be phased in by 2020.

With this overhaul of America’s health-care system comes a number of challenges, none more so than for community health centers already straining to meet the needs of local residents. The need for more primary-care physicians is great: they will make up the majority of clinicians seeing new patients, including about 20 million new Medicaid recipients. Yet the rates of doctors choosing to go into primary care are quite low. These clinicians need a broader knowledge base than specialists, but make less money and are generally given less respect.

“Primary-care docs continue to be looked down upon in the medical hierarchy, yet we are the ones who serve the people’s needs,” said Darwin Deen, M.D., who teaches at CCNY’s Sophie Davis School of Biomedical Education, established forty years ago with the mission to train doctors committing care for underserved populations. “…[W]e try and help our students understand that it is how your patients feel about you that is important, not how medical specialists see you.” Dr. Deen says that while less than half of Sophie Davis graduates end up going into primary care, that rate is two to three times higher than for other New York City medical schools.

Dr. Deen says that regardless of whether Sophie Davis students go into primary care or specialize, their commitment to the school’s public interest mission puts them in a “sweet spot” when it comes to facing the challenges of serving more people with diverse needs. “We have always felt we were preparing our students for what underserved communities need[.] I don’t think this law changes that at all.”

Keep an eye on Neighborhoods and Nations for this continuing series on the changing infrastructure of the U.S. health care system.